This bill creates a new "Opioid Prevention and Rehabilitation Program Fund" to support treatment services for people with substance use disorders. It imposes a 1-cent tax per milligram of active opioid ingredient on pharmaceutical distributors at the first wholesale sale in New Jersey. The collected tax funds will be used annually by the Department of Human Services to provide treatment for uninsured, underinsured, or Medicaid-enrolled individuals. The tax applies to opioid drugs distributed by licensed wholesale distributors, with definitions aligning with existing pharmaceutical distribution laws.
This bill increases the maximum weekly limit for reimbursable personal care assistant (PCA) services under New Jersey's WorkAbility Program from 40 to 112 hours per calendar week. It directly affects employed, permanently-disabled individuals who qualify for the program - specifically those working while meeting income thresholds (under 250% of federal poverty level for earned income) and paying a $25 monthly premium. The key mechanism removes the current 40-hour cap on PCA services, requiring the Commissioner of Human Services to seek federal Medicaid waivers and update regulations to implement the change. This adjustment allows greater flexibility for participants to access necessary personal care support while working.
This bill requires health insurance companies and Medicaid programs in New Jersey to cover screening, prevention, and treatment services for children's behavioral health issues without needing a formal mental health diagnosis. It allows providers to use "at-risk diagnosis" billing codes (like Social Determinants of Health Z-codes) for services such as early screenings and therapy for children under 18. The coverage must be provided at the same level as other medical services, including for children showing potential issues before a diagnosis is made. This applies to all private health plans, state employee health benefits, school employee health plans, and NJ FamilyCare Medicaid programs.
This bill requires New Jersey to take action against nursing homes that receive three consecutive one-star ratings from the federal Centers for Medicare and Medicaid Services (CMS). After two consecutive one-star ratings, the state must warn the facility and may impose sanctions like restricting new Medicaid admissions or reducing payments. For three consecutive one-star ratings, the state must mandate an 18-month improvement plan and may impose severe sanctions, including banning new admissions, removing Medicaid residents, or stopping payments. The bill directly affects nursing homes participating in New Jersey's Medicaid program that fail to meet quality standards, with consequences tied to federal CMS rating outcomes.
This bill requires New Jersey's Medicaid program to provide traditional fee-for-service coverage for long-term care services (like those from assisted living residences or personal care homes) to beneficiaries who are eligible for Medicaid's managed long-term services program but are still waiting to enroll in a managed care organization (MCO). Coverage begins when eligibility is confirmed and ends when MCO enrollment starts, preventing service gaps during the transition. It applies directly to Medicaid beneficiaries in this pending enrollment phase. The bill codifies an existing Medicaid policy, ensuring consistent coverage without creating new benefits.
This bill increases the percentage of cigarette and tobacco tax revenues dedicated to anti-smoking programs in New Jersey from 1% to 3%. It directs these funds - projected to rise from approximately $5 million to $15 million annually - to the Department of Health for evidence-based tobacco control programs. These programs must align with CDC best practices and focus on preventing youth smoking, reducing secondhand smoke exposure, and promoting cessation, with priority given to Medicaid populations and youth initiatives. The change applies to revenues collected under the Cigarette Tax Act and Tobacco Products Tax Act, effective for fiscal years beginning July 1, 2025.
This bill requires New Jersey's Medicaid program to cover community violence prevention services for eligible recipients. It adds these services to Medicaid coverage under existing "preventative and rehabilitative services" (Section 12 of the amended law), directly affecting Medicaid beneficiaries and violence prevention providers. The bill also establishes a state training and certification program for professionals working in violence prevention. This creates a new pathway for Medicaid reimbursement for evidence-based community violence intervention programs. The legislation is currently pending in the Senate Health Committee.
S 249 establishes a three-year oral health pilot program (the "MOM Project") in New Jersey's Department of Health, targeting low-income pregnant women and new mothers who live in medically underserved areas and are not enrolled in Medicaid. The program provides free oral health education (at least three hours covering hygiene, nutrition, and disease prevention), followed by one year of dental care including cleanings, risk assessments, and necessary treatments through community health centers. It appropriates $4.15 million to fund outreach, education, and dental services, requiring participating centers to partner with nonprofit maternal health groups to develop personalized treatment plans. The initiative aims to improve oral health outcomes for mothers and infants while collecting data on the program's impact.
S 2943 requires New Jersey's Department of Banking and Insurance (DOBI) to create an integrated enrollment platform connecting the state's health insurance exchange with the NJ FamilyCare program (which includes Medicaid and CHIP). This directly affects New Jersey residents applying for health coverage through the Individual Health Coverage Program, Small Employer Health Benefits Program, or NJ FamilyCare. The bill mandates DOBI, in coordination with the Department of Human Services, to integrate the exchange with Medicaid eligibility systems so applicants can determine eligibility for all programs through one platform. It also establishes a nine-member advisory committee with health insurance expertise to guide implementation, including consumer advocates and industry representatives.
This bill increases the maximum annual respite care funding limit by 10% for individuals enrolled in NJ FamilyCare who have an implantable cardioverter defibrillator (ICD). It specifically raises the current $6,559.63 annual cap to $7,215.60 for this subgroup, ensuring they receive 10% more respite care services than the standard limit. The policy directly affects eligible New Jersey residents with ICDs who qualify for NJ FamilyCare (the state's Medicaid program). The change modifies existing funding rules under the Statewide Respite Care Program without creating new eligibility criteria or services.
