MedicaidCoverageHigh impact
Newsletter Vol. 8, No. 07
New Jersey Medicaid·NJ · Pediatrics, General Practice·Provider Notice
Effective date
Feb 1, 1998
We identified it
Jun 20, 2026
Summary
New Jersey implements Plan A of the NJ KidCare program effective February 1, 1998, expanding Medicaid eligibility for uninsured children under 19 with family income at or below 133% of federal poverty level. Eligible children will receive comprehensive managed care benefits through participating HMOs (same as New Jersey Care 2000) with no copayments, plus fee-for-service coverage for certain specialty services like mental health and nursing facility care. Billing teams must recognize dual identification cards (State Eligibility ID + HMO ID) and route claims appropriately between HMOs and UNISYS (fiscal agent for FFS services).
Action Required
By February 1, 1998: (1) Billing team must update systems to recognize NJ KidCare Plan A eligibility and process claims through participating HMOs listed in policy attachment; (2) Configure billing software to route mental health, substance abuse, nursing facility, ICF/MR, and other fee-for-service benefits to UNISYS instead of HMOs; (3) Update claim submission procedures to verify beneficiary presents both State Eligibility ID and HMO ID before processing; (4) Remove copayment requirements from Plan A claims (zero copay for all covered services); (5) Train billing staff on covered services list and which services route to HMO vs. FFS (UNISYS); (6) Add note to system that organ transplant inpatient hospital costs route to FFS, not HMO; (7) Ensure staff understand 60-day annual limit on per-therapy rehabilitative services under HMO plan. Contact State for questions at 1-800-356-1561. Failure to properly route and process claims will result in denials and payment delays.