Horizon NJ Health

What Horizon NJ Health does

Horizon NJ Health is a New Jersey Medicaid managed care organization founded in 1994 and operating as an affiliate of Horizon Blue Cross Blue Shield of New Jersey, an independent licensee of the Blue Cross Blue Shield Association. The company is headquartered in West Trenton, New Jersey, with a parent-affiliated office at Three Penn Plaza East in Newark, and employs 501-1,000 people. It administers three core product lines: NJ FamilyCare (the state Medicaid program covering eligible children, adults, pregnant women, and disabled individuals), Managed Long Term Services and Supports (MLTSS) for members requiring long-term care to remain in home and community settings, and Horizon NJ TotalCare (HMO D-SNP), a Fully Integrated Dual Eligible Special Needs Plan serving individuals eligible for both Medicaid and Medicare. The company is described as New Jersey's largest community health plan with one of the largest provider networks of doctors, hospitals, and specialists in the state.

Horizon NJ Health generates revenue primarily through per-member-per-month (PMPM) capitated premium payments from the New Jersey Medicaid program and from CMS for the D-SNP line. Premium rates are set by eligibility category (children, adults, pregnant women, disabled, MLTSS, dual-eligible), and member out-of-pocket costs are minimal — typically $0 for lower-income tiers and up to $1-5 copays for prescription drugs in higher-income tiers; the D-SNP plan carries no cost to qualifying dual-eligible members. The go-to-market motion is sales-led but operates within a state-administered framework: enrollment is facilitated through the State of New Jersey's Health Benefits Coordinator and County Welfare Agencies, supplemented by Horizon field representatives, community events, Care-A-Van mobile health units, and provider office referrals.

The technology stack consists of a digital health plan administration platform with a member portal, the Horizon NJ MyCare mobile app (iOS and Android), digital member ID cards, an Availity-based provider portal for EDI claims and EFT payments, a 24/7 nurse chat and telehealth platform, and an Interoperability Developer Portal supporting FHIR-based API data exchange under the 21st Century Cures Act. Operations are supported by a network of vendor partnerships including LabCorp for laboratory services, eviCore for radiology benefit management, SKYGEN USA for dental administration, Davis Vision for vision services, Modivcare for medical transportation, and Propio for language interpreter services. Horizon NJ Health holds NCQA accreditations for Health Plan, Health Equity, and LTSS Distinction.

Name

Horizon NJ Health

Legal name

Horizon Blue Cross Blue Shield of New Jersey

Website

https://horizonnjhealth.com

Company type

Private

Founded year

1994

Operating status

Operating

Headcount range

501–1,000 employees

Short description

Horizon NJ Health is a New Jersey Medicaid managed care organization and affiliate of Horizon Blue Cross Blue Shield of New Jersey, administering NJ FamilyCare, MLTSS, and a D-SNP plan as the state's largest community health plan.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Services for the Elderly and Persons with Disabilities (624120)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Children’s & Family Medicaid Managed Care Plans (HLAEAEAF)

akta.pro secondary industries

D-SNP Supplemental Benefits & Flex Card/OTC Administration (HLAEAFAN), Maternity & Pregnancy (Perinatal) Medicaid Managed Care Programs (HLAEAEAH), Benefits, Insurance & Entitlement Navigation (Medicare/Medicaid/VA/LTC) (HSABAIAG)

Keywords

• Medicaid managed care
• Health insurance plans
• Long-term care services
• Dual-eligible coverage
• Community health plan

Headquarters

HQ city

West Trenton

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Supply Chain

Revenue model

1. Medicaid Capitation Premiums: Horizon NJ Health receives per-member-per-month (PMPM) capitated premium payments from the New Jersey State Medicaid program (NJ FamilyCare) in exchange for providing covered healthcare services to enrolled members. Premium rates are based on member eligibility categories including children, adults, pregnant women, disabled individuals, and MLTSS beneficiaries.
2. Medicare Advantage Premiums (D-SNP): Horizon NJ TotalCare (HMO D-SNP) receives Medicare Advantage premiums for members eligible for both Medicaid and Medicare, providing fully integrated dual-eligible special needs plan coverage.

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels8 records

Core offering

Horizon NJ Health is a New Jersey Medicaid managed care organization that administers the NJ FamilyCare (Medicaid) program, Managed Long Term Services and Supports (MLTSS), and Horizon NJ TotalCare (HMO D-SNP), a fully integrated dual-eligible special needs plan. The company provides comprehensive health coverage including medical, dental, vision, prescription drugs, mental health, and long-term care services to eligible children, adults, pregnant women, disabled individuals, and dual-eligible seniors in exchange for per-member-per-month capitation premiums from the State of New Jersey and CMS.

Product overview

Horizon NJ Health is a New Jersey Medicaid managed care organization offering a portfolio of health insurance products and wellness programs. The core products include NJ FamilyCare (Medicaid coverage), Managed Long Term Services & Supports (MLTSS), and Horizon NJ TotalCare (HMO D-SNP for dual-eligible beneficiaries). These are supported by digital tools including the Horizon NJ MyCare mobile app and Doctor & Hospital Finder. The company provides integrated wellness programs such as Horizon Healthy Journey, GEMS Prenatal Program, Care Management, and Horizon Behavioral Health. Additional member services include prescription drug coverage through an approved formulary, dental and vision services, nutritional support services, community resource finder, and member communications via Blue Notes and Care Notes newsletters.

Differentiator

Problem solved

Functional benefit

Products and services

• NJ FamilyCare New Jersey Medicaid program administered by Horizon NJ Health, providing affordable health coverage for eligible children, single adults, families, and pregnant women based on income level. Includes medical, dental, vision, prescription drugs, mental health, and hospitalization benefits.
• Managed Long Term Services & Supports (MLTSS) Program promoting independence, dignity and choice for members needing support services to remain in homes and communities. Includes dedicated care managers, personalized plans of care, assisted living, community residential services, personal care assistance, and nutritional support services.
• Horizon NJ TotalCare (HMO D-SNP)
• Horizon NJ MyCare App
• Horizon Healthy Journey
• GEMS Prenatal Program
• Care Management
• Horizon Behavioral Health
• Doctor & Hospital Finder
• Community Services Finder

Quantifiable outcome

• No referrals required for in-network specialists - simplifying member access to specialty care
• +1 more outcomes

Named customers3 records

Segments3 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

Feature5 records

Partnerships

Nine partnerships are on record, tiered supporting and core.

• Healthmap SolutionssupportingStrategic or Co-development PartnerHealthmap Solutions is identified as a new partner providing technology solutions to support plan operations and member services.
• Laboratory Corporation of America (LabCorp)coreTechnology or IntegrationLabCorp serves as the primary laboratory services provider for Horizon NJ Health members, integrated into the provider network for diagnostic testing services.
• eviCore healthcarecoreTechnology or IntegrationeviCore healthcare provides radiology imaging program management including contrast agents, radiopharmaceuticals, and radiology benefit management services.
• SKYGEN USAcoreTechnology or IntegrationSKYGEN USA provides dental services administration and clinical criteria management for NJ FamilyCare dental benefits.
• DAVIS VISIONsupportingTechnology or IntegrationDAVIS VISION provides vision services billing and administration for FQHC vision billing guide and member vision benefits.
• Modivcare (formerly LogistiCare)coreTechnology or IntegrationModivcare provides medical transportation services for members, having rebranded from LogistiCare. Handles non-emergency medical transportation and transportation to appointments.
• propio.comsupportingTechnology or Integrationpropio.com provides language interpreter services for Horizon NJ Health members to communicate with in-network providers, supporting limited English proficiency members.
• State of New Jersey - Division of Medical Assistance & Health ServicescoreStrategic or Co-development PartnerThe State of New Jersey contracts with Horizon NJ Health to administer NJ FamilyCare Medicaid benefits, MLTSS program, and other state healthcare programs for eligible residents.
• AvailitycoreTechnology or IntegrationAvaility provides the provider portal for electronic data interchange (EDI), electronic funds transfer (EFT), and claims processing between Horizon NJ Health and network providers.

Scale indicators2 records

Recent moves6 records

Expansion highlights5 records

Regional players

• Healthfirst: Large nonprofit Medicaid and D-SNP MCO serving New York. Comparable in scale, mission orientation, multi-product Medicaid+MLTSS+D-SNP portfolio, and BCBS-adjacent positioning to Horizon NJ Health, though operating in a different state.
• L.A. Care Health Plan: Largest publicly-operated Medicaid MCO in the US, serving Los Angeles County. Comparable scale, multi-product Medicaid portfolio, dual-eligible products, and focus on safety-net populations, though operating in a different geography.
• Inland Empire Health Plan (IEHP): Large public-sponsored Medicaid MCO in California serving dual-eligible, MLTSS-equivalent, and Medi-Cal populations. Comparable in scale, mission orientation, and multi-product Medicaid portfolio, though operating in a different state.

Broad incumbents

• CareSource: Nonprofit managed care plan with a strong Medicaid focus across multiple states including D-SNP products. Comparable in nonprofit governance, multi-state Medicaid orientation, and dual-eligible focus, though with broader geographic footprint.
• Horizon Blue Cross Blue Shield of New Jersey: Parent organization and BCBS licensee for New Jersey. Operates commercial, Medicare Advantage, and other lines alongside Horizon NJ Health, providing shared infrastructure, brand, and regulatory positioning that defines the subsidiary's market context.

Direct peers

• WellCare of New Jersey: Centene-affiliated Medicaid MCO participating in NJ FamilyCare. Competes directly with Horizon NJ Health across Medicaid eligibility categories and dual-eligible populations in New Jersey.
• UnitedHealthcare Community Plan of New Jersey: UnitedHealthcare's Medicaid MCO serving NJ FamilyCare members in New Jersey. Directly competes with Horizon NJ Health for the same state Medicaid contract, serving overlapping eligibility categories and dual-eligible populations.
• Aetna Better Health of New Jersey: CVS Health/Aetna's Medicaid managed care plan serving NJ FamilyCare members. Directly competes for the same NJ Medicaid contract, with overlapping D-SNP and MLTSS offerings.
• Amerigroup New Jersey: Anthem-affiliated Medicaid MCO operating in the NJ FamilyCare program. Competes head-to-head with Horizon NJ Health for state Medicaid members, dual-eligibles, and MLTSS beneficiaries in New Jersey.
• Molina Healthcare of New Jersey: Molina's New Jersey Medicaid MCO participating in NJ FamilyCare. Direct competitor for state Medicaid contracts, dual-eligible members, and MLTSS populations served by Horizon NJ Health.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks7 records

Key highlights7 records

Customer concentration

• Xx.com/HorizonNJHealth
• YouTubeyoutube.com/bcbsnj
• Facebookfacebook.com/HorizonBCBSNJ
• LinkedInlinkedin.com/company/horizon-nj-health

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Horizon NJ Health