KodaComplyHome care rules, state by state, in plain EnglishDocuments collected September 22, 2026

New Jersey home care rules

New Jersey licenses home health agencies through the Department of Health, and requires other businesses that employ, place or refer companions, personal care aides or other caregivers in the homes of people 60 and older or people with disabilities to register as health care service firms with the Division of Consumer Affairs. Medicaid (NJ FamilyCare) personal care for health plan members is authorized and paid by five health plans: Aetna, Fidelis Care, Horizon NJ Health, UnitedHealthcare and Wellpoint. From January 1, 2027, agencies giving personal care or home health services to health plan members must verify at least 80% of EVV visits with no manual edits, or risk losing referrals and contracts.

86 official documents·collected September 22, 2026·checked against them September 22, 2026
License for non-medical home care?Yes — registrationHealth care service firm registration with the Division of Consumer Affairs, renewed by July 1 each year. Covers companion, personal care and health care services in the home of anyone 60 or older or with a disability.
License for home health?CN + licenseDepartment of Health license under N.J.A.C. 8:42, plus a Certificate of Need. The July 1, 2025 call for home health applications was postponed.
EVV80% rule Jan. 1Health plan providers of personal care and home health must verify at least 80% of visits with no manual edits from January 1, 2027
Medicaid health plans5 plansAetna, Fidelis Care, Horizon NJ Health, UnitedHealthcare, Wellpoint

What changed, and what to do about it

Red means act now, amber means read it this month, grey is for the record.

Act nowNewsletter 36-09, September 2026 · introductory period October 1 to December 31, 2026

Health plan EVV: at least 80% of visits with no manual edits from January 1, 2027

DMAHS says agencies giving personal care (PCA) and home health services to health plan members must electronically verify at least 80% of EVV visits with no manual edits. Some edit reasons, such as GPS address errors, overnight visits and retro-authorizations, do not count against you. After three months in a row below 80%, plans stop new referrals; after six months, they must end the contract. Paid service units with no matching confirmed visit in the plan's EVV system (CareBridge or HHAeXchange) will be recouped.

What to do: Pull your manual-edit rate for recent months by tax ID. Find the aides and cases behind the edits, fix phone and address problems, and retrain on clocking in and out before October 1.
Read this monthMedicaid Alert MA-2026-03, June 2026 · claims submitted on or after June 1, 2026

Claims now pend, then deny, when a required license on file is out of date

For individual providers who need a license to enroll (servicing, billing, attending, prescribing, supervising and operating providers), claims pend for up to 4 weeks when the license on file in NJMMIS is not current, and then deny.

What to do: If your claims list an individual provider who needs a license to enroll (for example an attending or supervising provider), check the NJMMIS list of valid licenses and send any missing current license to Gainwell Provider Enrollment.
For the recordNotice filed June 26, 2025 (57 N.J.R. July 21, 2025)

No new Certificate of Need call for home health yet

The Department of Health postponed the call for home health care applications scheduled for July 1, 2025 while it surveys home health agencies. It will publish either a call or a cancellation in the New Jersey Register. The 2022 call was cancelled because the Department found no need for more home health services.

What to do: If you plan to open a home health agency, watch the New Jersey Register for the notice.

Deadlines coming up

Dates taken from the rules and notices as we read them.

8days
October 1, 2026

EVV 80% introductory period starts

Health plan PCA and home health providers have October 1 to December 31, 2026 to meet the 80% no-manual-edit standard.

100days
January 1, 2027

EVV 80% rule applies

Health plans start counting months of non-compliance; three in a row stops new referrals.

281days
July 1, 2027

Health care service firm registration renewal due

Renew with the Division of Consumer Affairs on or before July 1 each year (N.J.A.C. 13:45B-13.5).

646days
June 30, 2028

NJ FamilyCare 1115 demonstration approval period ends

MLTSS runs under this demonstration, approved April 1, 2023 through June 30, 2028.