New Jersey's MLTSS program has no enrollment cap — eligible people get services without waiting. That is the first thing to understand about New Jersey. The second is that while HHAeXchange is the statewide EVV aggregator, each of the five MCOs has a different billing configuration inside that system. Aetna, Horizon, United, Fidelis, Wellpoint each work differently. Knowing the difference before you submit a claim saves weeks of reconciliation. Here is the full picture.
New Jersey's Managed Long Term Services and Supports program operates under the NJ FamilyCare Comprehensive Demonstration (a 1115 waiver) and consolidated several prior waiver programs into a single managed care structure. The program covers personal care, homemaker services, respite, assistive technology, home modifications, community residential services, assisted living, and adult day health — the full range of HCBS. Unlike many states, MLTSS does not have an enrollment cap. There is no waitlist.
For home care agencies, this means your referral pipeline is bounded by eligible population and your credentialing status with MCOs — not by state enrollment slots. Applications from eligible individuals are processed through their county Board of Social Services (financial eligibility) and the Division of Aging Services (functional eligibility). The functional assessment uses a PCA assessment tool, and the MCO then manages care coordination after enrollment.
Not all MCOs operate in every county — verify county coverage for each plan through NJ FamilyCare's plan locator before developing referral relationships in a new area. Agencies must credential with each MCO separately through that plan's credentialing process. DMAHS enrollment gives you NJ FamilyCare provider status; MCO credentialing gives you the network access to bill each plan's members.
HHAeXchange is the statewide EVV aggregator — all NJ FamilyCare EVV data flows through HHAX regardless of MCO or payer. But the billing pathway and UB04 usage is MCO-specific, and getting it wrong creates claim rejections that take weeks to resolve.
Horizon NJ Health and Wellpoint NJ use CareBridge for EVV data collection — not HHAeXchange directly. CareBridge then aggregates and forwards data to HHAeXchange. For these two plans, providers either use HHAeXchange (which forwards to CareBridge) or use a third-party EVV system that integrates with HHAeXchange. Any EVV system must be able to transmit data for all MCOs to HHAeXchange — you don't need multiple or plan-specific EVV software.
| MCO | EVV Data Route | UB04 Billing for EVV Services? | Claims Submission |
|---|---|---|---|
| Aetna Better Health NJ | HHAeXchange directly | No — all billing through HHAX | Claims created and submitted through HHAeXchange |
| Fidelis Care (WellCare) | HHAeXchange | No UB04 for EVV services | Through HHAeXchange |
| Horizon NJ Health | CareBridge → HHAeXchange | No — providers must use HHAX for EVV services; cannot bill UB04 | Through HHAeXchange (CareBridge forwards to HHAX) |
| UnitedHealthcare Community Plan | HHAeXchange | Yes — UB04 billing allowed, but EVV data still required in HHAX | UB04 directly to plan or through HHAX |
| Wellpoint NJ (Amerigroup) | CareBridge → HHAeXchange | No — no UB04 for EVV services | Through HHAeXchange (CareBridge forwards to HHAX) |
| FFS / DMAHS | HHAeXchange as aggregator | FFS home health went live June 24, 2024 | Standard FFS claims to DMAHS; EVV data through HHAX |
EVV compliance is calculated and monitored per payer — MCO and FFS. Agencies must meet compliance criteria for each payer independently to maintain good standing. Check compliance rates per MCO in your HHAeXchange compliance reports, not just aggregate numbers.
The Personal Preference Program (PPP) is the consumer-directed personal care option within NJ FamilyCare MLTSS. Eligible members receive a monthly budget — determined by their MCO's PCA assessment — to use for personal care assistance. Members hire their own caregivers, including family members. Spouses are eligible as paid caregivers in New Jersey's PPP — this distinguishes NJ from states that prohibit spousal caregiving.
PPL (Public Partnerships LLC) currently serves as the primary fiscal intermediary, handling payroll, background checks, and tax withholding for PPP caregivers. Over time, individual MCOs may transition to different FI vendors after completing the state's readiness review process. Monitor your MCOs' PPP communications for any FI transitions.
MLTSS also includes Home-Based Supportive Care (HBSC) — services like shopping, housekeeping, and meal preparation — which can be participant-directed through Personal Employer Provider (PEP). Family members including spouses can serve as PEP caregivers for these services.
For traditional home care agencies, MLTSS services that do require trained/certified staff are still agency-directed. Your business is the agency-directed component — personal care, skilled respite, nursing, and related services where you employ and direct the caregivers. PPP and PEP are the participant-directed alternatives that members may choose for some or all of their authorized services.
It means the eligible population is not artificially constrained by enrollment caps. In states with HCBS waiver waitlists of 3–5+ years, even a well-credentialed agency can't grow into the program because eligible clients are waiting for slots. In New Jersey, that ceiling doesn't exist — if someone qualifies, they enroll. Your referral flow is determined by your credentialing status with each MCO, the strength of your relationships with MCO care managers, and your ability to take on new authorizations. Building referral relationships with MCO care managers and county ADRC/AAA contacts is the practical growth strategy.
HHAeXchange is the statewide aggregator — all NJ FamilyCare EVV data must flow through it regardless of MCO. But you don't need to use HHAeXchange as your primary EVV system if you already have an enterprise EVV solution. Your existing system can integrate with HHAeXchange via EDI to transmit visit data. The requirement is that whatever EVV system you use must be able to transmit to HHAeXchange. For Horizon and Wellpoint members specifically, the data flows through CareBridge first and then to HHAeXchange — but your agency's EVV system still just needs to feed HHAX as the aggregator.
Horizon NJ Health and Wellpoint NJ require EVV-covered services to be billed through HHAeXchange (which routes through CareBridge for those plans) — not on a paper or electronic UB04 directly to the plan. This is those plans' specific billing configuration for EVV services, reflecting how CareBridge integrates with HHAX. UnitedHealthcare Community Plan is the exception — it does allow UB04 billing but still requires the EVV data to be in HHAX. Verify each plan's current billing instructions through their provider training materials, because these configurations can be updated. Contact [email protected] for current HHAX billing guidance by plan.
The Personal Preference Program is the consumer-directed personal care option in MLTSS. Members receive a monthly budget and hire their own caregivers, including family members and spouses. Your agency doesn't operate inside PPP — PPL handles the fiscal intermediary functions. PPP is a consumer choice alternative to agency-directed care, not an additional revenue stream for agencies. If a member you're currently serving chooses to move from your agency to PPP, they leave your census. If a new potential client is interested in PPP, they work with PPL, not with your agency for that service type. Some members use PPP for some services and agency-directed care for others — ask at intake which service model applies to each authorization.
New Jersey agencies managing credentialing across five MCOs with different HHAeXchange billing configurations, monitoring EVV compliance per MCO independently, tracking PPP vs agency-directed authorizations for the same member, and keeping up with Aetna/Horizon/United/Fidelis/Wellpoint-specific billing rules are managing significant MCO-specific operational knowledge on top of daily care delivery. CareBravo delivers scheduling, HHAeXchange-integrated EVV compliance, billing with MCO-specific configuration handling, and authorization tracking as completed work — so the billing team isn't maintaining a per-MCO billing rule reference separately from the claims system.
New Jersey's no-enrollment-cap MLTSS structure creates genuine growth potential. But five MCOs, each with their own HHAeXchange billing configuration, means that getting paid correctly requires knowing each plan's specific process. The CareDrain Diagnostic shows what your current operational gaps cost monthly — before you build your New Jersey growth plan.