New Jersey § 30:4d-3d1

§ 30:4d-3d1.

a. Within 30 months of enactment of P.L.2023, c. 306 ( C.30:4D-3d1 ), 1 and conditional on the receipt of all necessary approvals and the securing of federal

financial participation pursuant to subsection g. of this section, the Department

of Human Services shall provide presumptive eligibility for Medicaid, including, where

appropriate, eligibility for the managed long-term services and supports program,

for an individual who is: seeking home and community-based services or PACE enrollment;

awaiting an eligibility determination for Medicaid or for the managed long-term services

and supports program or services provided through PACE; and likely to be financially

and clinically eligible for Medicaid and where necessary the managed long-term services

and supports program or services provided through PACE, as determined by the department. b. Conditional on federal financial participation, the department shall provide Medicaid

coverage for eligible home and community-based services or services provided through

PACE to an individual who is granted presumptive eligibility pursuant to this section.

Coverage provided under this subsection shall begin upon the receipt of an individual's

request for services, pursuant to subsection c. of this section, and shall be terminated

if the individual is determined clinically or financially ineligible for home and

community-based services or services provided through PACE under Medicaid during the

eligibility determination process. c. An individual seeking presumptive eligibility for home and community-based services

or services provided through PACE under Medicaid shall submit a request to the department

in a manner and form as determined by the commissioner. d. An individual granted presumptive eligibility pursuant to this section shall be

required to submit a completed application for Medicaid and any applicable Medicaid

waiver program offering home and community-based services or services provided through

PACE no later than the end of the month following the month in which presumptive eligibility

is granted. e. Conditional on federal financial participation, a home and community-based services

provider or PACE center shall be reimbursed for all Medicaid-eligible services rendered

to an individual who has been granted presumptive eligibility pursuant to this section,

regardless of whether the individual granted presumptive eligibility is determined

clinically or financially ineligible for home and community-based services or services

provided through PACE under Medicaid during the eligibility determination process. f. The department shall provide each individual granted presumptive eligibility pursuant

to this section a written notice explaining the terms and conditions of presumptive

eligibility and the home and community-based services or services provided through

PACE the individual will be eligible to receive. g. The commissioner shall apply for such State plan amendments or waivers as may be

necessary to implement the provisions of this section and to secure federal financial

participation for State Medicaid expenditures under the federal Medicaid program. The provision of presumptive eligibility pursuant to this section shall be contingent

on securing all necessary federal approvals and federal financial participation as

may be necessary to implement the provisions of this section. h. In designing the program required pursuant to subsection a. of this section, the

Department shall assess the success of other jurisdictions in providing for presumptive

eligibility for home and community-based services and related services for Medicaid

recipients; consider methods for minimizing costs due to determinations of clinical

or financial ineligibility; and engage with relevant stakeholders to determine how

to best tailor the benefit to the needs of the Medicaid population. i. As used in this section: “ Commissioner ” means the Commissioner of Human Services. “ Department ” means Department of Human Services. “ Eligibility determination ” means the administrative process by which the Division of Medical Assistance and

Health Services in the Department of Human Services or a county welfare agency reviews

a beneficiary's income, financial resources, and circumstances relating to the beneficiary's

application for benefits received under Medicaid or any applicable Medicaid waiver

program offering home and community-based services or services provided through PACE. “ Home and community-based services ” means community-based services provided under the managed long term services and

supports program or personal care assistant services provided in the home under New

Jersey's Medicaid State Plan. “ Medicaid ” means the Medicaid program established pursuant to P.L.1968, c. 413 ( C.30:4D-1 et seq. ). “ PACE ” means the program of all-inclusive care for the elderly as defined in section 1

of P.L.1997, c. 296 ( C.26:2H-88 ). 1

L.2023, c. 306, enacted Jan. 16, 2024.