New Jersey Medicaid Waiver Guide

Understanding New Jersey Medicaid

n 2014, New Jersey transitioned its waivers to a single, comprehensive Medicaid waiver that is an 1115 demonstration program. Children who meet a nursing home level of care can qualify for the Medicaid Managed Long Term Services and Supports (MLTSS) program, which is based only on the child’s income. General Information on New Jersey’s FamilyCare Comprehensive Waiver can be found on the Office of Home and Community Services page.

Some limited home and community based services for children with behavioral or developmental disabilities are provided as part of the Comprehensive Waiver through PerformCare or New Jersey Children’s System of Care, including in-home care, ABA, and respite. Through the Children’s Support Services Program, children receive services through three tiers. Low income children receiving Medicaid receive additional targeted HCBS services. Middle income children (up to 300%) receive both Medicaid state plan services and targeted HCBS services. Families over the income level only receive targeted HCBS services.

Types of Waivers

New Jersey FamilyCare Comprehensive Waiver

• Description from medicaid.gov: New Jersey’s new section 1115 demonstration entitled New Jersey Comprehensive Waiver (NJCW) is a statewide health reform effort that will expand existing managed care programs to include long term services and supports and expand home and community based services to some populations. This Demonstration builds upon existing managed acute and primary care programs and established provider networks. The 1115 Demonstration also combines under a single demonstration authority several existing Medicaid and CHIP waiver and demonstration programs, including two 1915(b) managed care waiver programs; a title XIX Medicaid and a title XXI CHIP section 1115 demonstrations and four 1915(c) programs.
• Online State Information: Comprehensive Medicaid Waiver or Medicaid Managed Long Term Services and Supports (MLTSS) program or PerformCare or New Jersey Children’s System of Care
• Official Federal Information
• How to Apply: For children who need nursing care, call Division of Disabilities Services (DDS) at 1-888-285-3036 to speak with an Information and Referral Specialist. For children with developmental, intellectual, or behavioral disabilities, see PerformCare or New Jersey Children’s System of Care.

Other online resources for New Jersey:

• Statewide Parent Advocacy Network (SPAN) is a non-profit organization advocating for individuals and families with neuro-differences.
• Autism New Jersey is an organization for families, professionals, and the general public providing information about autism and NJ specific resources.

Telephone Resources

• NJ medical assistance helpline – 800-356-1561
• NJ Family Cares number – 800-701-0710

Ordering Goally with a Medicaid Waiver

Talk with your case manager to see if the waiver program you have will cover Goally. If so, have your case manager email us at: [email protected] to place an order on your behalf.