MedicaidAdministrativeHigh impact
Newsletter Vol. 3, No. 14
New Jersey Medicaid·NJ·Provider Notice
We identified it
Jun 20, 2026
Summary
This New Jersey Medicaid policy establishes procedures for hospitals to use the Public Assistance Inquiry (PAC) form to document a patient's intent to apply for Medicaid when they cannot initiate the application during hospitalization. The PAC form establishes an application date and retroactive eligibility period (up to 3 months) to cover unpaid hospital bills, even if the formal Medicaid application is completed after discharge.
Action Required
Immediately: Billing and social services teams must implement PAC form procedures for all hospital admissions where Medicaid eligibility is unclear or delayed. Before discharge, screen all potentially eligible patients using the four screening questions (existing Medicaid/pending application, eligibility category, financial need, unpaid medical bills). For patients meeting criteria, complete PAC forms and submit to the appropriate Social Security Administration District Office or County Welfare Agency (CWA). Billing teams must track PAC form submission dates to establish retroactive eligibility windows. When Medicaid eligibility is later confirmed, submit unpaid hospital bills using FD Form Application for Payment of Unpaid Medical Bills to the Medicaid Retroactive Eligibility Unit within 6 months. For claims older than one year, obtain approval letter from Retroactive Eligibility Unit before submitting to Paramaxunisys. Failure to use PAC forms will result in unpaid hospital bills falling outside the retroactive eligibility period and remaining uncollected.