In 1995, New Jersey transitioned its Medicaid program from a traditional fee-for-service model to managed care, aiming to enhance healthcare access and coordination for beneficiaries. This shift means that instead of Medicaid directly paying healthcare providers for each service, beneficiaries enroll in a Managed Care Organization (MCO), also referred to as a health plan, which then manages their healthcare needs. These NJ Medicaid Managed Care plans offer comprehensive services, going beyond the standard NJ FamilyCare Medicaid benefits to provide coordinated care and extra support for their members.
What is a Managed Care Organization (MCO) in NJ Medicaid?
Under the NJ Medicaid Managed Care system, an MCO acts as a bridge between you and your healthcare services. Instead of receiving care and having the provider bill Medicaid directly for each service (fee-for-service), you choose an MCO. This MCO then receives a set payment from Medicaid to manage your healthcare. This system encourages a focus on preventive care and coordinated services, as MCOs are responsible for the health outcomes of their enrolled members. Think of your MCO as your personal healthcare coordinator within the New Jersey Medicaid program. They are responsible for ensuring you receive all the necessary medical assistance and services covered under your plan.
Participating NJ FamilyCare Medicaid Managed Care Organizations
Currently, five health plans, or MCOs, are part of the NJ FamilyCare Medicaid program. These plans work in partnership with the state to deliver quality healthcare services to Medicaid beneficiaries. You have the option to choose from the following Managed Care Organizations in New Jersey:
- Aetna Better Health of New Jersey
- Fidelis Care
- Horizon NJ Health
- UnitedHealthcare Community Plan
- Wellpoint (formerly Amerigroup New Jersey)
Enrolling in one of these NJ Medicaid Managed Care plans gives you access to a network of doctors, specialists, and hospitals, all working together to meet your healthcare needs.
Benefits of Managed Care in New Jersey Medicaid
The managed care approach in New Jersey Medicaid offers several advantages for beneficiaries compared to the older fee-for-service system. One of the primary benefits is improved access to healthcare providers. MCOs build networks of providers, ensuring members have a range of choices and easier access to necessary care. Furthermore, Managed Care Organizations place a strong emphasis on care coordination. This means your health plan helps to connect you with different healthcare services, manage your care plan, and ensure smooth transitions between different types of care.
In addition to improved access and coordination, NJ Medicaid Managed Care plans are designed to provide a comprehensive suite of preventive health services. By focusing on prevention, these plans aim to keep members healthy and avoid more serious health issues down the line. This proactive approach, combined with the full spectrum of Medicaid benefits, strives to deliver the best possible healthcare experience for New Jersey Medicaid recipients.
For those interested in further details, the NJ FamilyCare Managed Care Contract is available for public review. (PDF File) Additionally, information on the quality ratings of these health plans can be found in the NCQA report card, which evaluates plans based on care quality, member satisfaction, and ongoing improvement efforts.
