SPAN

35 Halsey Street 4th Floor

Newark, NJ  07102

(973) 642-8100

(973) 642-8080 – Fax

E-Mail address:  span@spannj.org

Website:  www.spannj.org

 

 

Statewide Parent Advocacy Network, Inc.

Empowered Families: Educated, Engaged, Effective!

 

Did you know…

You may have a choice about picking an HMO under NJ Medicaid/FamilyCare!

 

First of all, some people can stay in “regular” (fee for service) Medicaid/FamilyCare and not have to pick an HMO (Health Maintenance Organization) under managed care.  BUT even though it’s voluntary, you still need to call (866) 472-5338 and ask for an “exemption form” to opt out.  You may even get a letter asking you to pick an HMO.  Please note that if you receive this letter but do not opt out, you will be auto-assigned which means automatically enrolled in an HMO, -and that HMO may not cover your child’s current doctors. 

 

People who do not have to pick an HMO:

 

-Anyone who has Medicare or gets SSI (Supplemental Security Income) due to disability

-If you have a serious illness and are currently receiving specialized treatment from a physician whose services are unique and not participating in any HMO

-pregnant women

 

If you decide to pick an HMO:

 

Check if your doctors are in the HMO.  Then call the HMO to make sure before you sign up.  It is important that you check on each doctor, not just their office or hospital location, because it’s possible the HMO covers only some providers at that location. 

 

For tips on choosing an HMO or exemptions:

 

The Arc of NJ www.arcnj.org/information/issues.html/title/medicaid-medicare-and-dual-eligibles

 

See also SPAN’s Medicaid Factsheets at www.spannj.org/familywrap/medicaid_fact_sheets.htm

as well as our health advocacy free teleconferences at www.spannj.org/resources/index.htm#Health                       

 

 

November 2010