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Healthcare Needs Provided for by NJ Medicaid
Healthcare Needs Provided for by NJ Medicaid
Mandatory services provided for all New Jersey Medicaid clients:
- Inpatient and outpatient hospital treatment
- Laboratory tests and X-rays
- Early and Periodic Screening, Diagnostic and Treatment
- services
- Home health care
- Physician services
- Nurse-midwife services
- Assistance with family planning and any necessary supplies
- Nursing facilities for people over 21
Optional Services provided to New Jersey Medicaid clients enrolled in specific programs:
- Treatment in residential treatment centers
- Optical appliances
- Dental care
- Optometry services
- Chiropractic services
- Psychologist
- Podiatrist
- Prosthetics and orthotics
- Drugs necessary during long term care
- Drugs at retail cost
- Durable medical equipment
- Hearing aid services
- Hospice care
- Transportation
- Personal care services
- Licensed practitioner services
- Private duty nursing
- Services in a clinic
- Physical, occupational and speech therapy
- Inpatient psychiatric care for individuals under 21 and over 65
- Intermediate care facilities for the mentally retarded
For additional information on these services,
call 1-800-356-1561.
Behavioral Health
When to See a Doctor
Feeling hopeless? Sad? Helpless? Caring for your mental or behavioral health is important and will help you stay healthy. WellCare of New Jersey has providers who can help you. Search for a provider right here on our website.
See your doctor if you have any of these symptoms or call our Nurse Advice Line at 1-800-919-8807 for the names and phone numbers of providers who can help:
- Always feeling sad
- Feeling hopeless and/or helpless
- Feelings of guilt or worthlessness
- Problems sleeping
- No appetite
- Weight loss or gain
- Loss of interest in the things you like
- Problems paying attention
- Being upset
- Your head, stomach or back hurts, and your doctor has not found a cause
- Drug or alcohol problems
As a reminder, you must get a prior authorization (PA) to see a provider who is not in our network. You will have to pay for the care if you do not.
24-Hour Behavioral Health Crisis Line
Our 24-Hour Behavioral Health Crisis Line is 1-888-453-2534 (TTY 1-877-247-6272). If you or a family member is having a behavioral health crisis, call this number. A trained person will listen to your problem. He or she will help you decide the best way to handle it.
Is this an emergency?
Do you think that you may be a danger to yourself or others? If so, call 911 or go to the nearest emergency room (ER). Do this even if you are not in our service area.
If you’re not sure if it’s an emergency, call your primary care provider (PCP). Or the 24-Hour Behavioral Health Crisis Line at 1-888-453-2534 (TTY 1-877-247-6272).
Need Support? Help Is Now Just a Click Away!
We’ve made it easier for you to get behavioral health care when you need it. Go to our online programs anytime and anywhere, and you progress at your own pace!
To get behavioral health support, you can access these programs:
- RESTORE – for sleep problems – 6 sessions
- SHADE – for alcohol or substance use – 10 sessions
- FEARFIGHTER – for anxiety, panic and phobia – 9 sessions
- MOODCALMER – for mild to moderate depression – 4 sessions
To enroll, go to https://wellcare.cobaltcbt.com/. Click on “Create Account Now”.
Important Things to Remember:
- You do not need to get a prior authorization (PA) for a behavioral health emergency.
- The doctor who gives you your ER care may think you need post-stabilization care to maintain, improve or resolve your medical condition (we cover this type of care without a PA).
- After you leave the hospital, you will need to see your PCP within 24 to 48 hours.
- The hospital where you get your ER care may be out of our service area and, if so, you will be taken to a network facility when you can travel again.
Are You Outside of the Member Area?
Call the number on your member ID card. Once you are stable, call your provider. They will make plans to move you to a facility that is in your network.
I am a trauma informed and person centered Licensed Social Worker. My goal is to provide a safe space for individuals to discuss their mental health concerns. I am passionate about working with adults who struggle with anxiety and depression related to a trauma, and who need help with coping in their daily lives. I enjoy thinking out of the box and learning from my clients when it comes to helping them reach their goals! My clients can always expect someone who is companionate, kind, and honest when they walk into the room each day. Healing is not easy, there will be obstacles, but my goal is to be alongside you along the journey.
Autism Benefits
Autism Spectrum Disorder (ASD) is a collection of neurodevelopmental disorders characterized by communication challenges, repetitive behaviors and limited social skills. ASD services are available to any NJ FamilyCare Medicaid child member, under the age of 21, who has been diagnosed with ASD, defined by ICD-10-CM diagnosis codes F84.0 through F84.9.
Services effective January 1, 2020 for the NJ FamilyCare EPSDT Autism benefit include: Physical Therapy, Occupational Therapy, Speech Therapy, Alternative Communication Assessment and Devices and Sensory Integration.
NEW Coverage of Applied Behavior Analysis (ABA) Therapy
Effective April 1, 2020, NJ FamilyCare Medicaid will reimburse Medicaid-enrolled Applied Behavior Analysis (ABA) therapy providers for Autism Spectrum Disorder (ASD) treatment services, including behavior identification assessments, supporting assessments, adaptive behavior treatment, individual and group, and family adaptive behavior treatment.
ASD is a collection of neurodevelopmental disorders characterized by communication challenges, repetitive behaviors and limited social skills. ASD services are available to any NJ FamilyCare Medicaid child member, under the age of 21, who has been diagnosed with ASD, defined by ICD-10-CM diagnosis codes F84.0 through F84.9.
For questions and concerns related to the Autism Benefit, please contact the Medicaid/NJ FamilyCare Autism Inquiry Helpline at (609)588-8522 or [email protected]
Resources
DMAHS Guide to Autism Services
DMAHS Guide to Autism Services – Chinese
DMAHS Guide to Autism Services – Hindi
DMAHS Guide to Autism Services – Portuguese
DMAHS Guide to Autism Services – Spanish
DMAHS Guide to Autism Services – Tagalog
Provider Newsletter for the Provision of Applied Behavior Analysis (ABA) Therapy Services 4-1-20
Autism SPA Presentation January 2019
Expanded Mental Health and Substance Use Disorder Benefits
The following changes apply to NJ FamilyCare members enrolled in Managed Long Term Services and Supports (MLTSS), Special Needs Plans (FIDE-SNPs), or clients of the Division of Developmental Disabilities (DDD)
When you see a therapist who is in-network with Medicaid, each session you’ll pay only a copay, which typically ranges from $0-$75/session. Depending on your plan, you may first need to pay the provider’s full session fee until you meet your annual deductible, which is the total amount of medical expenses required before your health insurance starts to cover costs. Some plans cover the cost of in-network therapy sessions before the deductible is met; to verify whether your specific plan covers therapy sessions and at what rate, visit the Medicaid website or call the number on the back of your insurance card and ask about your coverage for outpatient mental health.
1 In-Network Provider
If you have a PPO or POS insurance plan, you can likely receive some reimbursement when you see a provider out-of-network. Some providers also offer a sliding scale payment system; consider filtering by Session Fee to find providers who fit your budget.
FAQs about how to find a therapist in New Jersey
How do I find a therapist in New Jersey ?
Find a therapist near you in New Jersey on Zencare. Narrow your search by using filters like insurance, therapy budget specialty, and provider identity. Mental health professionals on Zencare are vetted for their extensive experience treating individual adults, children and adolescents, as well as couples and families. Explore each potential therapist profile to learn more about their specialties, and watch an introductory video to get a sense of their personality. Book a free initial call to find the right therapist for you!
Does insurance cover therapy in New Jersey ?
Yes, most New Jersey health insurance carriers provide mental health benefits that cover therapy. However, the exact amount of coverage will vary based on the plan details and whether the selected provider is in-network or out-of-network with your insurance. If the therapist is in-network with your insurance, you’ll pay only a copay at each session after meeting your annual deductible. If the therapist is out-of-network with your insurance, you may still be able to receive reimbursement after paying the fee at the time of therapy session. If you have a PPO or POS insurance plan, you can likely receive some reimbursement when you see a therapist out-of-network in New Jersey . If you have an HMO, EPO, or Medicaid/Medicare plan, you likely cannot receive reimbursement, and would be responsible for the full out-of-network session fee. Note that services designed to treat topics which are not diagnosed mental health conditions, such as couples counseling and life coaching, are not typically covered by health insurance. The potential mental health provider must also be a licensed therapist in your state for the insurance company to cover services.
How do I find an affordable therapist in New Jersey ?
Many therapists offer a sliding scale, or a range of session fees based on financial need to clients who would not otherwise be able to afford typical therapy rates in New Jersey . If you are struggling to pay for therapy, consider asking for a sliding scale, looking for an in-network therapist , or seeking services through a local agency, college counseling center, or hospital.
How can I make an appointment with a therapist in New Jersey ?
Start your search for an appointment with a therapist in New Jersey on Zencare. Many mental health professionals located in New Jersey require clients to have an introductory call before booking a full appointment online. In this free call, the prospective therapist will ask about your goals for treatment, and make sure that their skills, specialized training, and scope of private practice are a match for your mental health issues. At the same time, you should assess if you feel comfortable talking with the therapist , as studies show that the most important determinant of successful therapy is the relationship between therapist and client. After an initial call, you’ll typically be given the option to book an appointment with the therapist , or continue your search if it’s not a good fit. At the initial session, you’ll likely discuss the therapeutic process and determine goals for your personal growth. Common therapy goals include learning effective coping strategies to deal with negative feelings, increasing self-awareness, and gaining a deeper understanding and insight into relationship patterns.
How can I find a therapist in New Jersey who sees clients after hours?
Find a therapist who sees clients after hours on Zencare. Many therapists in New Jersey offer appointments outside of traditional business hours. Simply filter by Office Hours under More Filters to choose the time of day that works best for you, whether that be early morning before work, in the evenings, or even over the weekend. After hours sessions are a good option for busy individuals, couples, and families dealing with hectic schedules and who need a flexible option for their mental health care.
How do I find a therapist in New Jersey who offers in-person sessions?
Find a therapist who offers in-person sessions on Zencare. Many therapists in New Jersey have resumed offering in-person sessions; you can filter by “In-Person” to find a provider who is accepting new clients for in-office sessions. You can also search by map to find providers in New Jersey near you. While some clients prefer in-person sessions because they offer a safe, neutral ground for the session to take place, for the widest range of therapist options, consider expanding your search to also include providers licensed in your state who offer telehealth, or therapy sessions via remote video call.
How do I find a therapist in New Jersey who offers online sessions?
Find a therapist who offers online sessions on Zencare. Most therapists in New Jersey continue to offer appointments online; you can filter by “Online” to find a provider who is accepting new clients for teletherapy sessions. In order to see a therapist , they must be licensed to provide online sessions to clients living in your state. Online therapy is different from text therapy, or asynchronous therapy; online therapy offers the same consistent relationship with a local New Jersey therapist that an in-person session would, with sessions taking place via phone or a video sessions through a secure teletherapy platform. Online therapy sessions are a convenient way to find a therapist near New Jersey without leaving the comfort of your home or office.
Where can I get mental health therapy in New Jersey ?
Start your search for mental health therapy in New Jersey on Zencare. All therapists are quality-vetted for excellence in clinical care. When you’re struggling with your mental health, it might be time to seek professional support in the form of counseling services, couples therapy, or psychiatric medication management. There are a wide range of private practice therapists to choose from in New Jersey ; consider narrowing your search by criteria like insurance carrier, therapy budget, specialty, or provider identity to find a great fit!
How can I start therapy in New Jersey ?
Start your search for a great therapist in New Jersey on Zencare. First, consider any logistic limitations, like how far you are willing to travel outside of New Jersey or if you are open to online sessions with a local provider. Also consider how much your therapy budget is, and when you are available for therapy. Then, make a list of priorities for your ideal therapist : do they match your identity, or have expertise in a specific area like anxiety or depression? There is no one reason to start therapy; many individuals in New Jersey go see a therapist when they need help to move forward through a difficult time, cope with symptoms of a mental illness such as a mood disorder, navigate life transitions, process relationship difficulties or improve their behavioral health. Use your priorities to filter on Zencare by insurance, speciality, and availability. Look through a few provider profiles to find the therapist you might click with, watch their introductory videos, and book a free call to find a great personal fit!
What kinds of mental health providers are available in New Jersey ?
There are many different kinds of mental health providers available in New Jersey , including psychologists, clinical social workers, and mental health counselors. As long as the provider is licensed in your state, the factor that matters most to therapy outcomes is the therapeutic alliance, or the relationship you build with your therapist. Common types of therapy provided in New Jersey include cognitive therapies, like Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), and insight-oriented therapies like psychodynamic therapy. Other providers offer a blend of techniques for a more interpersonal, holistic approach. Some mental health therapists in New Jersey also offer specialized treatment services, like couples therapy, premarital counseling, and family therapy. While most New Jersey providers are qualified to treat general challenges, like depression, anxiety disorders, trauma, relationship difficulties, and low self-esteem, for concerns such as substance abuse, personality disorders, and eating disorders, consider seeking expert care. Together with your therapist , you’ll build a treatment plan that addresses your reasons for seeking therapy and monitor progress toward your wellness goals and overall well being.
How does paying for therapy work in New Jersey ?
There are several options for paying for therapy in New Jersey . For many people, the most affordable way to seek mental health services is to look for a provider who is in-network with your insurance. Due to high demand and low availability, in-network providers often have long waitlists; to widen your options and start therapy sooner, you might also consider looking for an out-of-network provider. When you see an out-of-network therapist in New Jersey , you can ask for a sliding scale if you are unable to afford their typical session fees, or seek reimbursement from your insurance company if you have a PPO or POS plan. For clients who have an insurance plan with a high deductible and low medical costs, therapy costs are often comparable when you see a therapist in- or out-of-network. While paying for therapy can be a substantial investment, it’s also a great way to improve relationships, boost self-esteem, address symptoms of mental illness, and ultimately live a happier, more self-directed life.
