FY2026 Annual Report

Annual Report FY2026 11 NJAMHAA was instrumental in impacting legislation, now passed, that changed how long individuals may be held under the involuntary commitment process. While that time was extended from 72 to 144 hours several years ago, NJAMHAA advocated against the change being made permanent and it does remain temporary. In legislation passed by both houses, the current expiration date of August 31, 2026 is extended until April 30, 2027 with stricter reporting requirements in place for the Department of Human Services (DHS). This extension is accompanied by other legislation that will establish a voluntary pilot program to allow flexibility for psychiatric bed status. That bill has also passed both houses. NJAMHAA has had ongoing success in shaping the implementation of the carve-in of behavioral health services to Medicaid managed care in important ways. In FY2026, NJAMHAA continued its advocacy for extensions of transition policies, including automatic approvals of prior authorization (PA) requests and subsequent payment for claims. Ultimately, one managed care organization (MCO) of five was deemed ready to end its transition phase and began applying medical necessity in November 2025. Subsequently, two other MCOs met the readiness standard to end their transition in April and May of 2026, and a fourth just began applying medical necessity on July 1 st . NJAMHAA was also successful in having Medicaid direct the MCOs to properly review children’s partial hospital (PH) PA requests. Without separate regulations or guidance in place for children’s PH, MCOs were applying adult regulations and subsequently incorrectly denying services. NJAMHAA is currently advocating regarding the turnaround time for children’s PA requests for PH services. MCOs are taking up to seven days (sometimes longer) to approve current requests for children’s PH. All children’s PH requests have historically been considered urgent, by default, and therefore required a 24-hour turnaround, and NJAMHAA will continue working toward re-establishing this standard. Another recent advocacy effort relates to the July 1, 2026 carve-in of lab services. NJAMHAA has been meeting with DHS to advocate for amendments to the MCO contract that would require all MCOs to allow independent labs into their networks. While the Division of Medical Assistance and Health Services (DMAHS) requires MCOs to “uphold adequate access and service quality, including sufficient provider and member choice of labs and timely turnaround of test results”, MCOs are not required to contract with any willing provider. However, NJAMHAA advocacy did result in DHS announcing that the July 1, 2026 carve-in would proceed with a transition period during which all MCOs are required to reimburse out-of-network labs at the fee-for-service rate. This transition provision will be in place until the MCO networks comply with DMAHS-defined standards. On June 30, 2026, Gov. Sherrill signed into law a bill that extends parity reimbursement for telehealth through December 31, 2027. NJAMHAA will continue to address these and all challenges that members are facing as it has for 75 years, with persistence and results!