If you have Medicare and Medicaid and use a Medicare doctor for primary care services, you can continue to see your Medicare doctor. That doctor does not have to be in the Horizon NJ Health network.
If you do not have Medicare and know who you want to have as your Primary Care Provider, call Member Services at 1-844-444-4410 (TTY: 1-844-889-7700) so they can make the change. You will then get a new Horizon NJ Health member ID card in the mail with your new PCP’s name and phone number.
If you need to find a provider, you can search our online Provider Directory or call the MLTSS Member Services number: 1-844-444-4410 (TTY: 1-844-889-7700).
Horizon NJ Health needs proof that you want this person to represent you. We need a Personal Representative Form on file. You should have gotten a Personal Representative Form in your MLTSS Welcome Packet. If you do not have the form, call MLTSS Member Services at 1-844-444-4410 (TTY: 1-844-889-7700). Complete and sign the form and fax it to 1-609-583-3017 or mail it to Horizon NJ Health, 210 Silvia Street, West Trenton, NJ 08628.
If you have not yet met your Horizon NJ Health Care Manager, they will be in touch with you shortly. Each MLTSS member gets a Care Manager, who is your main contact for the MLTSS program.
After talking to you, your Care Manager will review care options and available services, then meet with you and your providers to tailor a flexible Care Plan that can change as your needs do.
As part of your Care Plan, you will get your Care Manager’s phone number – you can call with issues or worries. Your Care Manager will also call you on a regular basis to check how you are feeling and find out if anything has changed.
You, your Care Manager and your Care Management team (including providers and caregivers) will develop your plan of care to make sure you get what you need. Once your Care Plan is created, it will go into effect within 30 days.
Sometimes, Horizon NJ Health may need to review your request before you get a service. We may ask your primary care provider for an order or referral. This is to make sure you get the right care at the right place when you need it.
The Care Plan will be reviewed every 90 days. The Care Management team can change your Care Plan at any time after review or after any change in your condition.
If you are currently a Horizon NJ Health member and you would like to find out if you’re eligible for the MLTSS program, call our Member Services department at 1-844-444-4410 (TTY: 1-844-889-7700).
One of our representatives will walk you through an eligibility survey. The survey will find out if you meet certain clinical and financial guidelines. If so, you will be contacted by someone in our Care Management department for a full review. The Office of Community Choice Options (OCCO) makes the final decision about clinical eligibility for the MLTSS program.
If you are not currently a Horizon NJ Health member, you may contact the health plan/Managed Care Organization (MCO) plan in which you are enrolled. You can also start the enrollment process by:
Contacting the Aging and Disability Resource Connection (ADRC), also called the Area Agency on Aging. They will help you to start the enrollment process.
Your PCP will make the decision to send you to a participating specialist. You must have a referral to see a participating specialist. An eye doctor (for a medical problem such as cataracts or an eye infection) or a heart specialist are types of doctors you need a referral to see. Your PCP will give you a paper referral form or a prescription with the specialist’s name and phone number.
You do not need a referral for:
Routine gynecological care
Family planning services
Routine obstetrical care
Routine eye examinations by an optometrist or eye doctor
Behavioral health care for DDD members
Services at a Federally Qualified Health Center
Emergency room visits
Medicare-covered services for members enrolled in Medicare
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