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NJ will allow MCOs to exclude chronically low‑quality nursing homes; department lays out exclusion criteria and protections for residents
Summary
Starting July 1, 2025 the Department of Human Services will permit Medicaid MCOs to stop contracting prospectively with nursing facilities that repeatedly fail to meet CMS or state health standards; the department described specific exclusion criteria, safeguards for current residents and ties exclusions to a $50M quality‑incentive program and other rate investments.
The New Jersey Department of Human Services told the Assembly Budget and Appropriations Committee it will transition the Medicaid nursing‑home network policy to an “any willing qualified provider” model that allows managed care organizations to decline contracting with facilities that repeatedly fail to meet federal or state quality and safety benchmarks.
Effective date and scope: Department staff said the change takes effect July 1, 2025. Under the new approach, MCOs may choose not to contract prospectively with facilities that meet exclusion thresholds; the department emphasized MCOs cannot displace current residents by terminating payments if a contract ends — residents retain their choice to remain — and MCOs must increase care‑manager visits to monitor residents in such facilities.
Exclusion crite…
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