Bill Text: NJ A5436 | 2026-2027 | Regular Session | Introduced
Bill Title: Adjusts monthly Medicaid capitation rate for participants in Program of All-Inclusive Care for Elderly.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced) 2026-09-10 - Introduced, Referred to Assembly Aging and Human Services Committee [A5436 Detail]
Download: New_Jersey-2026-A5436-Introduced.html
Sponsored by:
Assemblywoman CAROL A. MURPHY
District 7 (Burlington)
SYNOPSIS
Adjusts monthly Medicaid capitation rate for participants in Program of All-Inclusive Care for Elderly.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning the "Program of All-Inclusive Care for the Elderly," and supplementing Title 26 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. As used in this act:
"Medicaid" means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Medicare" means the program established pursuant to Pub.L.89-97 (42 U.S.C. s.1395 et seq.).
"PACE" means the "Program of All-Inclusive Care for the Elderly," operated by a public, private, nonprofit, or proprietary entity, as permitted by federal law. The program is a comprehensive health and social services delivery system that integrates acute and long-term care services. PACE is a capitated program which provides services to disabled and frail elderly persons who are certified by the State as nursing home eligible to maximize their autonomy and continued independence.
2. The monthly Medicaid capitation rate for a Medicaid enrollee receiving services under the PACE program shall be no less than 98 percent of the amount that would otherwise have been paid by the State if the participant were not enrolled in the PACE program, and were instead receiving long-term care services under the Medicaid fee-for service delivery system.
3. The monthly Medicaid capitation rate for a participant who is eligible for both Medicare and Medicaid, and is receiving services under the PACE program, shall be no less than 95 percent of the amount that would otherwise have been paid by the State if the participant were not enrolled in the PACE program, and were instead receiving long term care services under the Medicaid fee-for service delivery system.
4. Each PACE program that begins operation on or after July 1, 2026 shall receive a monthly Medicaid capitation rate for all participants for the first 24 months of operation that shall be no less than 98 percent of the amount that would otherwise have been paid by the State if the PACE program participant were not enrolled in the PACE program, and were instead receiving long term care services under the Medicaid fee-for service delivery system.
5. The Commissioner of Human Services shall apply for such Medicaid waivers or State plan amendments as may be necessary to implement the provisions of this act and to secure federal financial reimbursements for State expenditures under the federal Medicaid program.
6. The Commissioner of Human Services shall adopt rules and regulations, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), as are necessary to effectuate the provisions of this act.
7. This act shall take effect immediately.
STATEMENT
This bill adjusts the monthly Medicaid capitation rate for participants in the Program of All-Inclusive Care for the Elderly (PACE program).
Under the bill, the monthly Medicaid capitation rate for a Medicaid enrollee receiving services under the PACE program is to be no less than 98 percent of the amount that would otherwise have been paid by the State if the participant were not enrolled in the PACE program, and were instead receiving long-term care services under the Medicaid fee-for service delivery system.
The bill provides that the monthly Medicaid capitation rate for a participant who is dually eligible for Medicare and Medicaid and is receiving services under the PACE program is to be no less than 95 percent of the amount that would otherwise have been paid by the State if the participant were not enrolled in the PACE program, and were instead receiving long term care services under the Medicaid fee-for service delivery system.
Under the bill, each PACE program that begins operation on or after July 1, 2026 is to receive a monthly Medicaid capitation rate for all participants for the first 24 months of operation that is to be no less than 98 percent of the amount that would otherwise have been paid by the State if the PACE program participant were not enrolled in the PACE program, and were instead receiving long term care services under the Medicaid fee-for service delivery system.
