NJ FamilyCare Coverage: Comprehensive Health Services Explained
NJ FamilyCare (New Jersey Medicaid/CHIP) Covered Services
NJ FamilyCare provides comprehensive coverage for eligible low-income residents. Benefits align with federal Medicaid/CHIP requirements plus state enhancements.
Covered Service Categories
| Category | Examples |
|---|---|
| Preventive Care | Well visits, immunizations (ACIP schedule), cancer screenings (mammo, Pap, colonoscopy), STI screening, developmental screening |
| Physician/Provider Visits | PCP, specialists (referral rules apply), FQHC/RHC, telehealth, urgent care, ER (emergent) |
| Hospital Services | Inpatient, outpatient, observation, ambulatory surgery, transplant (approved centers) |
| Surgery | Inpatient/outpatient, organ transplant, bariatric (criteria-based) |
| Diagnostics | Lab, X-ray, MRI, CT, PET, ultrasound, pathology, genetic testing (criteria) |
| Prescription Drugs | Formulary (PDL) – brand/generic; prior auth for non-preferred; $1–$3 copay (most) |
| Mental Health/SUD | Outpatient, IOP, PHP, residential, MAT (buprenorphine, methadone), crisis |
| Rehab/Habilitation | PT, OT, ST, cardiac/pulmonary rehab, DME, orthotics/prosthetics |
| Maternity/Newborn | Prenatal, delivery, postpartum (12 mo), newborn care, lactation, doula (pilot) |
| Dental (Children <21) | Comprehensive (EPSDT): preventive, restorative, ortho (medically necessary) |
| Vision (Children <21) | Exams, frames, lenses, contacts (EPSDT) |
| Transportation | Non-emergency medical (NEMT) to covered appointments |
| Long-Term Services | MLTSS (Managed Long Term Services & Supports) – HCBS, nursing home |