Beyond federal mandates, both Pennsylvania and New Jersey have enacted recent state-specific policies impacting HCBS financing and eligibility, with key legislative and waiver changes unfolding throughout 2024 and into 2025.

Pennsylvania: Rate Updates and CHC Waiver Renewal

PA's Community HealthChoices (CHC), the mandatory managed care program for long-term services and supports (LTSS), is the primary driver of policy changes.

HCBS Rate Updates: PA has implemented updated Medicaid HCBS rates, effective in January 2025, for services delivered under the CHC and OBRA waivers. These updates include new services being made available through the CHC Waiver Renewal and OBRA Waiver Amendment, requiring providers to check the specific procedure codes and service definitions for their specialties.

Dual-Eligible Alignment: Federal policies are pushing for greater alignment between the Medicare and Medicaid plans serving dually eligible beneficiaries in PA. Beginning in 2027, certain Dual Eligible Special Needs Plans (D-SNPs) in the CHC service area must limit new enrollment to those in the affiliated CHC MCO. This tightens the market and emphasizes the need for HCBS providers to contract with MCOs that offer aligned D-SNP products.

Workforce Oversight: As Pennsylvania grapples with the DCW shortage, ongoing legislative and regulatory efforts focus on monitoring and increasing the wage floor, largely fueled by the 80% DCW payment rule mentioned above.

New Jersey: Resource Limits and Program Focus

New Jersey’s Medicaid/NJ FamilyCare updates focus heavily on eligibility barriers and rebalancing the long-term care system.

Medicaid Resource Limit Increase (MLTSS): Legislation is being implemented in NJ that significantly increases the resource threshold for the Aged, Blind, and Disabled (ABD) eligibility group and for qualified applicants to the Managed Long-Term Services and Supports (MLTSS) Program. This change allows individuals to retain substantially more assets (e.g., rising from $2,000 to over $40,000 for an individual) while still qualifying for long-term care benefits.

Impact: This is a major legislative win for consumers, as it simplifies the application process and reduces the need for complex financial planning, potentially leading to higher MLTSS enrollment and increased demand for HCBS providers.

Focus on Housing and Social Needs: NJ is actively using Medicaid programs to address social determinants of health. Programs like the state's Healthy Homes initiative, which uses grant funding to construct affordable housing units for NJ FamilyCare members at risk of homelessness, reflect a broader state commitment to community integration. HCBS providers in NJ should seek partnerships to integrate housing support, care coordination, and supportive non-clinical services (like doula coverage, which is expanding under Medicaid) into their offerings.