If you or someone you care about is struggling with a substance use disorder and covered under
a Horizon NJ Health plan, quality addiction treatment may be far more accessible than you
realize. At Guardian Recovery, we work directly with Horizon NJ Health to help members verify
their benefits, understand their coverage, and begin care without unnecessary delays. Our
admissions team is here to make sure that financial uncertainty never becomes the reason
someone puts off getting the help they need.
What Is Horizon NJ Health?
Horizon NJ Health is New Jersey’s largest managed healthcare company, providing coverage
to more than 500,000 children and adults through the NJ FamilyCare and Medicaid
programs. Operating under the broader Horizon Healthcare Services, Inc. umbrella, Horizon NJ
Health is specifically dedicated to serving Medicaid-eligible individuals and families across
the state of New Jersey. The organization offers four distinct healthcare plan types, each
with varying levels of coverage and components of care:
- NJ FamilyCare — Medicaid coverage for eligible children, families, and adults
- Horizon NJ TotalCare (HMO D-SNP) — a Dual Special Needs Plan for members eligible
for both Medicaid and Medicare - Managed Long-Term Services & Supports (MLTSS) — for members who require long-term
care services and supports - Division of Developmental Disabilities (DDD) — specialized coverage for members with
developmental disabilities
Behavioral health services — including substance use disorder treatment and mental health
care — are covered benefits across Horizon NJ Health plans. New Jersey and federal behavioral
health parity laws require that these services be covered at a level comparable to physical
health benefits, and Horizon NJ Health’s dedicated Horizon Behavioral Health℠ program
supports members in accessing safe, effective mental health and substance use disorder care
around the clock, 24 hours a day, seven days a week.
Does Horizon NJ Health Cover Addiction Treatment?
Yes. Under the Affordable Care Act (ACA) and New Jersey state Medicaid requirements,
substance use disorder treatment is a covered essential health benefit. Horizon NJ Health
provides coverage across a broad spectrum of addiction treatment services, from medically
supervised detoxification and residential inpatient care to structured outpatient programming
including Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs
(IOP). Additionally, Horizon NJ Health supports the Office-Based Addiction Treatment
(OBAT) program in collaboration with the New Jersey Division of Medical Assistance and
Health Services, expanding access to Medication-Assisted Treatment (MAT) and coordinated
psychosocial support for members with substance use disorders.
Coverage specifics vary based on your individual plan and clinical necessity determinations.
That is why our insurance specialists work directly with Horizon NJ Health on your behalf —
verifying your benefits, identifying any potential out-of-pocket costs, and clarifying any
preauthorization requirements before treatment begins. We offer a free, confidential
benefits check so that you have a complete, clear picture of your coverage before taking
the next step toward recovery.
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coverage and take the first step toward recovery.
Addiction Treatment Programs Covered by Horizon NJ Health
Horizon NJ Health coverage is structured to support members across multiple levels of care,
ensuring the right type of treatment is available at every stage of the recovery journey. Our
clinical team works in coordination with your plan to maximize your available benefits across
all applicable program types.
Medical Detoxification
Medical detox is the essential first phase of addiction treatment, providing a clinically
supervised environment in which the body can safely withdraw from harmful substances under
continuous professional care. The medical detox process is conducted on an inpatient basis
and typically spans three to seven days, depending on the individual’s clinical progress
and the scope of their substance use history. Our program delivers around-the-clock
monitoring, evidence-based withdrawal management protocols, and medication-assisted
treatment (MAT) as clinically appropriate to ensure safety and comfort throughout the
withdrawal process. Inpatient medical detoxification is a covered benefit under Horizon NJ
Health plans when medically necessary, consistent with ASAM (American Society of Addiction
Medicine) level-of-care guidelines that Horizon NJ Health uses to determine appropriate
treatment placement.
Residential Inpatient Treatment
For individuals whose recovery requires a fully structured, live-in treatment environment
with continuous clinical oversight, residential inpatient treatment provides 24-hour care
that removes clients from the triggers and instability of their everyday environment. Program
lengths typically range from 30 to 90 days and integrate individual therapy, group
counseling, psychiatric support, medication management, and holistic wellness activities into
a purposeful daily schedule. Horizon NJ Health coverage often extends to short-term
residential rehabilitation when clinically indicated, and our team handles all benefit
verification and prior authorization coordination on your behalf.
Partial Hospitalization Program (PHP)
PHP — also referred to as Day Treatment or Partial Care under New Jersey’s
levels of care framework — provides high-intensity structured therapeutic programming during
standard daytime hours, allowing individuals to return home or to a sober living environment
each evening. These programs integrate individual counseling, group therapy, psychiatric
consultation, and medical monitoring within a coordinated, multidisciplinary framework. PHP
is commonly covered by Horizon NJ Health when clinical criteria support this level of
treatment, and our admissions team manages all necessary verification and prior authorization
procedures on your behalf.
Intensive Outpatient Program (IOP)
IOP offers consistent, structured clinical support for individuals who are ready to
manage daily responsibilities — such as work, school, or family commitments — while
continuing their treatment in a supervised setting. Sessions typically convene multiple times
per week and focus on relapse prevention, coping skill development, peer accountability,
and therapeutic reinforcement. New Jersey’s outpatient continuum also includes Methadone
Intensive Outpatient (MIOP) for members managing opioid use disorder through opioid
maintenance therapy. Horizon NJ Health coverage frequently includes IOP as part of a
comprehensive continuum of addiction care.
Medication-Assisted Treatment (MAT) and OBAT
Medication-Assisted Treatment combines FDA-approved medications with counseling and
behavioral therapies to address addiction at the biological, psychological, and social levels.
Horizon NJ Health — in collaboration with the New Jersey Division of Medical Assistance and
Health Services and the Division of Mental Health and Addiction Services — supports the
Office-Based Addiction Treatment (OBAT) program, which pairs MAT prescribed by eligible
providers with psychosocial navigators who coordinate ongoing care for members with
substance use disorders. Medications covered under Horizon NJ Health plans may include:
- Methadone — covered under all Horizon NJ Health plans as part of opioid maintenance
therapy - Buprenorphine / Suboxone / Subutex — typically covered for members with opioid use
disorder under specific clinical circumstances - Naltrexone / Vivitrol — monthly injections used to reduce cravings and support
recovery from opioid and alcohol use disorders
OBAT services are available for members enrolled in NJ FamilyCare, MLTSS,
Horizon NJ TotalCare (HMO D-SNP), and DDD plans. Our team can confirm your specific
eligibility and coordinate appropriate referrals as part of the admissions process.
Virtual Addiction Treatment
For members who face geographic, logistical, or personal barriers to in-person care,
virtual addiction treatment provides a clinically effective and flexible alternative.
Through secure telehealth platforms, clients can engage in individual therapy, group
counseling sessions, and medication management consultations from the privacy and comfort of
their own home. Horizon NJ Health may extend coverage to telehealth-delivered behavioral
health services, allowing members to access evidence-based treatment while maintaining the
demands of everyday life.
Coverage Options Made Simple
Mental Health and Co-Occurring Disorder Coverage
Substance use disorders and mental health conditions frequently occur together. Many
individuals seeking treatment for addiction are simultaneously managing underlying conditions
such as depression, anxiety, PTSD, bipolar disorder, or trauma-related presentations — a
clinical reality known as a co-occurring disorder or dual diagnosis. New Jersey state
law and federal behavioral health parity requirements mandate that Horizon NJ Health provide
mental health and substance use disorder coverage that is equivalent to physical health
benefits, ensuring members have access to the integrated, whole-person care they need.
The Horizon Behavioral Health℠ program provides the clinical infrastructure for this
integrated care, ensuring that both medical and behavioral health services are available and
coordinated to support each member’s overall health and recovery. Our clinical team
specializes in dual diagnosis treatment, addressing substance use and co-occurring mental
health conditions simultaneously through personalized, evidence-based care planning. Services
commonly covered by Horizon NJ Health include psychiatric evaluations, medication
management, individual therapy, group counseling, family therapy, case
management, and specialized behavioral health programming.
Psychiatric Services
Access to licensed psychiatrists and psychiatric nurse practitioners is a foundational
component of comprehensive addiction and mental health treatment. Horizon NJ Health plans
cover psychiatric evaluation and ongoing medication management, ensuring members receive
appropriate psychiatric care tailored to their specific diagnoses and clinical needs
throughout every phase of the recovery process.
Therapy and Counseling
Therapeutic services form the core of sustainable, lasting recovery. Whether engaging in
one-on-one sessions with a licensed therapist or participating in structured group counseling,
our qualified clinical team delivers targeted, evidence-based care within the scope of your
Horizon NJ Health benefits. Covered treatment modalities may include Cognitive Behavioral
Therapy (CBT), Dialectical Behavior Therapy (DBT), trauma-informed care, motivational
interviewing, family therapy, and relapse prevention programming. Horizon NJ Health also
covers family conference services, which help engage loved ones in the treatment and
recovery process.
Care Management Services
For members enrolled in the FIDE-SNP and MLTSS programs, Horizon NJ Health offers
intensive care management services through the Horizon Behavioral Health℠ program. Care
managers work directly with members to coordinate services, support treatment transitions,
build community connections, and help members navigate every aspect of their recovery journey
— from initial treatment entry through long-term sobriety maintenance.
Crisis Intervention
Horizon NJ Health provides coverage for off-site crisis intervention services, offering
immediate clinical support for members experiencing a behavioral health emergency. The
Horizon Behavioral Health program is accessible 24 hours a day, seven days a week, ensuring
that members always have a pathway to urgent care when they need it most.
Clinical Assessments and Diagnostic Services
Every effective treatment plan begins with a thorough, individualized clinical and medical
evaluation. Upon entering our program, each client undergoes a comprehensive intake
evaluation that examines physical health status, substance use history, mental health
presentation, co-occurring conditions, and relevant psychosocial factors. Our team uses
standardized psychological screening instruments, comprehensive psychiatric examinations,
substance use screening protocols, and integrated mental health appraisals to build a
complete clinical profile that directly guides each client’s personalized course of treatment.
Comprehensive intake evaluation and clinical assessment services are covered benefits under
Horizon NJ Health plans.
Aftercare and Continuing Support
Recovery is a long-term commitment, and the support network in place after primary treatment
ends plays a critical role in determining lasting outcomes. Horizon NJ Health coverage may
extend to aftercare and continuing care services designed to reinforce the skills and
progress developed during treatment while providing the accountability and community
connection needed to sustain sobriety over time. New Jersey also offers a range of pre- and
post-treatment recovery support services to help individuals transition seamlessly into and
out of care. Our aftercare planning team collaborates with each client to connect them with
the ongoing resources best suited to their individual needs, which may include continued
outpatient therapy, alumni programming, community peer support, relapse prevention
check-ins, and referrals to local recovery community organizations.
Questions About Insurance?
Find out exactly what your plan covers. We make insurance verification fast, easy, and private.
How to Use Your Horizon NJ Health Benefits at Guardian Recovery
Starting treatment with your Horizon NJ Health plan is a clear, manageable process, and our
admissions team is here to guide you through every step with compassion and expertise. Here
is what to expect when you reach out:
Our dedicated admissions coordinators will collect your Horizon NJ Health insurance
information, conduct a thorough review of your specific plan details, and clearly explain
which services are covered under your plan — including any applicable copays,
deductibles, and prior authorization requirements in accordance with ASAM level-of-
care guidelines. From there, we will schedule your initial clinical assessment and ensure you
feel fully informed and confident as you move forward with your treatment decisions. We
manage all insurance coordination so you can focus entirely on your recovery.
Whether you are reaching out for yourself or on behalf of a loved one, our team is available
24 hours a day, 7 days a week to answer questions, address concerns, and provide the
knowledgeable, compassionate support that makes the first step feel a little less daunting.
Do not let questions about your Horizon NJ Health coverage delay your path to healing.
Contact us today for your free, no-obligation benefits check and take the first step toward
lasting recovery.
