To Report Medicaid fraud or abuse in New Jersey:
Call 1800-937-2835 or visit : http://www.omig.state.nj.us/
Medicaid is the Federal/State Health Assistance Program that pays medical bills to eligible needy persons. Medicaid benefits are generally provided to eligible persons through Health Maintenance Organizations (HMOs). Medicaid also pays for nursing care facilities for eligible individuals.
Expenses Covered Under Medicaid Programs
- Physician services
- Dental and Optometry services
- Hospital in-patient care
- Hearing aids
- X-ray and laboratory services
- Medical transportation
- Nursing facility care
Residents of Gloucester County can file an application for Medicaid at our office.
Applications can be taken at home, in a hospital or in a nursing facility for those unable to travel to the office.
The State of New Jersey has numerous medical assistance programs that are available to eligible residents. Below is a summary of each of these programs.
Medical Assistance Programs Available
THE AIDS COMMUNITY CARE ALTERNATIVES PROGRAM (ACCAP) - this program offers many home and community-based services to individuals with Acquired Immune Deficiency Syndrome (AIDS) or with AIDS - related complex. Some of the services that may be provided include: home health care, homemaker services, medical transportation and respite care.
ASSISTED LIVING - program for eligible aged, blind and disabled individuals as an alternative to placement in a nursing facility.
BREAST & CERVICAL CANCER PROGRAM - provides full Medicaid benefits to uninsured women under age 65 who have been diagnosed with breast and/or cervical cancer. These women must be screened by the New Jersey Cancer Education & Early Detection Program.
CAREGIVER ASSISTANCE PROGRAM - provides in home services to disabled or senior citizens who are at risk of placement in a nursing facility. This program is designed to supplement an individual's normal support network.
DISABLED ADULT CHILDREN - Medicaid may be available for those who:
- Are at least 18 years old;
- Were determined disabled or blind prior to reaching the age of 22;
- Have been receiving Supplemental Security Income (SSI) on the basis of blindness or disability;
- Have lost SSI as a result of the receipt of child's insurance benefits under Social Security or an increase in those benefits on or after July 1, 1987 .
DISABLED WIDOW(ER) S - program for surviving spouses who lose their Supplemental Security Income as the result of the receipt of Title II benefits.
HOME AND COMMUNITY CARE BASED SERVICE PROGRAMS FOR BLIND OR DISABLED CHILDREN AND ADULTS (MODEL WAIVER) - is similar to the Community Care Program for the Elderly & Disabled. It provides many medical services to help qualified disabled individuals and children stay in their homes.
HOSPICE - program for the terminally ill whose life expectancy is 6 months or less.
INSTITUTIONAL MEDICAID - provides payment of institutional benefits, such as nursing facility care, for eligible New Jersey residents.
MEDICAID - provides medical assistance to TANF and GA eligible persons through a mandatory managed healthcare system. A variety of HMO's provide managed care to recipients.
MEDICAID ONLY - offers medical assistance to income/resource eligible aged, blind or disabled individuals or couples, based on living arrangements in the community, or to an individual in need of Title XIX facility (such as a hospital for acute care) for 30 consecutive days.
MEDICAID SPECIAL PROGRAM - provides Medicaid coverage to families, dependent or independent child under age 21, and pregnant women on behalf of an unborn child who meet certain guidelines.
MEDICAL ASSISTANCE PROGRAM - provides Medicaid benefits to Work First NJ recipients.
MEDICAL EMERGENCY PAYMENT PROGRAM FOR ALIENS - may provide payment for emergency services to persons who are not eligible for Medicaid or NJ Kid Care-Plan A because of citizenship/alien requirements for these programs has not been met. Eligible applicants must be 65 years of age or older, blind or permanently disabled, pregnant, under age 21 or a caretaker relative of children under 18 years of age and meet income guidelines.
MEDICAL EMERGENCY PRENATAL CARE FOR SPECIFIC PREGNANT ALIEN WOMAN - provides emergency prenatal care for a pregnant alien who is a resident of New Jersey but is not considered an eligible alien under INF regulations.
MEDICALLY NEEDY PROGRAM - offers specialized Medicaid coverage with limitations to certain groups of medically needy persons. These groups include pregnant women, dependent children under 21 years of age, persons 65 of age and older & persons who are blind or disabled . Each individual group has a specific group of covered medical services.
NEW JERSEY CARE PROGRAM - SPECIAL MEDICAID PROGRAM - provides complete Medicaid coverage to eligible pregnant women during their pregnancy and for 60 days following the date on which the pregnancy ends. Coverage is also provided to eligible infants, up to age 1, persons 65 or older, and blind or disabled persons .
NEW JERSEY KIDCARE - provides affordable health insurance coverage, through managed care (HMO), to income eligible children, from age 1 and up to age 19, in order to help meet certain health care needs.
NEW JERSEY KIDCARE PRESUMPTIVE ELIGIBILITY PROGRAM - provides children who appear to be eligible for the NJ Kid Care Program access to medical care while awaiting a full determination of eligibility for NJ Kid Care benefits.
NEW JERSEY SUPPLEMENTARY PRENATAL CARE PROGRAM - provides prenatal care services to eligible legally admitted immigrant women who entered the United States as permanent residents on or after August 22, 1996 and are ineligible for Medicaid due to a restriction in the Personal Responsibility and Work Opportunity Act of 1996.
NEW JERSEY WORKABILITY - Medicaid buy-in program for permanently disabled individuals between ages 16 and 65 who are employed and receiving Social Security Disability or Railroad Retirement benefits.
PICKLE AMENDMENT - Medicaid may be available under this program for individuals who have become financially ineligible for continued Medicaid coverage under the Supplemental Security Income (SSI) Program due to their receipt of Social Security cost of living increases.
PRESUMPTIVE ELIGIBILITY - offers prenatal care to eligible pregnant women prior to application for Medicaid benefits and while an application is being processed. The qualified Healthstart provider completes the application for Presumptive Eligibility.
QUALIFIED MEDICARE BENEFICIARY (QMB) PROGRAM - provides eligible recipients with payment of Medicare Part B medical insurance premiums and deductibles. QMB clients are automatically eligible for the New Jersey Care. . . Special Medicaid Program
TRAUMATIC BRAIN INJURY PROGRAM - provides home and community based services to eligible persons disabled by a traumatic brain injury. Eligible applicants must be 18 to 65 years of age and meet certain medical requirements regarding brain injuries.
MEDICAL TRANSPORTATION - The Medical Transportation unit of GCBSS, in conjunction with the Gloucester County Division of Transportation, arranges transportation for Medicaid recipients to and from medical appointments. Call 856-256-2281 for further information.
RETROACTIVE MEDICAID - Medicaid Only applicants may be eligible for help in paying medical bills incurred up to three months before their application for assistance. Caseworkers will have more details.
CHARITY CARE - Charity Care offers payment assistance for hospital care for New Jersey residents who are ineligible for health care coverage through private or governmental programs. Eligibility is based on income and asset limits.
NJ PROTECTS - A non income based health insurance program that covers individuals who have preexisting conditions and have been without health bennefits for 6 months. There is a monthly premium based on income. If interested please click on the following website: http://www.state.nj.us/dobi/division_insurance/njprotect/index.htm
Charity Care applications are available through hospitals and some health care provider agencies. GCBSS does not take Charity Care Applications