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Starting January 1, 2025, Fidelis Care will provide outpatient behavioral health benefits to NJ FamilyCare members. Learn more about the behavioral health benefit changes (PDF).

Rights and Responsibilities

You Have the Right to:

  • Ask for and receive information about the services available to you
  • Have access to and choice of qualified service providers
  • Be informed of your rights before getting selected and approved services
  • Receive services without regard to race, religion, color, creed, gender, national origin, political beliefs, sexual orientation, marital status or disability
  • Have access to appropriate services that support your health and welfare
  • Make decisions concerning your care needs
  • Choose between a nursing facility and a Home Based Supportive Care (HBSC), (whichever meets your needs)
  • Assume risk after being fully informed about the potential risks and consequences of your decisions
  • Participate in the development of and make changes to your plan of care
  • Request changes in services at any time, including adding, increasing, decreasing, or discontinuing services
  • Ask for, and receive from your Care Manager, a list of names and duties of any person(s) assigned to provide services for you under your plan of care
  • Receive help and guidance from your Care Manager to resolve concerns about your care needs and/or complaints about services or providers
  • Be informed of and receive, in writing, facility-specific resident rights upon admission to an institutional or residential setting
  • Be informed of all the covered/required services you are entitled to by the institutional or residential setting, and any charges not covered by our health plan while in the facility (what services would an institutional/residential setting require? Or could this be worded incorrectly/implying something that is incorrect?)
  • Not be transferred or discharged out of a facility except for medical necessity
  • To protect your physical welfare and safety or the welfare and safety of other residents, or
  • After reasonable notice, you fail to make payments to the facility that are based on your statement of available income for Medicaid payment

You Have the Responsibility to:

  • Provide all health and treatment-related information, including, but not limited to, medication, circumstances, living arrangements, informal and formal supports to your Care Manager, in order to identify care needs and develop a plan of care
  • Understand your health care needs and work with your Care Manager to develop or change goals and services
  • Work with your Care Manager to develop and/or change your plan of care to facilitate timely authorization and implementation of services
  • Ask questions when you don’t understand something
  • Understand the risks associated with your decisions about care
  • Report any significant changes to your health condition, medication, circumstances, living arrangements, informal and formal supports to your Care Manager
  • Let your Care Manager know if any problems occur or you’re not happy with the services being provided
  • Follow our rules and/or those rules in an institutional or residential setting