New Jersey
New Jersey’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.
At a glance
- Rate method
- Other
- Case-mix level
- None
- Classification
- None
- Rate updates
- Once a year
- Managed care (LTC)
- Yes
- Quality program
- Performance add-ons
- Paid outside the rate
- Small
- Bed hold
- Not paid
- Published rates
- Not published
- Assisted living
- Covered
- Personal needs allowance
- $50 / month
Overview
- New Jersey still has a case-mix price system in its rules (RUG-based direct care limited to 115% of the Class I median, an operating and administrative price at the median, fair rental value capital, provider tax pass-through), but it has not run it since the 2014-2015 rate years.
- Each year the Appropriations Act says FFS homes are paid 'no less than the rate received on June 30' of the prior year, plus a small across-the-board per diem adjustment, a provider tax add-on ($13.67 allowable cost plus a frozen 'quality-of-care' portion) and quality performance add-ons (up to about $22.75/day in FY2027).
- In practice each home's rate is a frozen 2014-era case-mix rate rolled forward with flat dollar add-ons; acuity changes since then do not move pay.
What matters in New Jersey
- Rates are frozen: each FY2027 rate starts from the home's own June 30, 2026 rate, a chain back to 2014 case-mix rates.
- Acuity no longer moves pay; quarterly RUG case-mix updates in the rules have been overridden by budget language since about FY2016.
- Quality and staffing add-ons are worth up to about $22.75/day in FY2027, paid by both FFS and managed care.
- Bed hold and therapeutic leave are not paid, despite the 50%/10-day rule still in the regulations.
- MLTSS managed care pays most long-stay residents; plans had to take every home at no less than the state rate through June 30, 2026.
- A 2020 law requires 90% of revenue on direct care, with rebates if missed; enforcement status is not confirmed.
Frequently asked
Does a New Jersey nursing home's Medicaid rate rise when its residents become sicker?
No. Since FY2016 each year's Appropriations Act pays fee-for-service homes the rate they received on June 30 of the prior year plus flat dollar add-ons, so acuity changes since about 2014 do not reach payment (Att. 4.19-D Section 22; FY2027 Act). N.J.A.C. 10:166-3.4 still calls for quarterly RUG case-mix updates, but budget language overrides it. The FY2025 and FY2026 Acts allowed a new rate method by regulation; none was found, and the FY2027 Act dropped that clause.
Does New Jersey Medicaid pay a nursing home to hold a bed while a resident is in the hospital?
No. The FY2025, FY2026 and FY2027 Appropriations Acts say homes 'shall not receive payments for bed hold or therapeutic leave days' for NJ FamilyCare residents. The rule at N.J.A.C. 10:166-1.14 still lists 10 hospital days at 50% of the rate and 24 therapeutic days a year at 100%, and it still requires the home to reserve the bed. The home holds the bed without pay.
Can a New Jersey Medicaid managed care plan pay a nursing home less than the fee-for-service rate?
Not through June 30, 2026: the MCO contract made nursing homes 'Any Willing Providers' and set their rate at the higher of the state rate or the negotiated rate (Art. 4.8.1.M). After that date the floor's status is unclear. The FY2027 Appropriations Act pays a home its negotiated MCO rate if it has one, and otherwise the FFS-equivalent rate it received on June 30, 2026, with the provider tax and performance add-ons on top. The FY2026 language barring plans from refusing any willing nursing home was not found in the FY2027 Act.
How much is paid outside the posted rate in New Jersey?
Small statewide; one county home over 500 beds draws Medicare-gap supplemental payments in FFS and managed care.
What does New Jersey Medicaid pay on Medicare coinsurance days?
Lesser-of: Medicare plus Medicaid may never exceed the home's Medicaid rate, so usually $0.
Does New Jersey require a minimum share of spending on care?
Yes in law: 90% of revenue on direct care with rebates (P.L.2020, c.89); implementation not confirmed.
How is the New Jersey nursing home provider tax charged?
Per non-Medicare day assessment; high- and low-Medicaid homes pay a reduced rate, county homes are exempt.
How the rate is set
How the method got here
| Effective | From | To | Change | Source |
|---|---|---|---|---|
| 2010-07-01 | Prior NJ cost-based prospective rates | Case-mix price system: RUG direct care limits, O&A price, fair rental value capital, provider tax pass-through; Class I/II/III | New Jersey moved Class I and II homes to prospective case-mix rates with a $5/$10 phase-in band. | https://www.nj.gov/humanservices/dmahs/documents/providers-st… |
| 2014-07-01 | Fee-for-service nursing home payment | NJ FamilyCare MLTSS: MCOs pay new long-stay NF residents; pre-July 2014 residents stay FFS | Long-term nursing home care moved into managed care for new admissions, with any-willing-provider protection at the state rate. | https://www.nj.gov/humanservices/dmahs/individuals-families/f… |
| 2015-07-01 | Case-mix rates recalculated with quarterly acuity updates (2019 baseline description) | Rate received on June 30 of the prior year plus appropriated flat add-ons | From FY2015 (TN 14-0012) each rate was set from the home's June 30, 2014 case-mix rate, and from FY2016 (TN 15-0004) the Appropriations Act froze each home's rate at its prior June 30 rate, overriding rebasing and quarterly case-mix updates; this is still the method. | https://www.nj.gov/humanservices/dmahs/documents/providers-st… |
| 2020-10-01 | Frozen rate plus small add-ons | Frozen rate +10%, at least 60% for CNA wages, with recoupment | A COVID 10% rate increase tied to CNA pay and infection control became permanent in the base from FY2022. | https://www.nj.gov/humanservices/dmahs/documents/providers-st… |
| 2024-07-01 | Quality add-ons on clinical measures only ($1.80 each) | Add-ons weighted to staffing hours and turnover plus clinical and CoreQ measures | FY2025 restructured performance add-ons toward PBJ staffing measures. | https://www.nj.gov/treasury/omb/publications/25approp/Departm… |
Verified October 11, 2026
Cost basis
- Uses cost reports
Yes
- Cost report
Medicare cost report (CMS-2540-10 freestanding / CMS-2552-10 hospital-based) plus NJ supplemental Medicaid schedules (Appendix U), due May 31 for the calendar year; public (Class II) homes use the same reports for full-cost interim rates and reconciliation.
- Base year and rebasing
Not rebased in practice. The rules call for annual rate years and quarterly case-mix redeterminations, but since FY2015 the base is the 'total adjusted case mix rate for June 30, 2014' and from FY2016 each year's Appropriations Act pays 'the rate received on June 30' of the prior year plus add-ons. FY2025 and FY2026 Acts allowed a 'new rate setting methodology' if DHS adopted regulations; that clause is gone from the FY2027 Act and no new method was found.
- Components
Component Method Notes direct care (case mix) Frozen. Formula: RN/LPN/aide cost, facility limit 115% of Class I Medicaid-day-weighted median (cut to 112% under the budget adjustment); Class II limit 105% of Class I Last applied around the June 30, 2014 rate; 10:166-3.9/3.10. direct care (non-case mix) Frozen; same limits as above Medical director, activities, pharmacy consultant, non-legend drugs, routine supplies, social services, routine oxygen. operating and administrative Frozen price: 100% of Class I median, cut to 95% under the budget adjustment; Class II at 104.5% of Class I Admin, dietary, laundry, housekeeping, maintenance, utilities, property taxes. capital Frozen fair rental value: $89,000/bed new value, 2%/yr depreciation, age cap 40 years, 8% rental factor, divided by greater of actual days or 95% of available days 4.19-D Section 11. provider tax add-on Pass-through: allowable-cost add-on fixed at $13.67 (FY2027) plus a 'quality-of-care portion' frozen at the June 30, 2026 amount FY2027 Appropriations Act. annual add-ons Flat per diem adjustments from appropriations: FY2024 $60M+$60M; FY2025 $37.2M+$37.2M; FY2026 $3.6M+$3.6M; FY2027 $1.8M+$1.8M (state + federal, FFS and MCO) Plus performance add-ons (see quality_incentive). - Inflation
Rules index to the CMS/Global Insight SNF market basket without capital, but no inflation is applied while rates are frozen; increases come only as appropriated flat add-ons.
Verified October 11, 2026
Case mix
- System
None
- Applied at
None
- How it works
Each home is paid its rolled-forward June 30 rate; budget language since FY2016 says no FFS home gets any other per diem adjustment, so current MDS acuity does not reach payment (Att. 4.19-D Section 22; FY2027 Act).
- Classification
RUG-based direct care case mix (version not stated in the rule) frozen into each home's rate as of June 30, 2014 (likely the Oct-Dec 2013 roster quarter; not confirmed)
- Applies to
Historically the direct care case-mix component only
- Acuity measured from
Rules: facility average Medicaid CMI from quarterly resident rosters, normalized to the July statewide Medicaid CMI (10:166-3.4, 3.10).
- Updated
Rules say quarterly; suspended in practice.
- Move to PDPM
No PDPM move found. N.J.A.C. 10:166-3.4 (recodified 11/18/2024) still says 'resource utilization group'. FY2025-FY2026 Acts allowed a new methodology by regulation; none was found and FY2027 dropped the clause.
Verified October 11, 2026
Low-acuity residents
None found. There is no separate rate for low case-mix residents; with case mix frozen every Medicaid resident in a home gets the same per diem (10:166-3; FY2027 Act).
Verified October 11, 2026
Capital
Fair rental value, frozen with the rest of the rate: $89,000 new bed value, 2% per year depreciation, age capped at 40 years (re-aging for renovations of at least $1,000/bed), 8% rental factor, divided by the greater of actual days or 95% of available days (Att. 4.19-D Section 11).
Verified October 11, 2026
Budget adjustment factor
The rules' target-rate mechanism cut O&A to 95% and direct care to 112% of the median and applied a factor of 0.92180 (SFY2012), 0.90800 (SFY2013-14) and 0.96220 (SFY2015, adding $42.41M). Since FY2016 the factor is moot: rates are the prior June 30 rate plus appropriated add-ons (Att. 4.19-D Sections 13 and 22).
Verified October 11, 2026
Add-ons and money outside the rate
Paid outside the posted rate
- Level
small
- Estimate
Under 5% of base statewide (judgment): the only lump-sum programs found are UPL payments to Class II homes over 500 beds, which in practice is one county home. Quality add-ons are paid inside the per diem. Dollar sizes not found.
- Components
FFS safety net supplemental payment (Medicare minus Medicaid gap, from FY2021); MCO state-directed UPL payment (from Jan 2022); both IGT-funded. Annual size not found.
Verified October 11, 2026
Payments by owner type
- Applies
yes
- Detail
Class II (county/government) homes: higher O&A price (104.5% of Class I) in the frozen formula; full-cost interim rates reconciled to as-filed and final cost reports (Section 14); exempt from the provider assessment; MCOs pay unnegotiated Class II homes the rate they would get as Class I; Class II homes over 500 beds with 85%+ Medicaid occupancy get UPL safety-net and MCO directed payments.
- Funding
IGT from the county facility (FY2027 Act: 'amounts received by the State from a Class II facility with greater than 500 licensed beds pursuant to an intergovernmental transfer agreement').
Verified October 11, 2026
Quality program
- Active
Yes
- Program
Nursing Facility performance add-ons (the MCO contract calls it the Nursing Facility Quality Incentive Payment Program, NF QIPP)
- Funding
State appropriation each year (Appropriations Act); described as 'dependent on budget appropriations'. Not stated as budget neutral.
- Size
Not stated as a pool; per-home maximum about $22.75/day in FY2027 (about $23.25 in FY2026).
- Paid as
Per diem add-on on both FFS and MCO rates
- Measures
Measure Source Weight How points are earned Long-stay residents losing too much weight MDS QM $2.50/day (FY2027; $3.00 FY2025-26) 4-quarter average at or below the lower of NJ or national average High-risk long-stay residents with pressure ulcers MDS QM $2.50/day At or below the lower of NJ or national average Hospitalizations per 1,000 long-stay resident days Claims QM $2.50/day At or below the lower of NJ or national average CoreQ resident and family satisfaction state survey $2.50/day Composite score 85% or higher Total nursing staff turnover PBJ $5.25/day (FY2027; $4.50 FY2025-26) 30% or less Total nurse staffing HPRD (adjusted) PBJ $5.25/day or $7.50/day $5.25 at NJ average up to 4.1 HPRD; $7.50 at 4.1 HPRD or more Staffing improvement PBJ $2.00/day (FY2027; $1.25 FY2025-26) Latest 4 quarters at least 100.5% of prior 4 quarters and between 3.6 and 4.1 HPRD - Scoring period
FY2027 (July 2026) rates use Q4 2024-Q3 2025 quality and staffing data (hospitalizations Q3 2024-Q2 2025): about a 9-18 month lag.
- Payment formula
Pass/fail per measure; each earned measure adds a fixed dollar amount to the per diem.
- Eligibility
Must file the CoreQ sample-size grid on time; excluded if, in the most recent calendar year, on the CMS SFF lists A, C or D, cited for two or more Level G-or-higher deficiencies, or rated one-star overall.
- Cadence
Annual, effective July 1
- Scores published
Not found
- Notes
Add-ons were $0.60 per measure in FY2020-FY2022, $1.80 in FY2023-FY2024, then restructured toward staffing in FY2025. Source: https://www.nj.gov/treasury/omb/publications/27approp/Departm… ; https://www.nj.gov/treasury/omb/publications/26approp/Departm… ; https://www.nj.gov/treasury/omb/publications/25approp/Departm… ; https://www.nj.gov/humanservices/dmahs/documents/providers-st…
Verified October 11, 2026
Provider tax
- Charged
per non-Medicare day
- Standard amount
Not confirmed. The statute sets the standard rate as whatever brings total collections to the federal maximum (6% of revenue) after reduced-rate homes pay; the current dollar amount was not found.
- Tiers
Who Test Amount High Medicaid occupancy homes (the highest-Medicaid homes needed to pass the federal uniformity waiver) medicaid_utilization $1 per non-Medicare day in the 2003 statute (current amount not confirmed) Low Medicaid occupancy homes (lowest 30% by Medicaid occupancy) medicaid_utilization $1 per non-Medicare day in the 2003 statute (current amount not confirmed) County homes and other excluded facilities (county geriatric centers, State-operated, Firemen's Home) public exempt - Lower for high-Medicaid homes
yes
- Returned in the rate
Provider tax add-on as an allowable cost ($13.67/day for FY2027, applied to MCO and FFS rates from July 1, 2026) plus the frozen quality-of-care portion; paid only to homes that pay the tax.
Verified October 11, 2026
Provider tax notes
Nursing Home Quality of Care Improvement Fund assessment (P.L.2003, c.105) on non-Medicare patient days, up to the federal 6% limit. Proceeds return as (1) a provider tax add-on recognizing the tax as an allowable cost ($13.67/day in FY2026-FY2027 budget language) and (2) a uniform 'quality-of-care' per diem add-on, frozen at the June 30 amount. FY2026 Act directed Treasury to collect 'the full statutorily authorized amount'.
Verified October 11, 2026
Supplemental payments
Medicare upper payment limit (UPL) supplemental payments to Class II (public) homes with more than 500 licensed beds and at least 85% Medicaid occupancy, funded by intergovernmental transfer from the facility (in practice New Bridge Medical Center, Bergen County): FFS 'safety net' payments from FY2021 (Att. 4.19-D p.36) and an MCO state-directed payment from January 1, 2022 (MCO contract 8.5.14). Public homes also get full-cost interim rates reconciled to cost. Sources: https://www.nj.gov/humanservices/dmahs/documents/providers-st… ; https://www.nj.gov/humanservices/dmahs/documents/providers-st… ; https://www.nj.gov/treasury/omb/publications/27approp/Departm…
Verified October 11, 2026
Other add-ons
Enhanced per diem for a Medicaid resident in a single-occupancy room (P.L.2023, c.181; amount not found). FY2027 Nursing Home Behavioral Health Add-On Pilot: $120 per qualifying resident day, $1,971,000, three homes, up to 30 residents each. COVID-era 10% increase (Oct 2020) is built into the frozen rates. Source: https://www.nj.gov/treasury/omb/publications/27approp/Departm…
Verified October 11, 2026
Units paid separately
Class III Special Care Nursing Facilities (ventilator/respirator, TBI/coma, pediatric, HIV, neurologically impaired, behavioral management) get separate cost-based rates; FY2027 floors: at least $450/day; TBI units licensed by July 1, 2023 get their June 30, 2022 base + $400; neurologically impaired young adult units at least the greater of their FY2024 base or $853.50/day. LTC-Behavioral Health NFs (expedited CON) get 85% of the average Class III behavior modification rate. Public homes get full-cost rates. Sources: https://www.nj.gov/treasury/omb/publications/27approp/Departm… ; https://www.nj.gov/humanservices/dmahs/documents/providers-st…
Verified October 11, 2026
Payment rules
Managed care for long-term care
- Status
yes
- Detail
NJ FamilyCare MLTSS (since July 1, 2014): MCOs pay long-stay NF and SCNF care with no day limit. Pre-July 2014 custodial residents remain FFS for the duration of their stay. Source: https://www.nj.gov/humanservices/dmahs/individuals-families/f…
Verified October 11, 2026
Who pays
mixed, mostly managed: NJ FamilyCare Managed Long Term Services and Supports (MLTSS), operated by the NJ FamilyCare MCOs under the 1115 Comprehensive Demonstration, pays custodial NF/SCNF care for anyone entering long-term care since July 1, 2014. Residents who were custodial Medicaid NF residents before July 1, 2014 stay in fee-for-service for the rest of their stay, so the FFS share is a shrinking legacy group. Short-term rehab in a NF is a Plan A (acute) MCO benefit.
Verified October 11, 2026
Managed care rate floor
Yes through June 30, 2026, status after that unclear. The MCO contract (01/2026) makes NFs, SCNFs and assisted living 'Any Willing Providers' through the end of SFY2026, and says rates during that period are 'the higher of: (a) the rate set by the State ... and (b) the negotiated rate' (Art. 4.8.1.M). The FY2027 Appropriations Act says homes with a negotiated MCO rate get that rate, and homes under an MCO contract without a negotiated rate get the FFS-equivalent rate they received on June 30, 2026 (minus the first provider tax add-on and performance add-ons, which are layered on top). The FY2026 Act's language that no MCO may deny a contract to any willing NF was not found in the FY2027 Act. Sources: https://www.nj.gov/humanservices/dmahs/documents/providers-st… ; https://www.nj.gov/treasury/omb/publications/27approp/Departm…
Verified October 11, 2026
Included in the daily rate
Included: routine medical supplies, routinely used DME (walkers, wheelchairs, pressure-relief mattresses), oxygen equipment and routine oxygen, non-legend drugs, in-house lab. Billed separately: legend drugs (pharmacy), physician, therapy by qualified outside providers, special equipment with prior authorization, outside lab/X-ray. Sources: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10… ; https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10… ; https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10…
Verified October 11, 2026
Bed hold
- Hospital stays
Not paid. Rule (10:166-1.14) says 10 days at 50% of the rate, but budget language says homes 'shall not receive payments for bed hold or therapeutic leave days for NJ FamilyCare beneficiaries' while still holding the bed.
- Leave days
Not paid (rule says 24 days/year at 100%; overridden by budget language).
- Occupancy rule
None
- Notes
The no-payment language is in the FY2025, FY2026 and FY2027 Acts; start year not confirmed. The bed must still be reserved per N.J.A.C. 8:85-1.14 (now 10:166-1.14).
Verified October 11, 2026
Personal needs allowance
- Per month
$50
- Effective
FY2027 Appropriations Act (July 1, 2026); same $50 in FY2025 and FY2026 Acts
- Notes
Set each year in budget language notwithstanding N.J.S.A. 30:4D-6a; applies to NF, psychiatric hospital and developmental center residents on Medicaid or SSI.
- Confidence
high
Verified October 11, 2026
Medicare coinsurance days
- Method
lesser_of
- Rule
'Medicare Part A coinsurance may be paid by the New Jersey Medicaid Program, but the total combined Medicare/Medicaid reimbursement may never exceed the facility's Medicaid Nursing Facility rate'; the resident's income offsets coinsurance first. Medicare Advantage cost-sharing rule not found.
- Effect
Because Medicare's SNF payment is usually above the Medicaid rate, the home usually receives $0 of the coinsurance.
- Confidence
high for FFS Part A; MA not confirmed
Verified October 11, 2026
Required care spending
- Applies
yes
- Rule
P.L.2020, c.89: DHS must set a direct care ratio requiring 90% (or more by regulation) of a home's aggregate revenue to be spent on resident direct care, effective no later than July 1, 2021; homes that miss it must pay pro rata dividends/credits to the State and all payers by June 30 of the next year. Also set a CNA-type direct care minimum wage $3 above the state minimum and the FY2021-22 rule that 60% of the 10% COVID increase go to direct care wages with recoupment. Implementing regulation and enforcement not confirmed. P.L.2020, c.112 sets minimum CNA ratios (1:8 day, 1:10 evening, 1:14 night) but those are staffing, not spending, rules.
Verified October 11, 2026
Occupancy rules
- Applies
yes
- Rule
Only in the frozen formula: fair rental value capital was divided by the greater of actual resident days or 95% of available days. No current occupancy penalty found.
Verified October 11, 2026
MDS accuracy penalties
Periodic MDS verification review; findings 'shall be used to reduce an NF's per diem payment rate to reflect the audited costs, days, case mix index' (10:166-1.12). No thresholds or dollar amounts stated; with case mix frozen the practical effect is unclear. Late cost reports: 0.25%-3% monthly rate penalties. Source: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10…
Verified October 11, 2026
Published rates and changes
How often rates change
- A home's rate changes
annual
- When
July 1 each State fiscal year via the Appropriations Act (prior June 30 rate + flat adjustment + performance add-ons; provider tax add-on also July 1 for FY2027, October 1 in earlier years). No quarterly case-mix changes in practice.
Verified October 11, 2026
When rates change
July 1 (SFY). Through FY2025 the provider tax add-on and prior-year add-ons ran July 1-September 30 with the new add-on from October 1; FY2027 applies all from July 1, 2026.
Verified October 11, 2026
Posted rates
- Home-level rates published
No
- Where
Not found on DMAHS pages checked (state plan, provider resources, MLTSS pages)
- Format
none
- History
none found
Verified October 11, 2026
Rate build-ups
- Published
No
- Where
Not found
Verified October 11, 2026
Recent changes
| Effective | Change | Headline | Direction | Size | Source |
|---|---|---|---|---|---|
| 2023-07-01 | FY2024 added a per diem adjustment funded by $60M state plus $60M federal, across FFS and managed care. | $120M across-the-board per diem increase | increase | $60,000,000 State + $60,000,000 federal | https://www.nj.gov/humanservices/dmahs/documents/providers-st… |
| 2024-07-01 | FY2025 added $37.2M state plus $37.2M federal per diem adjustment and restructured add-ons to $3.00 clinical/CoreQ and $4.50-$6.75 staffing measures. | $74.4M increase; staffing-weighted quality add-ons | increase | $37,200,000 State + $37,200,000 federal | https://www.nj.gov/treasury/omb/publications/25approp/Departm… |
| 2024-11-18 | Nursing facility rules moved from N.J.A.C. 8:85 (Health) to N.J.A.C. 10:166 (Human Services) without changing the rate formula. | Rate rules recodified to N.J.A.C. 10:166 | structural | https://www.law.cornell.edu/regulations/new-jersey/title-10/c… | |
| 2025-07-01 | FY2026 added only $3.6M state plus $3.6M federal and directed collection of the full statutory provider assessment. | Small $7.2M increase; full provider assessment collected | increase | $3,600,000 State + $3,600,000 federal | https://www.nj.gov/treasury/omb/publications/26approp/Departm… |
| 2026-06-30 | MCO contract's any-willing-provider protection and higher-of state rate floor for NFs expires at the end of SFY2026 unless the Commissioner extends it. | MLTSS any-willing-provider protection expired June 2026 | structural | https://www.nj.gov/humanservices/dmahs/documents/providers-st… | |
| 2026-07-01 | FY2027 added $1.8M state plus $1.8M federal, raised staffing add-ons to $5.25/$7.50, cut clinical add-ons to $2.50, fixed the tax add-on at $13.67, and started a $120/day behavioral pilot. | Near-flat rates; staffing add-ons raised | increase | $1,800,000 State + $1,800,000 federal; max add-on about $22.75/day | https://www.nj.gov/treasury/omb/publications/27approp/Departm… |
Verified October 11, 2026
Assisted living
Medicaid assisted living
- Covered
yes
- Program
NJ FamilyCare MLTSS (1115 Comprehensive Demonstration): assisted living residences, comprehensive personal care homes, assisted living programs
- What is paid
Services only; the resident pays a state-set room and board charge (SSI-only residents pay room and board but no cost share). P.L.2023, c.80 adds an increased per diem based on the home's Medicaid share.
- Rate
Minimum per diem $91.10 (assisted living facilities), $81.10 (comprehensive personal care homes), $71.10 (assisted living programs) in FY2027; FY2026 was $91.10/$81.10/$79.10.
- Limits
Any willing provider status for AL also ran through June 30, 2026; NF level of care required.
Verified October 11, 2026
Sources
- NJ Medicaid State Plan Attachment 4 (incl. 4.19-D nursing home reimbursement, TN 24-0012 TOC, Section 22 FY2015-FY2024) · state plan
- FY2027 Appropriations Act, Department Appropriations (DHS General Medical Services language) · statute
- FY2026 Appropriations Act, Department Appropriations · statute
- FY2025 Appropriations Act, Department Appropriations · statute
- NJ FamilyCare MCO contract (01/2026 accepted) · agency page
- DMAHS MLTSS page · agency page
- N.J.A.C. 10:166 Long-Term Care Services (recodified from 8:85, eff. 11/18/2024) · regulation
- P.L.2020, c.89 (direct care ratio, wage floor) · statute
- P.L.2020, c.112 (minimum CNA staffing ratios) · statute
- P.L.2003, c.105 Nursing Home Quality of Care Improvement Fund Act · statute
- MACPAC 2019 nursing facility payment compendium (baseline only) · secondary
Other states
Alabama · Alaska · Arizona · Arkansas · California · Colorado · Connecticut · Delaware · District of Columbia · Florida · Georgia · Hawaii · Idaho · Illinois · Indiana · Iowa · Kansas · Kentucky · Louisiana · Maine · Maryland · Massachusetts · Michigan · Minnesota · Mississippi · Missouri · Montana · Nebraska · Nevada · New Hampshire · New Mexico · New York · North Carolina · North Dakota · Ohio · Oklahoma · Oregon · Pennsylvania · Rhode Island · South Carolina · South Dakota · Tennessee · Texas · Utah · Vermont · Virginia · Washington · West Virginia · Wisconsin · Wyoming