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NJ FamilyCare

Medicaid

Our NJ FamilyCare plan is for children, parent or caretaker relatives, and adults without dependent children. It’s also for people who need extra support and care to live safely at home. You qualify based on income and health care needs. View the benefits below to see all that our plan offers.

Available ang planong ito saan ka man nakatira sa New Jersey.

More information on eligibility and enrollment can be found on the NJ FamilyCare website.

  • NJ FamilyCare Steps to Enroll
  • Tingnan ang Eligibility (magbubukas ng modal window)

Mga Benepisyo at Feature

Pangangalaga Habang Walang Sakit at Kapag May Sakit

Get the care you need to be at your best — or to get better if you are injured or sick. Kasama rito:

  • Well Visits. Preventive checkups, shots and lab tests.
  • Therapy Services. Physical or other therapy to help you be your best.
  • Lab and X-rays. Lab tests, x-rays and diagnostic imaging are covered.
  • Shots and Vaccines. Routine shots to help keep you healthy.
  • Urgent Care. Immediate care for a sudden illness or injury.

Wala nang mas mahalaga pa sa kalusugan at kapakanan mo at ng iyong sanggol. Ito ang dahilan kung bakit kabilang sa aming mga benepisyo sa plano ang:

  • Choice of Doctor. Find an OB-GYN you trust in our network.
  • Prenatal Visits. Care for you before your baby is born.
  • Healthy First Steps®. Get extra support to help you and your baby stay healthy.
  • Choice of Birth Center. Pick from over 100 network hospitals across New Jersey.

Kung mayroon kang hika, diabetes o isa pang pangmatagalang kundisyon, maaasahan mo kami. Tinitiyak ng aming plano na nakukuha mo ang pangangalaga, suporta at mga serbisyong kailangan mo. Kabilang sa mga benepisyo ang:

  • Case Management. Personal support from an experienced professional.
  • Diabetic Supplies. Insulin, needles and more ordered by your doctor.

Make sure your sight, teeth, speech and hearing are at their best. Kabilang sa mga benepisyo ang:

  • Vision. Routine exams and help paying for eyeglasses and contact lenses.
  • Dental. We cover cleanings, checkups and dental work.
  • Hearing. Tests, check-ups and hearing aids are covered (some limitations apply).

Understanding Dental Coverage - Ingles Spanish

Get the medical care and equipment you need to recover safely at home. Benefits may include:

  • Equipment and Supplies. In-home medical and safety equipment are covered.
  • Nurse Visits. Medical care to help you safely recover at home.
  • Chore Services. Someone to do your errands, cleaning or laundry.
  • Personal Care. Someone to help with dressing, bathing and feeding if needed.

Kung minsan, maaaring kailanganin mo ng kaunting karagdagang tulong sa paggamit ng iyong planong pangkalusugan. Para sa mga pagkakataong iyon, maaari kang umasa sa:

  • Interpreters. An interpreter can go with you to medical visits.
  • Member Services. Your benefit questions are answered 24/7

The MLTSS program is focused on serving frail, elderly, and disabled individuals. This program combines traditional health care benefits (doctor visits, hospital stays, labs) and long term services and supports (providing help in home or community with daily living activities) such as:

  • Care Management. Someone to get you the care and support needed.
  • Home and Vehicle Modifications. In-home medical and safety equipment are covered, plus needed modifications to a vehicle.
  • Home Meal Delivery. If you can't safely make meals, we'll provide them.
  • Mental Health & Addiction Services. Counseling and other treatments are covered.
  • Personal Emergency Response System. Sends an urgent request for someone to help you.
  • Adult Day Care. Friendship and social activities in a safe setting.
  • Respite Care. In-home help to give your caregiver a rest.
  • Personal Care. Someone to help with dressing, bathing and dining.

Learn more about the MLTSS program here

Adult Day Care

Companionship is important. Adult day care provides care and companionship for seniors who need extra help during the day.

Caregivers also benefit, knowing their loved one is well cared for and safe during the day.

Services will vary by the member's coverage type and may include:

  • Social connections and friendship.
  • Bathing and personal care.
  • Meals.

Caregiver Training*

For MLTSS members: Caring for a loved one or a friend is an act of love and devotion. It can also leave the caregiver emotionally and physically exhausted.

Our workshops teach:

  • Caregiving basics.
  • Healthy eating and help with eating.
  • Health insurance basics.
  • How to care for yourself while caring for a loved one.
  • Caring for a loved one with dementia or Alzheimer's disease.

Along with instruction, caregivers have an opportunity to socialize with others and build a network of support.

Care Management*

Do you or a loved one have a serious health problem or a high-risk pregnancy? If so, our care managers are in your corner. They will:

  • Explain medical terms in plain language.
  • Coordinate your doctor appointments.
  • Provide your care team with your medical records.

Your care manager will stay close by throughout the medical journey. He or she will:

  • Think beyond your immediate medical needs.
  • Make sure you have support at home, so you can focus on getting better.

Pagpili ng Doktor

You or your child gets a primary care provider (PCP) who is your main doctor. Gamitin ang tool na Maghanap ng Doktor para makita kung nasa aming network ang iyong doktor.

If you don't have a doctor, or if your doctor is not in our network, we can help you find a new one close to you.

Ang iyong PCP ay ang iyong pangunahing doktor para sa:

  • Preventive care.
  • Paggagamot kung mayroon kang sakit o injury.
  • Mga referral sa mga espesyalista para sa ilang partikular na kondisyon.

Pagpili ng Birth Center

Mahalagang pumili ng ospital kung saan ka manganganak. That's why you can pick from 100 network hospitals across New Jersey.

We also encourage you to tour the hospital's birthing center. Nang sa gayon ay maging pamilyar ka rito. And you'll be more relaxed when you have your baby.

Community Transition Services*

For MLTSS members: We want to help you live in the place that is right for you. If needed, our plan will help cover the cost of moving from a nursing facility into your community.

Covered items can include:

  • Household goods.
  • Security deposit.
  • Utility deposit.
  • Your first week of food, as needed.

Chore Services

If you are having difficulty performing day-to-day household activities, chore services can step in. They can take on the routine tasks that may be hard for you to do on your own.

Services will vary by the member's coverage type and may include:

  • Pagsasagawa ng mga gawain.
  • Paglilinis ng bahay.
  • Doing laundry.
  • Paghahanda ng mga pagkain.

Pangangalaga sa Ngipin

Routine exams and cleanings every six months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, that's covered as well. If approved, the plan covers:

  • Crowns and bridges.
  • Dentures.
  • Oral surgery and root canals.

Understanding Dental Coverage - Ingles Spanish

Diabetic Supplies

If you have diabetes, you may need insulin, needles, wipes and glucose strips. If medically necessary, we cover all that and more.

Ang aming plano ay may kasama ring mahuhusay na serbisyo upang tulungan kang mapamahalaan ang iyong diabetes, kabilang ang:

  • Classes on keeping diabetes in control.
  • Pag-coordinate sa pangangalaga ng doktor.
  • Pagpaplano sa pagkain at pagpili ng mga pagkain.

Mga Kagamitan at Supply

Ang iyong kalusugan at kaligtasan sa tahanan ay mahalaga.

Sakop ng aming plano ang medikal na kagamitang ibinilin ng iyong doktor o case manager. Kabilang rito ang mga gamit tulad ng:

  • Mga kama sa ospital.
  • Mga oxygen tank.
  • Wheelchairs or wheelchairs.

Pangangalaga sa Pandinig

Ang problema sa pandinig ay maaaring makaapekto sa iyong pang-araw-araw na pamumuhay sa maraming paraan. Kabilang sa aming plano ang mga serbisyo at suporta para matulungang protektahan ang iyong pandinig.

Sinasalo namin ang:

  • Mga eksaminasyon, therapy, at test.
  • Mga hearing aid at baterya.

Some limitations apply.

Healthy First Steps®

The Healthy First Steps team is here for you. Tutulungan ka ng aming programang magawa ang mga tamang hakbang para mapanatiling malusog ang iyong sarili at ang iyong sanggol. 

Tutulungan ka namin:

  • Pumili ng provider sa pagbubuntis at isang pediatrician (doktor ng bata).
  • Mag-iskedyul ng mga pagpapatingin at pagsusulit at ayusin ang mga pagbiyahe papunta sa mga pagpapatingin mo.
  • Kumuha ng mga supply, kabilang ang mga breast pump para sa mga nagpapasusong ina.
  • Kumonekta sa mga mapagkukunan sa komunidad tulad ng mga serbisyo sa Women, Infants and Children (WIC).

Home Meal Delivery*

For MLTSS members: Taking care of the basics, like cooking, can be hard to do yourself after an illness or sickness. That's why we'll bring nutritious meals to you to help you through tough times. You can get up to 1 meal delivered per day, if needed.

Pagkakaospital

Our plan pays for all expenses related to a hospital stay, so you can rest and heal.

Sakop ng aming plano ang:

  • Pangangalaga ng isang nurse.
  • Kuwarto at matutuluyan.
  • Mga supply at kagamitan.
  • Paggagamot at mga therapy.
  • Mga diagnostic na test at eksaminasyon.

At pagkalabas mo sa ospital, hindi ka mag-iisa. Titiyakin naming makakakuha ka ng follow-up na pangangalaga para maipagpatuloy ang pagpapagaling sa tahanan.

Mga interpreter

Kailangan magkaunawaan kayo ng iyong doktor. Magiging mahirap ito kung hindi ka magaling magsalita ng Ingles. We can arrange for a medical interpreter to be at your appointment.

We also have people at our phone centers who speak more than one language. Sa malamang, mayroon kaming taong nagsasalita ng wika mo.

Lab and X-ray Services

Mainam na malaman nang maaga pa lang kung ano ang problema.

  • Mga laboratoryo at pagte-test.
  • Mga x-ray, scan at iba pang imaging.

Tutulungan ka naming makuha ang impormasyong kailangan mo upang mapabuti ang iyong kalusugan o maibalik ka sa pinakamalusog mong kundisyon.

Mga Gamot

Our plan includes medicines and refills for prescriptions written by your doctor or specialist. Thousands of drugs are covered.

We also cover some over-the-counter medicines with a written order from your doctor.

And we make getting your medicine easy. You can fill your prescriptions at:

  • Local pharmacies in our network.
  • Services that deliver right to your door.

Mga Serbisyo para sa Miyembro

Minsan kailangan mo ng tulong para maunawaan ang iyong mga opsyon sa pangangalagang pangkalusugan. With us, you have someone you can call 24/7. Sasagutin namin ang iyong mga tanong sa simple at kumpletong paraan.

Maaari ka rin naming tulungang humanap ng:

  • Mga doktor.
  • Mga parmasya.
  • Mga ospital o iba pang mga pasilidad na pangkalusugan.
  • Mga lokal na resource.

Mga Pagbisita ng Nurse

Sometimes you may need continued care after you leave the hospital or urgent care center. If your health is at risk after a serious illness, surgery or injury, a nurse will visit you at home to:

  • Provide medical care for you.
  • Answer your questions and concerns.

Personal na Pangangalaga

Minsan mahirap gawin nang mag-isa ang mga pangunahing kaalaman pagkatapos magkaroon ng sakit o injury.

Services will vary by the member's coverage type and may include:

  • Pagbibihis.
  • Pagligo.
  • Pagpapakain.

Mga Pagpapatingin Habang Nagbubuntis

A pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN.

Ang lahat ng iyong inirerekomendang pagpapatingin at pagpapasuri sa klinika habang nagbubuntis ay sinasaklaw.

Sa mga pagpapatinging ito, ang klinika ay:

  • Titiyaking malusog kayo ng iyong sanggol.
  • Ipapaliwanag kung ano ang dapat asahan sa bawat yugto ng iyong pagbubuntis.
  • Sasagutin ang iyong mga tanong.

Respite Care*

For MLTSS members: Mayroon ka bang mga kapamilya o kaibigan na nag-aalaga sa iyo sa tahanan? Kung mayroon, hinihiling naming suportahan sila sa kanilang pagsusumikap. Kaya kami nagbibigay ng pansamantalang pangangalaga para makapagpahinga ang iyong mga tagapag-alaga. Ang respite na pangangalaga ay nag-aalok sa mga tagapag-alaga ng pansamantalang bakasyon malayo sa kanilang mga mahal sa buhay na may karamdaman o mga espesyal na pangangailangan sa pangangalaga.

Mga Iniksyon at Bakuna

Routine shots help keep you healthy.

Sakop ng aming plano ang:

  • Mga inirerekomendang iniksyon at bakuna.
  • Mga diagnostic na test at eksaminasyon.

Mga Serbisyo sa Therapy

Makakatulong ang physical, occupational at speech therapy sa iyo na gumaling mula sa malubhang injury o sakit, o maabot ang buo mong potensyal.

Nagbibigay ang aming plano ng:

  • Occupational therapy.
  • Physical therapy.
  • Speech therapy.

Agarang Pangangalaga

Posibleng mayroon kang injury o biglaang sakit na hindi nakamamatay pero kailangan ng agarang atensyon.

Our plan covers care at:

  • Mga center ng agarang pangangalaga.
  • Mga unit ng medikal na tulong.
  • Iba pang walk-in na klinika.

Pangangalaga sa Paningin

You'll get the care, eyeglasses and treatment that let you see life more clearly.

Kasama sa saklaw ang:

  • Routine exams.
  • Help with paying for eyeglasses and contact lenses.

This benefit is offered by March Vision.

Mga Pagpapatingin Habang Walang Sakit

Makakatulong sa iyo ang mga pagpapatingin habang walang sakit sa iyong doktor na manatiling malusog. Maaaring matukoy kaagad ang mga problema sa kalusugan sa mga pagpapatinging ito para magamot ang mga ito.

Kabilang sa mga serbisyong pang-iwas sa sakit ang:

  • Mga checkup para sa mga adult at mga bata.
  • Pangangalaga sa sanggol nang walang sakit.
  • Pangangalaga para sa mga babaeng nagbubuntis.
  • Mga regular na iniksyon at pagte-test.
  • Mga mammogram.

Walang copayment para sa pangangalagang pang-iwas sa sakit.

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