Medicaid Managed Care Organization (MCO) System of New Jersey
The Medicaid Managed Care Organization (MCO) system is a healthcare delivery framework designed to manage the cost, utilization, and quality of services provided to beneficiaries.
New Jersey began transitioning from the traditional fee-for-service model to a managed care approach in 1995. Under this system, the state Medicaid agency contracts with MCOs—health insurance companies—to provide a comprehensive package of healthcare services.
This structure aims to improve health outcomes by streamlining the delivery of care and enhancing service quality.
MCO System Framework
New Jersey’s Medicaid and public health insurance services are collectively known as NJ FamilyCare.
Medicaid recipients in New Jersey enroll in a specific health plan managed by an MCO through the NJ FamilyCare program. The MCO is responsible for coordinating the member’s overall medical care, ensuring that services are efficient and accessible.
Key Aspects
- Structured Network: Provides better care coordination than traditional methods through a network of verified doctors and hospitals.
- Value-Added Services: MCOs have the authority to offer additional benefits (such as dental, vision care, and health incentives) that go beyond the standard requirements of regular Medicaid.
- Integrated Care: There is an increased emphasis on the integration of behavioral health and physical health services, ensuring beneficiaries receive more comprehensive care.
List of New Jersey Managed Care Providers
Five major health plans participate in the NJ FamilyCare program. These insurers provide services in all 21 counties in the state, including Bergen, Hudson, and Essex.
*Fidelis Care does not provide services in Hunterdon County.
- Aetna Better Health of New Jersey
- Address: 3 Independence Way, Suite 400, Princeton, NJ 08540
- Member Services: 1-855-232-3596 (Available 24/7)
- TTY for Hearing Impaired: 711
- Website: aetnabetterhealth.com/newjersey
- Fidelis Care (formerly WellCare of New Jersey)
- Address: 33 Washington Street, 1st Floor, Newark, NJ 07102
- Member Services: 1-888-453-2534 (Mon-Fri, 8 AM–6 PM)
- TTY for Hearing Impaired: 711 or 1-877-247-6272
- Website: fideliscarenj.com
- Horizon NJ Health
- Address: 1700 American Blvd., Pennington, NJ 08534
- Member Services: 1-800-682-9090 (Mon-Fri, 8 AM–8 PM)
- Provider Only: 1-800-682-9091
- TTY for Hearing Impaired: 711
- Website: horizonnjhealth.com
- UnitedHealthcare Community Plan
- Address: 333 Thornall St, 9th Floor, Edison, NJ 08837
- Member Services: 1-800-941-4647
- Provider Only: 1-888-362-3368 (Mon-Fri, 8 AM–6 PM)
- TTY for Hearing Impaired: 711
- Website: uhccommunityplan.com/nj
- Wellpoint (formerly Amerigroup New Jersey)
- Address: 101 Wood Avenue South, 8th Floor, Iselin, NJ 08830
- Member Services: 1-800-600-4441 / Provider Only: 1-800-454-3730 (Mon-Fri, 8 AM–6 PM)
- TDD: 1-800-852-7899
- Website: wellpoint.com/nj
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