MedicaidCoverageMedium impact
Newsletter Vol. 2, No. 52
New Jersey Medicaid·NJ · Infectious Disease, Internal Medicine, Palliative Care·Provider Notice
We identified it
Jun 20, 2026
Summary
The AIDS Community Care Alternatives Program (ACCAP) has been revised to restrict enrollment eligibility. AIDS-Related Complex (ARC) is no longer an acceptable diagnosis for program entry; only AIDS diagnosis or HIV-positive status in children under a specified age now qualifies. Additionally, re-evaluation of nursing facility care needs and annual program requirements will now be conducted by ACCAP nurse case managers instead of Medicaid District Office Regional Staff Nurses.
Action Required
Immediately: Billing and clinical teams must update patient eligibility criteria in the billing system and EMR to exclude patients with AIDS-Related Complex (ARC) diagnosis from ACCAP program enrollment. Providers must re-evaluate current ACCAP patients diagnosed with ARC for program continuation or discharge. Coordinate with ACCAP nurse case managers (rather than Medicaid District Office staff) for all future nursing facility care assessments and annual program re-evaluations. Update internal workflows and contact lists to route these re-evaluation requests to ACCAP case management. Failure to apply updated eligibility criteria may result in claims denials or program removal for ineligible beneficiaries.