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NJ Family Care

You can choose from a selection of NJ FamilyCare Managed Care Organizations (MCOs) in New Jersey for Managed Long Term Services and Supports (MLTSS). Another option is  the Program of All-Inclusive Care for the Elderly (PACE) program:

  1. NJ FamilyCare MCOs provide the full range of coordinated health services, long-term services and supports and prescription drug benefits. If you have both NJ FamilyCare and Medicare coverage and you select an NJ FamilyCare MCO, your Medicare health and prescription plans won't change. Medicare will be your primary insurance and NJ FamilyCare will be secondary.

    Not all MCOs operate in all counties, so you must choose an MCO operating in the county where you live.

    Click Here for a List of NJ FamilyCare Health Plans.
     
  2. A PACE organization coordinates and provides all Medicare and NJ FamilyCare services, including nursing facility care and prescription drugs. Many participants are transported to a PACE center to receive services in addition to receiving services in the home as needed. To participate in the PACE program, you must be 55 years of age or older and able to live safely in the community at the time of enrollment. There are currently four PACE organizations in seven counties. To be eligible to enroll, you must live in the PACE provider service area.

Medicare and Medicaid services, including nursing facility care and prescription drugs. Many participants are transported to a PACE center to receive services in addition to receiving services in the home as needed. To participate in the PACE program, you must be 55 years of age or older and able to live safely in the community at the time of enrollment. There are currently four PACE organizations in seven counties. To be eligible to enroll, you must live in the PACE provider service area.

What are the options?

Beginning July 1, 2014, your Medicaid home and community-based services will be covered and provided by your current NJ FamilyCare managed care organization (MCO). This means that:

  1. If you are in an MCO, all of your NJ FamiyCare health care, community-based long-term services and supports (including assisted living, community residential and mental health and substance abuse services, wellness and recovery programs) and prescription drug benefits will be coordinated by the MCO you choose.
  2. If you are in a Dual Eligible Special Needs Plan (D-SNP), this means all of your Medicare and NJ FamilyCare health care, community-based long-term services and supports and prescription drug benefits can be coordinated by the same MCO that also offers your D-SNP coverage or by another NJ FamilyCare MCO, or by enrolling in the PACE program of your choice.

 

But there are these options if you want to choose a different type of Medicaid managed health plan. For example:

  • If you only have NJ FamilyCare, you can choose from one of the NJ FamilyCare MCOs or enroll in a PACE (Program of All-inclusive Care for the Elderly) program.
  • If you have NJ FamilyCare and Medicare, you can choose from one of the NJ FamilyCare MCOs or enroll in a PACE program.

 

MEDICAID Managed Care Organization (MCO)
NAME COUNTIES
Amerigroup New Jersey, Inc. All except Salem
Healthfirst Health Plan of New Jersey, Inc. Atlantic, Bergen, Essex, Hudson, Mercer, Middlesex, Morris, Passaic, Somerset, Sussex, Union and Warren
Horizon NJ Health All
UnitedHealthcare Community Plan All
WellCare Health Plans of New Jersey Essex, Hudson, Middlesex, Passaic and Union
To enroll in a Medicaid MCO, call 1-866-472-5338 (TTY: 1-800-701-0720)

Program of All-inclusive Care for the Elderly (PACE)
NAME COUNTIES
LIFE at Lourdes - To enroll, call (856) 675-3355 Most of Camden
Lutheran Senior LIFE - To enroll, call (201) 706-2091 Parts of Hudson
LIFE St. Francis - To enroll, call (609) 599-5433 Mercer and parts of northern Burlington
Inspira LIFE - To enroll, call (856) 418-5433 Parts of Cumberland, parts of Gloucester and parts of Salem
For more information on PACE,
call 1-800 MEDICARE (1-800-633-4227), (TTY: 1-877-486-2048), or visit www.medicare.gov/Nursing/Alternatives/PACE.asp or www.npaonline.org on the web

 
 
 
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