Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
This memorandum outlines lessons learned from a series of strategic conversations the Centers for Medicare & Medicaid Services held with Medicare Advantage organizations in December 2023 and January 2024 regarding calendar year 2023 implementation of Dual Eligible Special Needs Plan enrollee advisory committees.
Ombudsman programs can offer beneficiary protections as part of Medicaid managed care programs. These programs are particularly important for beneficiaries with complex physical and behavioral health conditions, including many dually eligible individuals. For the demonstrations under the Financial Alignment Initiative, the Centers for Medicare & Medicaid (CMS) and states incorporated ombudsman programs to help to resolve enrollees’ problems and alert Medicare-Medicaid Plans (MMPs), states, and CMS of emerging trends and issues.
This webinar provides an overview of the role of ombudsman programs in integrated care programs serving dually eligible individuals. Using the ombudsman programs developed for the demonstrations under the Financial Alignment Initiative as an example, the webinar examines ways that states have structured these programs, the types of supports that they can offer, and the value they provide to both consumers and state Medicaid agencies.
Learning Objectives: By the end of this presentation, attendees should be able to:
The Center for Consumer Engagement in Health Innovation released a report The Biggest Value is Getting the Voice of the Member describing its findings on the composition, function, and impact of the Consumer Advisory Councils operating within Medicare-Medicaid Plans (MMPs) operating in capitated model demonstrations under the Financial Alignment Initiative. The report covers topics including, recruitment and training of consumer members, accommodations to help consumers participate, and ensuring representativeness and diversity.
This webinar highlights the importance of beneficiary ombudsman programs and provides an overview of available supports, including Medicare resources and state programs that provide assistance to dually eligible beneficiaries. Representatives from Ohio’s Office of the State Long-Term Care Ombudsman and CareSource, a MyCare Ohio health plan, shared promising practices and lessons learned from their efforts supporting beneficiaries enrolled in MyCare Ohio, a capitated financial alignment demonstration.
This presentation provides a brief history of ombudsman program and describes the Medicaid managed care ombudsman programs in Texas and Vermont.
This webinar provides an overview of partnerships between Medicaid agencies and SHIPs in both PA and SC.
This technical assistance tool covers key issues in RFPs and contracts related to consumer protection including marketing, member materials and education, continuity of care, and grievance and appeals processes.