For providers

Together, we can improve health care quality

Covered services

The New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) administers the benefits for recipients of Medicaid and NJ FamilyCare A, B, C and D.

The covered services table in the member handbook show what services Aetna Better Health of New Jersey and Medicaid Fee-for-Service (FFS) covers. Members under NJ FamilyCare C or D may have to pay a copayment at during their visit. All services must be medically necessary and the provider may have to ask for prior approval before some services can be provided.

Services noted under “Medicaid FFS” are not the responsibility of Aetna Better Health of New Jersey. If a member requires these services, please have them call our Member Services Department so we can help them find a provider.

 

Overview of population served

To be eligible for New Jersey Medicaid, a person must:

• Be a resident of New Jersey be a U.S. Citizen or qualified alien (most immigrants who arrive after August 22, 1996 are barred from Medicaid for five years, but could be eligible for NJ FamilyCare and certain programs for pregnant women)
• Meet specific standards for financial income and resources

In addition, a person must fall into one of the following categories:

FamilyCare A:

• Uninsured children below the age of 19 with family incomes up to and including 133 percent of the federal poverty level
• Pregnant women up to 200 percent of the federal poverty level

FamlyCare B:

• Uninsured children below the age of 19 with family incomes above 133 percent and up to and including 150 percent of the federal poverty level.

FamilyCare C:

• Uninsured children below the age of 19 with family incomes above 150 percent and up to and including 200 percent of the federal poverty level.

FamilyCare D:

• Parents/caretakers with children below the age of 19 who do not qualify for AFDC – related Medicaid with family incomes up to and including 200 percent of the federal poverty level
• Parents/caretakers with children below the age of 23 years and children from the age of 10 through 22 years who are full time students who do not qualify for AFDC Medicaid and family incomes up to and including 250 percent of the federal poverty level who were transferred to the NJ FamilyCare program effective November 1, 2001
• Children below the age of 19 with family income between 201 percent and up to and including 350 percent of the federal poverty level.
• Adult and couples without dependent children under the age of 19 with family incomes up to and including 100 percent of the federal poverty level who applied as such for NJ FamilyCare benefits prior to September 1, 2001, and continuously have received those benefits

Adults and couples without dependent children under the age of 23 years, who do not qualify for AFDC Medicaid, with family incomes up to and including 250 percent of the federal poverty level who were transferred to the NJ FamilyCare program effective November 1, 2001.

 

Provider Advisory Committee

We invite our providers to join our provider advisory committee. Our committee meets quarterly. The committee consists of providers who serve Medicaid beneficiaries, other indigent populations, and members with special needs.

We value your input. Your recommendations may be used to improve quality management activities and policy and operations changes. If you are interested in joining the provider advisory committee, please contact provider relations at 1-855-232-3596.