On December 21, 2023, New Jersey Governor Phil Murphy signed AB 5225 into law, requiring the development of a palliative care services benefit aimed to improve the quality of life for Medicaid beneficiaries with serious illness and their caregivers. The benefit will give access to needed ongoing assistance by an interdisciplinary team, including management and support for pain and other issues related to a serious illness and to necessary care coordination and navigation services by specialists. This legislative victory, championed by Assemblywomen Angela McKnight, Shanique Speight, and Carol Murphy, as well as senators Richard Codey and Nellie Poe, came less than a year after its February 2023 introduction into state legislature, signaling a broad range of support for the benefit across the state. New Jersey Division of Medical Assistance and Health Services (DMAHS) has led the development of an amendment to the New Jersey Medicaid State Plan and implementation of the benefit has begun. Benefit launch is set for April 1, 2026 and will be available for all Medicaid beneficiaries meeting eligibility criteria through their health plan.
The benefit is intended to be delivered at the same time as seeking treatment with the goal of improving quality of life while reducing unnecessary inpatient stays and emergency room visits. The benefit’s program guidance not only defines the services associated with specialty community-based palliative care services but also identifies the types of providers able to deliver such a benefit and the training requirements for each required member of the interdisciplinary team. Included in the benefit is reimbursement for non-palliative care providers to assess their patients for program eligibility and make a referral to a contracted palliative care provider. New Jersey DMAHS has developed trainings for interested parties focused on a benefit overview and provider qualifications and on the enrollment and credentialing process, and care management, billing and claims, and provider tools.
To qualify as a community-based palliative care provider, organizations must enroll in New Jersey Medicaid, become credentialed to deliver palliative care services, and contract with a managed care organization (MCO). Members of the interdisciplinary team must demonstrate they have sufficient proficiency in delivering palliative care services, either through certification or training. Organizations such as the Center to Advance Palliative Care (CAPC), Goals of Care Coalition of New Jersey (GOCCNJ), and the Home Care and Hospice Association of New Jersey are working to support providers by deploying benefit-specific training plans, certification support, and capacity-building initiatives. To support workforce development efforts, CAPC launched 8 provider-specific learning pathways, including education for MCO case managers.
The successful implementation of a statewide palliative care benefit requires the participation and input from healthcare organizations and community stakeholders in the design process. The New Jersey DMAHS worked collaboratively with GOCCNJ, Home Care and Hospice Association of New Jersey, MCOs, and other organizations across the state to gain community input and develop the benefit.
The success of the New Jersey bill is part of a movement on the part of state Medicaid and legislative leaders to respond to the needs of the growing number of Medicaid beneficiaries with serious illness. Several state Medicaid agencies have either implemented or advanced palliative care benefits through state legislation or administrative provisions, including California, Hawai’i, Oregon, Maine, Colorado, Washington, Ohio, Maryland, and Texas. If approved by the Centers for Medicare and Medicaid Services, New Jersey’s state plan amendment would be the second receiving federal approval. Hawai’i received federal approval for their community-based palliative care benefit in May 2024 and launched the benefit in January 2025.
To learn more about implementing a Medicaid community-based palliative care benefit, contact the C-TAC team for more information at info@thectac.org.
