Five plans currently hold NJ FamilyCare managed care contracts: Aetna Better Health of New Jersey, Fidelis Care, Horizon NJ Health, UnitedHealthcare Community Plan, and Wellpoint. DMAHS also contracts separately for a Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) product line serving members eligible for both Medicare and Medicaid, under its own model MIPPA contract distinct from the mainstream managed care contract.

• Aetna Better Health of New Jersey
• Fidelis Care
• Horizon NJ Health
• UnitedHealthcare Community Plan
• Wellpoint

Long-term services and supports are integrated into managed care through MLTSS, which took effect July 1, 2014. MLTSS coordinates nursing facility care, assisted living, community residential services, home and vehicle modifications, home-delivered meals, respite, and personal emergency response systems through the same five NJ FamilyCare managed care plans that handle acute and primary care, rather than through a separate LTSS-specific vendor. One legacy carve-out remains: nursing facility residents who were already receiving custodial Medicaid coverage before July 1, 2014 stay in fee-for-service for the duration of that stay. MLTSS eligibility itself is determined by New Jersey's Division of Aging Services rather than by the health plans. A related, older layer of the program (a set of standalone 1915(c) home- and community-based services waivers, including the Global Options for Long Term Care, Community Care, Community Resources for People with Disabilities, AIDS Community Care Alternatives, and Traumatic Brain Injury waivers) wound down between 2014 and 2021 as their populations moved into MLTSS, consistent with the program's own stated design.

Integrated into managed care

Behavioral health has moved from a largely carved-out system toward integration into managed care in stages, and that process is not yet complete. Coverage for behavioral health services for MLTSS, FIDE SNP, and Division of Developmental Disabilities beneficiaries was aligned with the managed care plans effective July 1, 2018, with FIDE SNP enrollees more broadly following in October 2018. A far larger integration, described by the state as the most significant behavioral health change since managed care itself began, started with Phase 1 on January 1, 2025, moving outpatient behavioral health services (outpatient counseling and psychotherapy, partial hospitalization, substance use disorder outpatient counseling, intensive outpatient and partial care services, and related peer support and case management programs) onto MCO coverage and billing for the broader NJ FamilyCare population, not just the MLTSS/FIDE SNP/DDD populations already integrated. A subsequent Phase 2, covering residential and opioid treatment programs, was expected to begin sometime after January 2026, with its exact scope and timing left to be determined based on how Phase 1 went; some behavioral health services, particularly residential and opioid treatment, may still be carved out depending on where that rollout currently stands.

Carved in

Dental care is listed among the services covered by NJ FamilyCare's managed care plans. No single statewide dental administrator vendor was identified; dental appears to be handled as an in-plan benefit by each of the five managed care organizations rather than carved out to one dedicated vendor.

Pharmacy benefits are carved into each managed care plan rather than run through one statewide pharmacy benefit manager. Wellpoint's NJ FamilyCare pharmacy benefit, for example, is administered through CarelonRx. A 2021 industry-commissioned analysis evaluated carving pharmacy out of the managed care benefit package and estimated it would cost the state tens of millions of dollars annually; New Jersey has not adopted a carve-out, and pharmacy remains a plan-administered benefit.

Non-emergency medical transportation is covered as part of NJ FamilyCare and is administered through Modivcare, a national NEMT broker. CMS's own most recent managed care enrollment data reports Modivcare's NEMT figure at well over 1.5 million, a number that is almost certainly a count of trips or encounters rather than enrolled members, since New Jersey's total Medicaid population is nowhere near that size; it should not be read as a member count.

• Modivcare

Gainwell Technologies serves as NJ FamilyCare's fiscal agent, operating the NJMMIS provider portal (njmmis.com) that handles provider enrollment, claims processing, remittance advice, and the state's rate and fee schedule publications.

66 agency updates tracked for New Jersey. Available with Pro.