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NJ FamilyCare Managed Long Term Services and Supports (MLTSS)

Managed Long Term Services and Supports (MLTSS) programs are focused on serving frail, elderly, and disabled individuals. It is important to understand that the program combines traditional health care benefits (doctor visits, hospital stays, labs) and long term services and support (providing help in home or community with daily living activities).

For more information on MLTSS, visit the State of New Jersey's MLTSS page.

This plan is available in the following counties: This plan is available statewide.

NJ FamilyCare is a comprehensive health insurance program that provides a wide range of services. In addition to NJ FamilyCare Services (NJFC), MLTSS members will also receive the following benefits:

  • Care Management
  • Home and Vehicle Modifications
  • Home Delivered Meals
  • Personal Emergency Response Systems
  • Mental Health and Addiction Services
  • Assisted Living
  • Community Residential Services
  • Nursing Home Care

If you would like a copy of the member handbook or provider directory, please call Member Services at 1-800-941-4647 (TTY: 711).

Who is Eligible?

Members who have been assessed for long-term services and supports and have met both financial and clinical eligibility requirements established by the State for MLTSS to receive care management and supportive services are eligible.

The purpose of MLTSS is to enable individuals who are at the nursing home level of care to receive person-centered services in the least restrictive and most integrated setting.

The link below takes you to another website. Once there, select "NJ UnitedHealthcare Community Plan" to access a list of in-network dentists.

If you would like a copy of the member handbook or provider directory, please call Member Services at 1-800-941-4647 (TTY: 711).

Search for a dental provider for MLTSS

New Jersey Smiles Program

New Jersey Smiles Directory (June 2013)

Choose a county:
Atlantic
Bergen
Burlington
Camden
Cape May
Cumberland
Essex
Gloucester
Hudson
Hunterdon
Mercer
Middlesex
Monmouth
Morris
Ocean
Passaic
Salem
Somerset
Sussex
Union
Warren

Pharmacy Lookup Tool

Please call MLTSS at 1-800-645-9409, TTY: 711 and speak to Care Management.

Please see the state of NJ's FAQ

Co-Payments The amounts of money you pay directly to the provider for the service you receive. Certain NJ FamilyCare beneficiaries are required to pay a co-payment.

NJ FamilyCare-A state health insurance program for people with low income who meet certain eligibility requirements. Programs can vary from state to state.

Medicaid/MLTSS Managed Long Term Services and Supports (MLTSS) programs are focused on serving frail, elderly and disabled individuals. It is important to understand the program combines traditional health care benefits (doctor visits, hospital stays, labs) and long-term services and support (providing help in home or community with daily living activities).

Medicare A federal health insurance program for people who are 65 or older, disabled persons or those with end-stage renal disease. Medicare eligibility is not based on income, and basic coverage is the same in each state.

SSI Supplemental Security Income

healthfinder®
Since 1997, healthfinder® has been recognized as a key resource for finding the best government and nonprofit health and human services information on the Internet. healthfinder® links to carefully selected information and Web sites from over 1,700 health-related organizations.

www.state.nj.us/humanservices
This link will take you to the Department of Human Services for the state of New Jersey.

www.state.nj.us
This link will take you to New Jersey's official state home page.

www.cms.hhs.gov
This will link you to other State Children's Health Insurance Programs (SCHIP)

www.njhelps.org
The NJ Helps DHS Services Home Page is designed to give consumers a one-stop shopping resource for the wide range of programs and services provided by the Department of Human Services and its partners, to assist individuals, families and communities in New Jersey.

www.njfamilycare.org

This will link you to the NJFamilyCare website.

www.nj.gov/nj/community/senior
This will link you to the Aging & Disability Resource Connection (ADRC). The New Jersey Division of Aging and Community Services (DACS) administers programs designed to make it easier for seniors to get the help they need to support their well-being and maintain themselves in the community for as long as possible with independence, dignity and choice.

www.state.nj.us/njparentlink
This will link you to The Early Childhood Parenting and Professional Resource Center. The goal of the website is to improve the accessibility, coordination and delivery of information and services to parents of young children, and to improve communication capabilities for ongoing service collaborations and policy development.

Member Handbooks
Member Handbook (English)
Member Handbook (Español)

News Bulletins
National Flu Campaign Questions and Answers: English  | Español

Notice of Privacy Practices
We have a Notice of Privacy Practices that tells you how health information about you may be used and shared. We are required by law to let you know that the Notice is available, and how you can get a copy of it. You can download a copy of our Notice of Privacy Practices below.
NOTICE OF PRIVACY PRACTICES
AVISOS DE PRÁCTICAS DE PRIVACIDAD DEL PLAN DE SALUD

Member Rights
As a member of UnitedHealthcare, you have certain rights concerning health care. Click here for more information in English or Español.

Seasonal Flu Facts
Questions and answers regarding the seasonal flu vaccine.
Click here, for more information.

Quick Facts About H1N1
We want to help you understand some important facts about the novel H1N1 Flu so you can help protect you and your family. Click here for more information.

Social Security Number Privacy
Protecting personal information is important to UnitedHealth Group companies, so we protect the confidentiality of Social Security numbers that we receive. Read Bulletin Details Click here for more information.

Take Charge of Your Health: Get a Flu Shot
Flu season is here. The flu can be very serious. Getting a flu vaccine is your best protection against the flu. The best time to get your flu shot is October through December. You should talk to your doctor about having a flu shot. Or you can call our Customer Service Center.

Third Party Liability
A guide to understanding health coverage in New Jersey if you have Medicaid and Medicare and/or other health insurance.
Click here for more information.

Protect Your Children from Lead Poisoning
Lead poisoning can cause serious health problems. You can't see it or smell it. Here's what you need to know to keep your kids out of danger. Click here for more information.

Citizenship Documents Required
There are new laws that may require you to show proof of citizenship in order to renew your health coverage. Click on a document below to read about what you will need:

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Spanish
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Arabic
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NCQA LTSS Distinction Seal

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NJ FamilyCare

Disclaimer information
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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call 1-800-905-8671 TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Nurseline disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your doctor's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) information, please contact our Member Services at 1-844-445-8328 (TTY 711) from 7 a.m. to 8 p.m. Monday through Friday (voice mail available 24 hours a day/7 days a week) for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio (plan Medicare-Medicaid), comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al 1-844-445-8328 (TTY 711) de lunes a viernes de 7 a.m. a 8 p.m. (correo de voz disponible las 24 horas del día, los 7 días de la semana).

UnitedHealthcare Connected® (Medicare-Medicaid Plan)

UnitedHealthcare Connected® (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan) es un plan de salud que tiene un contrato tanto con Medicare como con el programa MassHealth (Medicaid) para proporcionar los beneficios de ambos programas a sus miembros.

ATTENTION: If you speak an alternative language, language assistance services, free of charge, are available to you. Call the Member Engagement Center 1-866-633-4454, TTY 711, 8 am - 8 pm, local time, 7 days a week. The call is free.

ATENCIÓN: Si habla español, tiene a su disposición servicios de asistencia gratuitos en su idioma. Llame al Centro de participación de miembros/a Servicio al Cliente al 1-866-633-4454, TTY 711, de 8 am a 8 pm, hora local, los 7 días de la semana. La llamada es gratuita.

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele Sant Angajman Manm/Sèvis Manm nan 1-866-633-4454, TTY 711, 8 am - 8 pm, lè lokal, 7 jou sou sèt. Apèl la gratis.

[សម្គាល់៖ ប្រសិនបើលោកអ្នកនិយាយភាសាខ្មែរ លោកអ្នកអាចរកបានសេវាកម្មជំនួយផ្នែកភាសាដោយឥតគិតថ្លៃបាន។ ទូរសព្ទទៅ​មជ្ឈមណ្ឌល​ចូលរួម​ជាមួយ​សមាជិក/សេវាកម្ម​សមាជិក  1-866-633-4454, TTY 711, 8 ព្រឹក - 8 យប់ ម៉ោងក្នុងមូលដ្ឋាន 7 ថ្ងៃ​ក្នុង​មួយ​សប្ដាហ៍។ ការហៅទូរស័ព្ទគឺឥតគិតថ្ល។

[ເຊີນຊາບ: ຖ້າທ່ານເວົ້າ ພາສາລາວ, ພວກເຮົາມີບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາໂດຍບໍ່ຕ້ອງເສຍຄ່າໃດໆໃຫ້ແກ່ທ່ານ. ໂທ​ຫາ​ສູນ​ຕິດ​ຕໍ່​ພົວ​ພັນ​ສະ​ມາ​ຊິກ/ຝ່າຍ​ບໍ​ລິ​ການ​ສະ​ມາ​ຊິກ 1-866-633-4454, TTY 711, 8 ໂມງ​ເຊົ້າ - 8 ໂມງ​ແລງ, ຕາມ​ເວ​ລາ​ທ້ອງ​ຖິ່ນ, 7 ວັນ​ຕໍ່​ອາ​ທິດ. ການ​ໂທ​ແມ່ນ​ບໍ່​ເສຍ​ຄ່າ.

ATENÇÃO: Se fala português, é-lhe disponibilizado um serviço gratuito de assistência linguística. Telefone para o Centro de Conexão dos Associados/Serviços de Atendimento a Associados 1-866-633-4454, TTY 711, 8h00 - 20h00, hora local, 7 dias por semana. A chamada é gratuita.

ВНИМАНИЕ! Если Вы говорите по-русски, можете бесплатно воспользоваться помощью переводчика. Звоните в центр взаимодействия с участниками/отдел обслуживания участников по номеру телефона 1-866-633-4454, TTY 711, 8:00 - 20:00 по местному времени, без праздничных и выходных. Звонок бесплатный.

LƯU Ý: Nếu quý vị nói tiếng Việt, chúng tôi có dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho quý vị. Xin gọi cho Trung tâm Tham gia Hội viên/Dịch vụ Hội viên 1-866-633-4454, TTY 711, 8 am - 8 pm, giờ địa phương, 7 ngày trong tuần. Cuộc gọi này là miễn phí.

[注意：如果您说中文，您可以获得免费语言帮助服务。致电会员服务中心/会员服务 <1-866-633-4454>，听障专线（TTY）711，当地时间<上午 8 点 - 晚上 8 点>，每周 <7> 天。该通话是免费的。

UnitedHealthcare Connected benefit disclaimer 

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits and/or copayments may change on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call 1-866-441-0395, TTY 711, 8 am - 8 pm., local time, Monday - Friday (voicemail available 24 hours a day/7 days a week). The call is free. You can call Member Engagement Center and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers. 

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al 1-877-542-9236, TTY 711, de 8am. a 8pm, hora local, de lunes a viernes (correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro. Los servicios Language Line están disponibles para todos los proveedores dentro de la red.

Potential for contract termination

How to end your membership in our plan

As long as you are still eligible for Medicare and MassHealth, you can leave UnitedHealthcare Connected for One Care without losing your Medicare and MassHealth benefits. If you are over age 65 and you decide to leave One Care, you will not be able to enroll in a One Care plan later. If you think you want to end your membership in our plan, there are a few ways you can get more information about what will happen, and how you can still get Medicare and MassHealth services.

  • Call MassHealth Customer Service at 1-800-841-2900, Monday – Friday, 8 am – 5 pm, TTY users (people who are deaf, hard of hearing, or speech disabled) may call 1-800-497-4648. 
  • Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users (people who have difficulty hearing or speaking) may call 1-877-486-2048. 
  • Contact a SHINE counselor at 1-800-243-4636. TTY users (people who are deaf, hard of hearing, or speech disabled) may call 1-800-439-2370.

If you decide to end your membership, call MassHealth or Medicare and tell them you want to leave UnitedHealthcare Connected for One Care. 

  • Call MassHealth Customer Service at 1-800-841-2900, Monday – Friday, 8 am – 5 pm TTY users (people who are deaf, hard of hearing, or speech disabled) may call 1-800-497-4648; OR 
  • Send MassHealth an Enrollment Decision Form. You can get the form at www.mass.gov/one-care or by calling plan contact information if you need us to mail you one; OR 
  • At times when MassHealth Customer Service is closed, call Medicare at 1-800-MEDICARE (1- 800-633-4227), 24 hours a day, 7 days a week. TTY users (people who have difficulty hearing or speaking) should call 1-877-486-2048. When you call 1-800-MEDICARE, you can also enroll in another Medicare health or drug plan. More information on getting your Medicare services when you leave our plan is in the chart on page 188 in your Member Handbook/Evidence of Coverage. 

Your coverage with UnitedHealthcare Connected for One Care will end on the last day of the month that we get your request.

Other situations when your membership ends

These are the cases when MassHealth or Medicare must end your membership in our plan: 

  • If there is a break in your Medicare Part A and Part B coverage. 
  • If you are no longer eligible for MassHealth. Our plan is for people who are eligible for both Medicare and MassHealth. 
  • If you join a MassHealth Home and Community Based Services (HCBS) Waiver program 
  • If you move out of our service area. 
  • If you move into an Intermediate Care Facility operated by the Massachusetts Department of Developmental Services. 
  • If you go to jail or prison for a criminal offense. 
  • If you are not a United States citizen or are not lawfully present in the United States. – You must be a United States citizen or lawfully present in the United States to be a member of our plan. – The Centers for Medicare & Medicaid Services will notify us if you aren’t eligible to remain a member on this basis. – We must disenroll you if you don’t meet this requirement. 
  • If you have or get other comprehensive insurance for prescription drugs or medical care. UnitedHealthcare Connected for One Care MEMBER HANDBOOK 191 Chapter 10: Ending your membership in UnitedHealthcare Connected for One Care If you have questions, please call UnitedHealthcare Connected for One Care at 1-866-633-4454, TTY 711, 8 am – 8 pm local time, 7 days a week. The call is free. For more information, visit www.UHCCommunityPlan.com. 
  • If you let someone else use your Member ID Card to get care. 
  • If your membership ends for this reason, Medicare may ask the Inspector General to investigate your case, and MassHealth may ask the Bureau of Special Investigations to investigate your case. 

We can also ask you to leave our plan if you continuously behave in a way that is so disruptive that we cannot provide care for you or other members of our plan. We can only make you leave if we get permission from Medicare and MassHealth first.

UnitedHealthcare Connected® benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call 1-877-542-9236, TTY 711, 8 a.m. - 8 p.m., local time, Monday - Friday (voicemail available 24 hours a day/7 days a week). The call is free.

You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al 1-877-542-9236, TTY 711, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

Los servicios Language Line están disponibles para todos los proveedores dentro de la red.

UnitedHealthcare Senior Care Options (HMO SNP) Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

Availability of non-english disclaimer

ATTENTION: If you speak an alternative language, language assistance services, free of charge, are available to you. Call 1-800-905-8671 TTY 711.

ATENCIÓN: Si habla Español, hay servicios de asistencia lingüística disponibles para usted y que no tienen cargo. Llame al 1-800-905-8671 TTY 711.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system.

Formularies

The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary.

NCQA

UnitedHealthcare Connected® has a Model of Care approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 2017 based on a review of UnitedHealthcare Connected’s Model of Care.

Important provider information

The Choice is Yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non- contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 888-638-6613 TTY 711.

Declaration of Disaster or Emergency

If you’re affected by a disaster or emergency declaration by the President or a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non- contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.

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Last Updated: 07.26.2021 at 02:38 PM CDT

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