Beneficiary Engagement, Counseling, and Support

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.

03/09/2021

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:

2018

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.

March-18

This webinar provides an overview of partnerships between Medicaid agencies and SHIPs in both PA and SC.

This brief describes opportunities for Medicaid agencies to partner with State Health Insurance Assistance Programs (SHIPs) in educating Medicare-Medicaid enrollees and their families on new integrated care program options.

This brief describes approaches that states have used to communicate early integrated care program results. Strategies discussed include developing program indicator dashboards, disseminating beneficiary experience data, and sharing success stories.

Beneficiary Engagement, Counseling, and Support

Lessons Learned from Dual Eligible Special Needs Plans Enrollee Advisory Committee Strategic Conversation

State Approaches to Developing and Operating Ombudsman Programs for Demonstrations under the Financial Alignment Initiative

Perspectives on Ombudsman Programs Serving Dually Eligible Individuals: Services Offered and Value Added

Building Relationships between Managed Care Organizations and Beneficiary Ombudsman Programs

Partnering with SHIPs to Improve Care

Medicaid Agency Partnerships with State Health Insurance Programs: Opportunities to Improve Care for Medicare-Medicaid Enrollees

Communicating Early Results of Integrated Care Efforts for Dually Eligible Individuals: State Approaches