1) New Jersey has established a managed care system for over 10 years for children's behavioral health services and more recently expanded this to include children and youth with intellectual and developmental disabilities (I/DD). 2) PerformCare is the administrative service organization that manages access and funding for services for children through the Children's System of Care, including respite care and summer camps. 3) Concerns have been raised about whether managed care organizations provide adequate care coordination for individuals in the system who receive services from multiple providers and about lack of consistent support for families from PerformCare.

1. New Jersey and the Managed
Care System for Children and
Adults with Intellectual and
Developmental Disabilities
Shirla Simpson, Deputy Director
NJ Council on Developmental Disabilities

2. Established Managed Care for over
10 years in New Jersey’s
Children’s System of Care for
Behavioral Health Services. The
provider is PerformCare which
supports members in the public
and private sectors.
Children’s System of Care

3. PerformCare is a member of
AmeriHealth and is the NJ
Administrative Service Organization
(ASO) for the Children’s System of
Care since 2009. (They are the
second ASO provider in NJ for the
CSOC).
The Children’s System Provider

4. Access to Services
To access the Children’s and Youth
services, parents, caregivers and
system providers can call toll free
24 hours a day, 7 days per week.
The system never closes.

5. Children and Youth with
Intellectual/Developmental
Disabilities
As of January 1, 2013, the Children’s
System of Care assumed responsibility for
determining eligibility and providing services
to children/youth with I/DD.

6. Funding
All Family Support funding is
managed by PerformCare
which includes Respite Care.
Families also receive
assistance for services such as
Summer Camps through
PerformCare.

7. Adult System of Care
In 1995, NJ Medicaid began moving
Medicaid beneficiaries into managed
care. Persons receiving Medicaid
“enroll in a Health Plan which manages
their healthcare and offers special
services to which Medicaid clients are
entitled.”
Taken from Division of Medical
Assistance & Health Services Website.

8. Managed Care Providers
There are currently 5 providers in NJ:
Amerigroup NJ
Healthfirst NJ
Horizon NJ Health
United Healthcare Community Plan
WellCare
All companies do not serve statewide.

9. New Legislation
In August, 2011 NJ Governor Christie
signed into law a 3 year Medicaid
Accountable Care Organization (ACO)
demonstration project. The project will
test the ACO as an alternative to Medicaid
Managed Care within the adult system to
Integrate social services.
ACO applicants are required to be
nonprofit organizations.

10. Managed Long Term Services
and Supports (MLTSS)
Effective July 1, 2014, MLTSS replaces
several Medicaid health plans including
the Community Resources for People
with Disabilities (CRPD). The CRPD was
serving children and adults.
Issues: The CCW was not transitioned
into this plan for the same services and
they do not qualify for NJ DDD services
under plan (day program).

11. Additional Issues for Families and
System under Managed Care
• Hope by system providers that
managed care MCO care managers
would provide the high level of care
coordination.
• Multiple providers of many services to
individuals in the system, therefore
many service plans.
• Perform Care is not in a care manager
role, family is assisted by different
person each time, not a constant.

12. NJ DD Council
• Have established Monthly meetings for
a small group of statewide Family
Support Council members to meet with
the Assistant Commissioner of DDD to
discuss many of these ongoing issues.
• Also Bi monthly meetings for members
to also meet with the Director of the
Department of Children and Families
and PerformCare.

13. Council Continues……
• Advocate for all Managed Care
representatives to be trained in the
areas of Developmental Disabilities
for the individuals and their families.
• Thank you for your time!