Healthcare (Medicare)

in committee · New Jersey · General Assembly Feb 24, 2026

A 4445: Expands Medicare health care coverage to all New Jersey residents.

This bill would expand Medicare coverage to all New Jersey residents, regardless of age, health, or disability status, replacing current Medicaid and other state/local health programs with a unified New Jersey Medicare program. It requires the state to apply to federal Centers for Medicare & Medicaid Services (CMS) for a waiver to modify Medicare rules, with CMS estimating costs and adjusting premiums based on existing Medicare/Medicaid payments. The bill prohibits health insurers from offering plans covering services already provided by Medicare to prevent duplication. This would directly affect all New Jersey residents and health insurance providers in the state, as it would eliminate redundant coverage options.

Topics ✓ HealthcareSupports HealthcareBill explicitly expands Medicare coverage to all NJ residents regardless of age/health, replacing Medicaid with unified program to increase access and eliminate coverage gaps.95% confidence

Sub-Topics Insurance Medicaid Medicare

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in committee · New Jersey · Senate Feb 2, 2026

S 3264: Requires health insurance carriers to use federal resource-based relative value scale when determining reimbursement values for evaluation and management billing codes appended by modifier 25.

This New Jersey bill (S 3264) requires health insurance companies to use the federal Medicare/Medicaid resource-based relative value scale (RBRVS) when setting payment rates for specific doctor visits. It specifically applies to evaluation and management services (coded 99202-99499) that include modifier 25, which identifies a significant, separate visit occurring on the same day as another procedure. The law mandates that insurers base reimbursement payments on the federal RBRVS system, which calculates rates based on the resources needed to deliver care. This affects all health insurance carriers in New Jersey and directly impacts healthcare providers who bill for these specific types of visits.

Topics ✓ HealthcareSupports HealthcareMandates insurers use federal RBRVS for fair reimbursement of complex doctor visits, standardizing payments to prevent underpayment and improve provider access.95% confidence

Sub-Topics Insurance Medicaid Medicare

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in committee · New Jersey · General Assembly Feb 19, 2026

A 4265: Requires Medicaid reimbursement rates for certain primary and mental health care services match reimbursement rates under Medicare.

This bill (A4265) requires New Jersey's Medicaid program to set reimbursement rates for certain primary care and mental health services at no less than 100% of the corresponding Medicare rates, effective July 1, 2023, and annually thereafter. It directly affects Medicaid providers - including family physicians, nurse practitioners, midwives, and mental health specialists like clinical social workers and psychiatrists - who serve Medicaid patients. The law mandates that Medicaid rates for these services cannot be lower than Medicare rates, but does not require rate decreases from prior years. It also requires the state to submit a report within one year on implementation impacts, including changes in access and quality of care for Medicaid beneficiaries.

Topics ✓ HealthcareSupports HealthcareRequires Medicaid rates to match Medicare for primary/mental health services, increasing provider reimbursement and improving access to care for Medicaid patients.95% confidence

Sub-Topics Medicaid Medicare Mental Health

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in committee · New Jersey · Senate Jan 13, 2026

S 2983: Establishes requirements for sanctions and other actions involving low-performing nursing homes.

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.

Topics ✓ HealthcareSupports HealthcareMandates improvement plans and sanctions for low-performing nursing homes to ensure quality care standards, protecting patient safety and care access.85% confidence

Sub-Topics Long-Term Care Medicaid Medicare

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in committee · New Jersey · Senate Jan 13, 2026

S 504: Establishes "Fair Access to Health Care Networks Act;" appropriates $2 million.

The "Fair Access to Health Care Networks Act" requires New Jersey health insurance carriers to include any State-licensed health care provider - such as ambulatory surgical centers, diagnostic labs, imaging centers, and private practices - in their networks upon application. Carriers must reimburse these providers at a minimum of 200% of Medicare rates for equivalent services (unless the provider agrees to a lower rate) and cannot exclude them based on size, ownership, or hospital affiliation. If a carrier fails to respond to an inclusion request within 90 days, the provider is automatically provisionally included. The Department of Banking and Insurance will enforce the law, imposing civil penalties of up to $25,000 per violation, with $2 million allocated for administration.

Topics ✓ HealthcareSupports HealthcareMandates insurer inclusion of all licensed providers at 200% Medicare rates, expanding network access and protecting provider participation in healthcare networks.95% confidence

Sub-Topics Hospitals Insurance Medicare

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in committee · New Jersey · Senate Jan 13, 2026

S 1621: Increases the income eligibility threshold and eliminates asset test for Medicare Savings Programs; Appropriates funds.

This bill (S 1621) would expand access to New Jersey’s Medicare Savings Programs by raising the income eligibility limit to 133 1/3% of federal poverty levels and eliminating the asset test (which previously disqualified people with modest savings). It directly affects low-income seniors (65+), blind individuals, and people with disabilities who need help affording Medicare costs. The bill requires the state to appropriate new funds to cover these expanded benefits, simplifying eligibility without requiring applicants to meet asset limits. This change aims to make Medicare coverage more accessible for vulnerable residents who currently face barriers due to savings thresholds.

Topics ✓ Budget & TaxesSupports Budget & TaxesBill appropriates new state funds to expand Medicare Savings Programs for low-income seniors, directly funding essential healthcare access through increased budget allocation.95% confidence ✓ HealthcareSupports HealthcareExpands Medicare Savings Program eligibility for low-income seniors/blind/disabled by raising income limits and removing asset test, requiring state funding to increase access to Medicare coverage.95% confidence

Sub-Topics Medicare

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in committee · New Jersey · Senate Jan 13, 2026

S 2592: Requires certain issuance standards and open enrollment for Medicare supplement policies.

This bill (S 2592) prohibits insurers from denying or charging more for Medicare supplement policies (Medigap) based on health status, medical history, or claims experience. It requires insurers to accept all applicants year-round for these policies, regardless of whether they enrolled in Medicare due to age or disability. The law applies to all Medicare supplement policies sold in New Jersey, ensuring continuous enrollment without health-based restrictions. It does not override federal rules allowing pre-existing condition limitations under specific circumstances.

Topics ✓ HealthcareSupports HealthcareProhibits health-based denial for Medigap, ensuring access to Medicare supplement coverage without restrictions on enrollment.95% confidence ✓ VeteransSupports VeteransBill removes health-based barriers for Medigap, improving healthcare access for veterans using Medicare (common for veteran healthcare needs).75% confidence

Sub-Topics Medicare

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in committee · New Jersey · Senate Jan 13, 2026

S 1774: Establishes minimum Medicaid reimbursement rates for certain ambulance transportation services.

This bill sets a minimum $300 payment rate per basic life support emergency ambulance transport under New Jersey's Medicaid program, increasing from the current $58 rate. It also establishes a minimum $8.94 per loaded mile reimbursement for ground ambulance mileage, with annual adjustments tied to the Medicare rate. The changes apply to all Medicaid-covered emergency transports starting July 1, 2024, affecting ambulance providers serving Medicaid patients. The law requires the state to update Medicaid rules and seek federal approval for these reimbursement changes.

Topics ✓ HealthcareSupports HealthcareIncreases Medicaid ambulance reimbursement from $58 to $300 per transport, ensuring adequate funding for emergency services and improving access to care for Medicaid patients.95% confidence

Sub-Topics Medicaid Medicare

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in committee · New Jersey · Senate Jan 13, 2026

S 1373: Requires medical fee schedule by automobile insurers to provide for reimbursement of certain services provided by ambulatory surgical center at rate of 300 percent of Medicare payment rate.

This bill requires New Jersey automobile insurers to reimburse ambulatory surgical centers (ASCs) for certain services at 300% of the Medicare Part B payment rate - instead of current rates - if the service isn't already listed in the state's medical fee schedule. It also mandates that unlisted medical supplies used with these services be reimbursed at invoice cost plus 20%. The policy directly affects ASCs and insurers by establishing a standardized, higher reimbursement rate for uncovered ASC services, aligning with Medicare guidelines. This change aims to ensure ASCs receive fair compensation for services not previously covered under insurer fee schedules.

Topics ✓ HealthcareSupports HealthcareRequires 300% Medicare reimbursement rate for ASCs, expanding provider payments and improving access to surgical services under auto insurance coverage.95% confidence

Sub-Topics Insurance Medicare

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in committee · New Jersey · Senate Jan 13, 2026

S 426: Expands Medicare health care coverage to all New Jersey residents.

This bill (S 426) would require New Jersey to provide Medicare health care coverage to all state residents - regardless of age, health, or disability status - expanding the federal program beyond its current eligibility rules. It mandates the state to seek federal waivers from CMS to replace existing health programs (like Medicaid) with universal Medicare coverage, with costs adjusted based on existing Medicare/Medicaid payments. The bill also prohibits private insurers from offering duplicate coverage for services already provided through Medicare. This would apply to anyone domiciled in New Jersey for 30 days prior to applying, starting immediately upon enactment.

Topics ✓ HealthcareSupports HealthcareExpands Medicare coverage to all NJ residents regardless of age/health, removing eligibility barriers and mandating universal access per bill text.95% confidence ✓ VeteransSupports VeteransBill expands Medicare coverage to all residents including veterans, improving healthcare access beyond current eligibility rules.80% confidence

Sub-Topics Medicaid Medicare

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