Information for New Jersey Medicaid Patients
Update
As of July 31, 2023
We're pleased to share that Nemours Children’s Health has renewed its contract with WellCare NJ FamilyCare. Families with a WellCare plan can continue to get care from Nemours Children’s.
Unfortunately, Horizon NJ Health and Amerigroup Community Care were not willing to work with Nemours Children’s to reach a viable solution for reimbursement. We will no longer be in-network with those plans starting August 1, 2023.
As of that date, we will also be unable to schedule appointments for new patients with a Horizon NJ Health or Amerigroup Community Care plan.
Most existing patients will be able to continue seeing Nemours Children’s providers through November 30, 2023, and even up to one year for certain conditions, or until they transition to a new provider.
View the Frequently Asked Questions for more information.
- Overview
- Frequently Asked Questions
- Resources
Effective August 1, 2023, Nemours will not be able to see patients who have insurance with Horizon NJ Health or Amerigroup Community Care.
If your child has an emergency, they can still come to the emergency room at Nemours Children's Hospital, Delaware. As always, in an emergency you should call 911 or go to the nearest emergency room.
Please refer to the FAQs tab for answers to some common questions about this change or to the Helpful Resources tab for contact information and links to health plan provider networks.
New FAQs for WellCare NJ FamilyCare patients:
Nemours Children’s Health has renewed its contract with WellCare. Your child can continue to get care from Nemours Children’s in New Jersey. Your child’s coverage will not change.
1. If my child needs emergency care, can I take them to Nemours Children’s Hospital?
Yes. If your child is having a medical emergency, call 911 or go to the nearest emergency room, including Nemours Children’s Hospital.
2. What should I do if my child is getting treatment from a Nemours Children’s specialist?
Your child may continue to see the specialist. If you need to reschedule an appointment, please call our scheduling department at (800) 416-4441.
3. Can my child see a Nemours Children’s provider or get care at Nemours Children’s Hospital?
Yes. Nemours Children’s and WellCare NJ Family Care reached an agreement. This means that we are a participating provider in WellCare’s network. Your child can receive all types of care at Nemours Children’s.
4. How do I reschedule an appointment at Nemours Children’s?
Please call our scheduling department at 800.416.4441 to reschedule your child’s appointment.
For Horizon NJ Health and Amerigroup Community Care Patients:
Starting Aug. 1, 2023, Nemours Children’s providers and the Nemours Children’s Hospital, Delaware will no longer be part of these insurance plans: Horizon NJ Health or Amerigroup Community Care. Here are some common questions and answers.
1. If I am currently on a Horizon NJ Health or Amerigroup Community Care insurance plan, can I switch to WellCare to continue receiving care at Nemours Children's?
Yes. You can change your HMO once a year during the Open Enrollment period from October 1 to November 15. You also have the option of changing your plan for “good cause” at any time by calling NJ FamilyCare/Medicaid at (866) 472-5338 (TTY 800-701-0720). When you enroll with an HMO for the first time you may also change to another HMO within 90 days of enrollment for any reason.
2. After Aug. 1, 2023, can I take my child to Nemours Children’s Hospital, Delaware if they need emergency care?
Yes. If your child is having a medical emergency, call 911 or go to the nearest emergency room, including Nemours Children’s Hospital, Delaware. This change in your child’s health insurance will NOT affect your child’s ability to get emergency care from Nemours Children’s or a Nemours Children’s provider at our hospital or any partner hospital.
3. My child is getting treatment from a Nemours Children’s specialist. What happens after Aug. 1, 2023?
If your child is in the middle of an ongoing course of treatment, call your health plan to ensure they will continue to receive care through Nov. 30, 2023.
If your child is receiving the type of care shown below, the date of their coverage with Nemours Children’s will be extended as follows:
- Post-operation — Jan. 31, 2024
- Cancer treatment — July 31, 2024
- Psychiatric treatment — July 31, 2024
Treatments or services not mentioned may be considered for extension on a case-by-case basis. Contact your health plan for information.
4. Can I still make an appointment for my child to see a Nemours Children’s provider before Aug. 1, 2023?
Yes, Nemours Children’s will do our best to schedule new appointments for patients with Horizon NJ Health or Amerigroup Community Care before Aug. 1, 2023. We will not be scheduling any new patients after that date.
5. What if my child already has an appointment to see a Nemours Children’s provider after Aug. 1, 2023?
If your child is a new Nemours Children’s patient, we will contact you try to reschedule your appointment for before Aug. 1, 2023. If we are unable to move your appointment, it will be canceled, and you will need to find a new in-network provider with your health plan.
If your child is in an active course of treatment as described in question 2, your appointment will take place as scheduled.
6. My child has a surgery/procedure scheduled on or after Aug. 1, 2023. Will that be canceled?
We’ll try to reschedule. If we are unable to reschedule, we will contact your health plan to determine your continuity of care plan.
7. My child has other health insurance in addition to Horizon NJ Health/Amerigroup Community Care. Can I still go to Nemours Children’s?
If your child has another health insurance plan, it may cover care delivered by Nemours Children’s. To find out, go to Nemours.org/insurance or contact the insurance plan directly.
8. Can I switch my child’s care to a doctor who is not at Nemours Children’s?
You can visit your health plan’s website or contact your health plan directly through Member Services and asking for a list of in-network providers.
Member Services hotlines:
- Horizon NJ Health
(800) 682-9090 - WellCare NJ FamilyCare
(888) 453-2534 - Amerigroup Community Care
(800) 600-4441 - The New Jersey Medicaid Hotline
(800) 356-1561
Call the New Jersey Medicaid hotline if you have trouble reaching your health plan or if you have concerns about moving your child’s care to a new provider: (800) 356-1561
9. How can I transfer my child's medical record to a new provider?
Once you choose a new provider, we can send your child’s medical record to them for free. You will need a Release of Information form, which you can obtain by calling (866) 956-7299 (press 1 to request copies of medical records) or online at Nemours.org/MedicalRecord.
Finding a new provider who works with your health plan
Links to the provider networks for the three NJ Medicaid plans are listed below. You can also call the Member Services phone numbers for additional support.