In 1995, New Jersey began moving Medicaid beneficiaries from a traditional fee-for-service health coverage program, where providers bill Medicaid directly, to managed care. Under managed care, beneficiaries enroll in a health plan or managed care organization (MCO) which coordinates their members' healthcare and offers special services in addition to the regular NJ FamilyCare Medicaid benefits enrollees receive.
Five health plans 鈥�(also known as MCOs) participate in New Jersey's NJ FamilyCare Medicaid program. They are:
Through managed care, New Jersey beneficiaries have better access to healthcare providers and care coordination than they would have through Medicaid's traditional fee-for-service program. Managed care health plans are also able to provide a comprehensive package of preventive health services that, combined with the full range of Medicaid benefits, allows for the best healthcare possible.
The public is invited to view the current NJ FamilyCare Managed Care Contract. (PDF File)
New Jersey FIDE SNP Model MIPPA Contract (PDF File)
The National Committee for Quality Assurance (NCQA) updates a for New Jersey health plans. Each health plan is rated based on the quality of care their members receive (HEDIS®), how happy enrollees are with their care (CAHPS®), and health plans’ efforts to keep improving (NCQA Accreditation standards).
