The Need and Vision for a New York State Medicaid Managed Care Ombudsman Program

The creation of the State’s “Care Management for All” initiative represents a sea change in how and where people with disabilities or chronic illnesses access care through the Medicaid program.  This creates the need for an advocacy program specializing in consumer education, community training, and advocacy services tailored to meet the unique needs of these populations.

Medicaid Matters New York proposes a Medicaid Managed Care Ombudsman Program to meet the advocacy needs of people newly-enrolled in Medicaid Managed Care or some form of care management under “Care Management for All.”

Recipients would benefit from: learning how to access services in a managed care environment; help in securing a change in or restoration of benefits, services, or supports; advocacy to obtain accommodations for their disabilities; and the fruits of systemic advocacy addressing patterns such as improper notices, inadequate networks or accommodations, or unlawful care management practices.  There are various programs and services currently provided to the target population that offer similar elements contemplated by the program design.  There is not, however, sufficient capacity within the current disability and legal services networks to provide the proposed level of service without a significant increase in resources.

This proposal is designed to expand and target advocacy services to reach a group of people numbering as many as 1.5 million who will be entering managed care for the first time in the next few years.  It is intended to drive resources to the various groups in local communities that serve the newly mandated populations in order to strengthen their capacities and competencies and target help for this new wave of people as they enter and adjust to various.  The emphasis of the program is to strengthen local capacity and improve disability literacy and accommodations in managed care settings, and it recognizes the complexity of the work involved in serving those with multiple and profound needs.

The full proposal is available here.