If you are receiving General Assistance, you are still covered by NJ FamilyCare for your health care needs. But your coverage plan is now called NJ FamilyCare Plan G. And there have been some major changes in the way you get your health care services.

Inpatient Hospital Care

One of the ways that FamilyCare has changed is that since June 15, 2002, you must apply for Charity Care if you need inpatient hospital care. But you will not have to go through the longer process that is required for other Charity Care applicants. You will have to show only your NJ FamilyCare card when you apply for Charity Care at a hospital and your hospital bills will be covered by Charity Care.

Substance Abuse Services

Another change is that substance abuse services will be provided through the Substance Abuse Initiative (SAI). This program is administered through Work First New Jersey, and you apply at your local board of social services.

Medicaid “Fee-for-Service”

The biggest change in FamilyCare is that General Assistance beneficiaries are no longer in HMOs. Since July 1, 2002, this means that you do not have to go to a medical provider who is in an HMO’s network. But you must now find a Medicaid-participating doctor, dentist, or other medical provider who will bill Medicaid directly for the cost of your care. This is different from getting Medicaid through an HMO, and it is called Medicaid “fee-for-service.” Many of the doctors who are in the HMO networks do not accept Medicaid’s fee-for-service patients, so you will probably have to find a new medical provider. Almost all pharmacies accept Medicaid fee-for-service, so you will probably not have to change pharmacies to get your prescription medicines.

If you do not know of a Medicaid fee-for-service provider, your General Assistance caseworker at your local board of social services will help you find one. If you still need help finding a doctor or other Medicaid fee-for-service provider, you can call the Health Care Access Project through LSNJ-LAW™, Legal Services of New Jersey’s statewide, toll-free legal hotline, at 1-888-576-5529.

This article originally appeared in the November 2002 issue of Looking Out for Your Legal Rights^®.