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A4485 FISCAL ESTIMATE
LEGISLATIVE FISCAL ESTIMATE
ASSEMBLY, No. 4485
STATE OF NEW JERSEY
222nd LEGISLATURE
DATED: MAY 22, 2026
SUMMARY
Synopsis:
Establishes minimum Medicaid reimbursement rate for
structured day program services provided to beneficiary eligible for brain
injury services.
Type of Impact:
Annual increase in State costs and revenue.
Agencies Affected:
Department of Human Services.
Office of
Legislative Services Estimate
Fiscal Impact
Year 1 and Thereafter
State Cost Increase
$6.8 million to $18.2
million
State Revenue Increase
$3.4 million to $9.1
million
�
The
Office of Legislative Services (OLS) concludes that the Department of Human
Services will incur between $6.8 million and $18.2 million in additional annual
Medicaid expenditures in order to increase the reimbursement rate for
structured day program services for beneficiaries with traumatic brain
injuries. As
eligible State Medicaid expenditures for
these services are reimbursed 50 percent by federal funds, this bill will also increase
annual State revenue between $3.4 million and $9.1 million, for a net annual
State cost between $3.4 million and $9.1 million.
BILL DESCRIPTION
����� This bill requires the Medicaid per diem or encounter
reimbursement rates for Structured Day Program Services provided by an approved
brain injury service provider to a Medicaid beneficiary requiring treatment for
a brain injury to be equal to the average of the reimbursement rates for Tier D
and Tier E Day Habilitation Services provided to an eligible Medicaid
beneficiary by the Division of Developmental Disabilities in the Department of
Human Services.
FISCAL ANALYSIS
EXECUTIVE BRANCH
����� None received.
OFFICE OF LEGISLATIVE SERVICES
����� The OLS concludes that the department will incur
between $6.8 million and $18.2 million in additional annual Medicaid
expenditures in order to increase the reimbursement rate for structured day
program services for beneficiaries with traumatic brain injuries.� As
eligible State Medicaid expenditures for these services are
reimbursed 50 percent by federal funds, this bill will also increase annual
State revenue between $3.4 million and $9.1 million, for a net annual State
cost between $3.4 million and $9.1 million.
�����
According to
testimony before the Assembly Aging and Human Services Committee on May 7, 2026,
the current reimbursement rate for structured day program services is
approximately $3.65 for every 15 minutes of service.
�Testimony
from the Brain Injury Alliance of New Jersey before the same committee
indicated that roughly 350 Medicaid beneficiaries with traumatic brain injuries
currently receive structured day program services.�
����� The OLS estimate assumes
that this rate of $3.65 per 15 minutes of service would be increased to the
average
of FY 2026 Medicaid reimbursement rates for Tier D and Tier E day habilitation
services provided by the Division of Developmental Disabilities, which is $9.89
for every 15 minutes of service according to the division�s public notice from
December 2025
. �The low end of the OLS estimate
represents the annual cost under the bill if the assumed 350 current traumatic
brain injury structured day program clients received five hours of structured
day program services for three days per week.� The high end of this estimate
represents the annual cost under the bill if the 350 current clients received
eight hours of structured day program services for five days per week. This
range is based upon information regarding typical minimum and maximum service
utilization as reported by structured day program providers for Medicaid beneficiaries
with traumatic brain injuries.
����� The OLS notes that these
structured day program services are reimbursed under the Medicaid Managed Long
Term Services and Supports program.� Under this program, the State pays managed
care organizations a per-beneficiary, per-month capitation rate to cover a
broad array of long-term care services for eligible individuals.� Ultimately,
any costs incurred by the managed care organizations due to increased provider
reimbursements under this bill will be passed on to the State in the form of
higher capitation rates, as determined by the State�s annual capitation rate
setting process.� However, it is possible that other factors in the capitation
rate setting process, which the OLS cannot determine, may affect the actual net
State costs incurred under the bill.
Section:
Human Services
Analyst:
Sarah M. Schmidt
Principal Research Analyst
Approved:
Thomas Koenig
Legislative Budget and Finance Officer
This legislative fiscal estimate has been produced by the
Office of Legislative Services due to the failure of the Executive Branch to
respond to our request for a fiscal note.
This fiscal estimate has been prepared pursuant to P.L.1980,
c.67 (C.52:13B-6 et seq.).