Healthcare (Medicaid)

introduced · New Jersey · General Assembly

A 5364: Authorizes provision of adult day health services on remote basis.

New Jersey Assembly Bill 5364 authorizes licensed adult day health facilities to provide services remotely to enrolled individuals who cannot or choose not to attend in person. The bill requires that all in-person services capable of being delivered safely via telehealth be made available remotely, including daily wellness checks, access to nursing and social work professionals, and the delivery of meals and activity materials at no extra cost. Facilities are permitted to bill for these remote interactions at the same rate as in-person care, provided they maintain written documentation and include the services in the patient's care plan. Additionally, the legislation directs state health and human services commissioners to adopt necessary regulations and seek federal Medicaid funding to support this ongoing provision of remote care.

Topics ✓ HealthcareSupports HealthcareBill expands access to adult day health services by authorizing remote delivery via telehealth, ensuring continuity of care for patients.95% confidence

Sub-Topics Medicaid Telehealth

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introduced · New Jersey · General Assembly

A 5436: Adjusts monthly Medicaid capitation rate for participants in Program of All-Inclusive Care for Elderly.

New Jersey Assembly Bill 5436 adjusts the monthly Medicaid payments made to providers of the Program of All-Inclusive Care for the Elderly (PACE). The bill mandates that these capitation rates be set at no less than 98 percent of what the state would otherwise pay for long-term care services under a fee-for-service model. For participants who are eligible for both Medicare and Medicaid, the required payment rate is set at no less than 95 percent of the standard fee-for-service cost. Additionally, any new PACE program starting operations on or after July 1, 2026, will receive a guaranteed minimum rate of 98 percent for its first 24 months to support initial operations.

Topics ✓ HealthcareSupports HealthcareBill mandates higher Medicaid capitation rates for PACE providers, ensuring funding levels close to fee-for-service costs to support elderly long-term care.85% confidence

Sub-Topics Long-Term Care Medicaid Medicare

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introduced · New Jersey · General Assembly

A 5388: Establishes "Medicaid Pharmacy Benefit Transparency and Accountability Act."

New Jersey Assembly Bill 5388 establishes the "Medicaid Pharmacy Benefit Transparency and Accountability Act" to increase oversight of how prescription drugs are managed for Medicaid beneficiaries. The bill requires the State Auditor to conduct regular audits of pharmacy benefits managers, reviewing their income sources, rebates, and payment models, with findings reported quarterly to the Legislature. It also mandates that these managers disclose financial information to the state, remit all manufacturer rebates directly to the department, and prohibits them from steering patients to affiliated pharmacies. Additionally, the legislation sets a minimum reimbursement rate for pharmacies at the national average drug acquisition cost plus a $10.92 dispensing fee, while requiring the Department of Human Services to study alternative pharmacy service models within 24 months.

Topics ✓ HealthcareSupports HealthcareBill enhances oversight of Medicaid pharmacy benefits to ensure accountability and proper fund management for beneficiaries.85% confidence

Sub-Topics Medicaid Prescription Drugs

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in committee · New Jersey · Senate Jun 15, 2026

S 4470: Eliminates 16 hour per 24-hour period coverage limit on private duty nursing services for certain Medicaid enrollees who are 21 years of age or older.

This bill removes the existing 16-hour daily limit on private duty nursing services for Medicaid recipients in New Jersey who are 21 years of age or older. Under the new rules, eligible individuals whose medical condition is deemed severe enough by the Commissioner of Human Services could receive up to 24 hours of care in a single day. The legislation also directs the state health official to seek necessary federal approvals and update regulations to allow for this increased coverage.

Topics ✓ HealthcareSupports HealthcareBill removes a daily limit on private duty nursing, expanding access to care and strengthening support for severe Medicaid recipients.95% confidence

Sub-Topics Medicaid

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in committee · New Jersey · Senate Jun 8, 2026

S 4434: Requires health insurance and Medicaid reimbursement of clinical laboratories regardless of managed care plan participation.

This bill requires health insurance companies and Medicaid programs in New Jersey to pay clinical laboratories for services regardless of whether those labs are part of a managed care network. Under the new rules, non-participating labs must be reimbursed at the same rate as participating ones, though insurers retain the right to review services for medical necessity. The legislation also prohibits state Medicaid officials from forcing laboratories to join the managed care system as a condition for receiving payment or transitioning from a fee-for-service model. These changes directly affect insurance carriers, managed care organizations, and licensed clinical laboratories by mandating coverage and equal pay rates for out-of-network providers.

Topics ✓ HealthcareSupports HealthcareBill ensures non-discriminatory reimbursement for clinical labs, protecting patient access to essential diagnostic services.90% confidence

Sub-Topics Insurance Medicaid

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in committee · New Jersey · Senate Jun 22, 2026

S 4493: Establishes "Oral Health Equity Act."

This bill creates the Oral Health Equity Act to improve access to dental care for uninsured and underinsured residents in New Jersey's medically underserved areas. It directs the Department of Human Services to partner with community oral health centers to provide comprehensive services, including initial exams, restorative treatment, and regular follow-up visits. The legislation ensures these centers receive reimbursement rates equal to or higher than those given to federally qualified health centers and requires the state to seek necessary Medicaid waivers to fund the program.

Topics ✓ HealthcareSupports HealthcareBill establishes the Oral Health Equity Act to improve access to dental care for uninsured residents and ensures reimbursement rates for community centers.95% confidence

Sub-Topics Medicaid

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in committee · New Jersey · Senate May 14, 2026

S 4237: Establishes "Kidney Disease Study Commission."

This bill creates the Kidney Disease Study Commission within New Jersey's Department of Health to investigate kidney disease disparities affecting minority and underserved populations. The nine-member commission will include state officials and six public appointees tasked with researching the causes of higher disease rates and lower transplant success in these communities, while also examining treatment patterns under Medicaid and private insurance. To carry out its work, the commission will hold public hearings, utilize state resources, and submit annual reports to the Governor and Legislature detailing its findings and recommendations for future action.

Topics ✓ HealthcareSupports HealthcareBill establishes a commission to investigate kidney disease disparities and improve treatment patterns, directly advancing healthcare equity and access.90% confidence

Sub-Topics Medicaid

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in committee · New Jersey · Senate May 11, 2026

S 4201: Authorizes coverage of prescriptive hormone replacement therapy.

This New Jersey bill requires private health plans, state-purchased insurance contracts, and Medicaid to cover a 12-month supply of prescription hormone replacement therapy for individuals who do not need refrigeration. The legislation defines these drugs as FDA-approved medications used to regulate hormone levels but explicitly excludes certain weight-loss drugs. While the law mandates this coverage, it allows for specific exceptions, such as limiting refills during the last quarter of a plan year if a full supply was already provided, or temporarily reducing supplies to 90 days during acute drug shortages. Additionally, insurance providers retain the ability to use standard drug management strategies to oversee how these medications are prescribed and dispensed.

Topics ✓ HealthcareSupports HealthcareBill mandates insurance coverage for hormone replacement therapy, expanding access to essential medical treatments and strengthening patient care.95% confidence

Sub-Topics Medicaid

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in committee · New Jersey · Senate May 11, 2026

S 4190: Requires DHS to submit Medicaid State plan amendment to federal government requesting approval to create Health Home Program for certain Medicaid beneficiaries with sickle cell disease.

This bill requires the New Jersey Department of Human Services to request federal approval for a new Health Home Program specifically for Medicaid recipients with sickle cell disease who are at risk of developing a second chronic condition. Once approved, the state must implement this program within 180 days, which involves coordinating primary, acute, behavioral, and long-term care services to address the needs of these patients as a whole. The legislation also mandates the creation of necessary rules and regulations to support the program's operation.

Topics ✓ HealthcareSupports HealthcareBill creates a new Health Home Program to coordinate comprehensive care for sickle cell patients, expanding access and strengthening health services.95% confidence

Sub-Topics Long-Term Care Medicaid

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in committee · New Jersey · Senate May 21, 2026

S 4311: "Self-Directed Care Access Act"; requires DHS to establish common intake system and application process for Medicaid self-directed care programs.

This bill directs New Jersey's Department of Human Services to create a single online portal that allows individuals to apply for and manage their own home and community-based services through various Medicaid waiver programs. The system will include a standardized application form and an automated screening process that matches eligible applicants with the appropriate self-directed care options. Additionally, the bill requires uniform documentation rules to simplify the hiring process for personal care workers hired directly by program participants. These changes aim to streamline access to existing services while remaining subject to necessary federal approvals.

Topics ✓ HealthcareSupports HealthcareBill improves patient access to home and community-based services by creating a unified online portal for Medicaid applications.90% confidence ✓ TechnologySupports TechnologyBill mandates an online portal and automated screening, advancing digital access and efficiency in public services.60% confidence

Sub-Topics Medicaid Digital Government

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