The Division of Medical Assistance and Health Services (DMAHS) has been providing mandatory managed care services for the AFDC/TANF and NJ KidCare/FamilyCare populations since 1995 and 1998, respectively, through the New Jersey Care 2000 program. On October 1, 2000, the program was expanded to move the Aged, Blind and Disabled (ABD) populations into mandatory managed care. The new, expanded program, New Jersey Care 2000+, requires all non-dually eligible (Medicaid, no Medicare) ABD clients, and clients of the Division of Developmental Disabilities (DDD), including individuals enrolled in DDD's Community Care Waiver, to enroll in an HMO to receive their Medicaid benefits.
Education and outreach to these populations to encourage voluntary enrollment began on October 1, 2000. Clients in all counties have been outreached, and are now considered as a mandatory population.
The provider community is an integral part in the health care of our clients. We invite you to learn more about specific prescription drug services, information pertaining to HMO prior authorization, the care management program, specific preventive programs, the AIDS Drug Distribution Program (ADDP) and much more about the managed care program by viewing the managed care contract, and the D-SNP contract.
To assure that you can continue to provide services to your patients who are required to enroll, or who may elect to enroll, in a Medicaid-contracted HMO, please let your patients know in which HMOs you participate. You must be a part of the provider network in a Medicaid-contracted HMO in order to provide services to your patients who are enrolled in that organization. Patients may select their HMO based on whether a specific provider is in that network.
Call the provider services telephone number of any of the Medicaid-contracted HMOs for information regarding provider applications. Patients may call the member services telephone number of any of the Medicaid-contracted HMOs with questions they may have, such as questions about changes in enrollment or primary care provider selection.
Any questions regarding the auto-assignment process, or Medicaid managed care should be directed to the managed care hotline at 1-800-356-1561.
Note: Hotlines are not accessible when New Jersey State government offices are closed.
Frequently, the Division of Medical Assistance and Health Services distributes Provider Newsletters regarding important contract information and updates. To view previous newsletters visit www.njmmis.com.