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NJ FamilyCare and Managed Care

NJ FamilyCare is the single program for all public medical assistance in New Jersey, including all adults and children eligible for services under any state or federal authority. The Department of Human Services' Division of Medical Assistance and Health Services (DMAHS) administers the state- and federally-funded NJ FamilyCare program for over 1.5 million low- to moderate-income adults and children. NJ FamilyCare provides health coverage to parents/caretakers and dependent children, pregnant women, and people who are aged, blind or disabled and/or those requiring long-term services and supports. NJ FamilyCare pays for hospital services, doctor visits, prescriptions, nursing home care, home and community-based services and other healthcare needs.

While NJ FamilyCare offers a few services through traditional fee-for-service arrangements, the majority of Medicaid benefits are provided through contracts with managed care health plans, also commonly referred to as managed care organizations (MCOs). Today, the majority of NJ FamilyCare beneficiaries are enrolled in managed care health plans (MCOs) that provide most health care benefits in exchange for a per member, per month payment. DMAHS has been providing mandatory managed care services for eligible beneficiaries since 1995.  Health plans ensure quality and cost-effective care by emphasizing prevention and coordination of care.  Their care management programs help ensure clients have continuity of care and receive services that are appropriate. Health plans also provide enabling services such as language translation, community outreach, and health educational programs that facilitate effective communication and access to appropriate and timely care.

The provider community plays in integral role in the care of our beneficiaries. We invite providers to learn more about NJ FamilyCare managed care services by viewing the NJ FamilyCare Managed Care Contract, and the D-SNP Contract. Providers are also encouraged to inform their patients of the MCOs accepted by the provider office. Generally, providers must be a part of the network of an NJ FamilyCare-contracted MCO in order to provide services to patients. Patients may select their MCO based on whether a specific provider is in that network.

The Division of Medical Assistance and Health Services distributes Provider Newsletters regarding important Medicaid and MCO contract information and updates. To view Provider Newsletters, visit www.njmmis.com.

Call the provider services telephone number of any of the NJ FamilyCare-contracted MCOs for information about the in-network contracting process.  Patients may call the member services telephone number of any of the NJ FamilyCare-contracted MCOs with questions, such as changes in enrollment or primary care provider selection.

Any questions about Medicaid managed care, including the MCO auto-assignment process, should be directed to NJ FamilyCare's  Medicaid Hotline at 1-800-356-1561 (TTY: 1-800-701-0720)

Note: The Medicaid Hotline is not accessible when New Jersey State government offices are closed.

 
 
 
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