What is the Medicaid program?
Medicaid is the state and federally funded health assistance program for certain groups of adults and children with low-to moderate income and resources. Medicaid benefits are provided to the majority of eligible persons through Health Maintenance Organizations. Medicaid also covers individuals who reside in nursing homes and assisted living facilities.
What services does the Medicaid program provide?
- Physician Services
- Dental and Optometry Services
- Laboratory and X-Ray Services
- Hospital Services
- Medical Transportation
- Hearing Aids
- Prescriptions and Durable Medical Equipment
Note: Depending upon the Medicaid program you are enrolled in, not all of the Medicaid services listed may be available to you.
What medical assistance programs are available?
BREAST AND CERVICAL CANCER PROGRAM - provides Medicaid Benefits to uninsured individuals under the age of 65 who have been diagnosed with breast or cervical cancer and are in need of treatment. Individuals must be screened through the New Jersey Cancer Education and Early Detection Screening Program (NJCEED) administered by the New Jersey Department of Health and Senior Services. For more information on where individuals can get free screening services call 1-800-328-3838.
MEDICALLY NEEDY - offers limited Medicaid coverage to individuals in a community setting who are blind, disabled, or 65 or older and have income or assets too high to qualify for coverage under NJ FamilyCare. The Medically Needy program was closed to new long term care applicants as of December 1, 2014. Individuals who receive coverage through the Medically Needy program do not receive HMO coverage, prescription coverage or inpatient hospitalization coverage.
MEPPA (MEDICAL EMERGENCY PAYMENT PROGRAM FOR ALIENS) - may cover medical bills related to the treatment of an emergency medical condition and is only for NJ residents who meet other Medicaid eligibility requirements except for their US citizenship/legal status. Undocumented immigrants or immigrants who do not have legal permanent resident status for 5 years may apply if they have had a recent medical emergency. An application must be made within 3 months of the date of the emergency to be considered for coverage under this program.
MLTSS (MANAGED LONG TERM SERVICES AND SUPPORTS) - refers to the delivery of long-term care services and supports through New Jersey Medicaid’s NJ FamilyCare managed care program. Under MLTSS, an individual’s HMO will coordinate all healthcare services whether the individual is at home, in an assisted living facility, a residential facility or a nursing home. The consolidation of Medicaid programs under the name NJ FamilyCare also includes the programs that have historically covered the aged, blind and disabled populations who require long-term care. MLTSS is the program that now encompasses programs formerly known as ACCAP (Aids Community Care Alternative Program), CRPD (Community Resources for Persons with Disabilities), GO (Global Options), Hospice, and TBI (Traumatic Brain Injury).
PACE (Program of All-Inclusive Care for the Elderly) is another MLTSS program that provides customized care to individuals age 55 and older who live in the service area and meet the nursing facility level of care established by Medicaid. Services include but are not limited to: primary care, hospital care, prescription drugs, home care, medical transportation, physical therapy, adult day care, assisted living and nursing home care. Individuals receive a customized care plan that is delivered by a coordinated interdisciplinary team. In Mercer County the PACE program is offered through Life St. Francis (609-599-5433). Inquiries can also be directed to the Mercer County Board of Social Services.
NJ FAMILYCARE - provides health coverage to children, pregnant women, parents/caretaker relatives, single adults, childless couples, the aged, blind, disabled and individuals qualified for long-term care services.
NJ FamilyCare’s comprehensive health coverage program provides a wide range of services depending on the person’s eligibility category. Most NJ FamilyCare beneficiaries (except MEPPA) have their health care coordinated by an HMO of their choosing.
NJ WORKABILITY - is a program under NJ FamilyCare that provides coverage to disabled individuals under the age of 65 who are employed.
QUALIFIED MEDICARE BENEFICIARY (QMB) PROGRAM - provides eligible Medicare recipients with payment of their Medicare Part B medical insurance premium and deductibles. Coverage for QMB is included in most NJ FamilyCare programs and does not require a separate application.