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MEDICAID MODERNIZATION: An Update on the Health Consumer Ombudsman Alliance Report

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By Deanna Clingan-Fischer, State Long-Term Care Ombudman

As your State Long-Term Care Ombudsman, I always appreciate the opportunity to share more about my office and recent legislative changes that will help us assist you with your health care needs.

The mission of the Office of the State Long-Term Care Ombudsman is to serve as an advocate for residents of nursing and residential care facilities, as well as for tenants of assisted living programs and elder group homes.  My team works to protect the health, safety, welfare and rights of individuals residing in long-term care by investigating complaints, seeking resolutions to problems and providing advocacy to enhance the quality of life and care.

We have eight Local Long-Term Care Ombudsmen to serve residents and tenants in specific areas of the state.  Our office  also has a Discharge Specialist to advocate on behalf of residents who receive a notice of involuntary discharge or facility closure and two Volunteer Coordinators dedicated to implementing a certified volunteer program to recruit, train, and monitor certified volunteer long-term care ombudsmen.

Managed Care Ombudsman Program (MCOP)

After the 2015 legislative session, we were directed to take on two new responsibilities. The first was to hire a new team member to serve as the Managed Care Ombudsman for the approximately 57,000 Iowans who are covered under the seven Medicaid Home and Community Based Services (HCBS) waivers and institutional care. Our new Managed Care Ombudsman is already working with Iowans in transition, providing unbiased assistance with coverage questions and issue resolution. When the state fully transitions on March 1, the Managed Care Ombudsman will also connect members to our legal resource network to assist with new legal rights to grievances, appeals, and fair hearings. 

The second task was to lead a group of agencies and consumer organizations to develop a proposal for a Health Consumer Ombudsman Alliance, a statewide consumer assistance program for health care needs. You can see a complete listing of Alliance workgroup members in our final report. The proposed Alliance would help provide unbiased information and assistance to those attempting to navigate the complex Medicaid system, obtain and understand coverage, access health services and resolve problems. The group’s report was sent to lawmakers and the Governor in December and detailed five recommendations:

  1. Establish a Health Consumer Ombudsman Alliance.
    The purpose of the Alliance would be to identify gaps and discuss the overall health care needs of Iowans, make recommendations to address issues encountered and make appropriate consumer referrals. The Alliance would start with Medicaid managed care members and expand to help other groups of Iowans in the future.

  2. Develop a Medicaid Managed Care Information Program.
    The group recommended establishing a program to assist Medicaid members in obtaining objective and unbiased information, counseling and options for enrollment beyond what they are able to receive independently. The program, based upon the current Senior Health Insurance Information Program (SHIIP) model, will provide free, in-depth, one-on-one counseling and assistance to Medicaid members and their families and caregivers.

  3. Implement a Statewide Single Point of Entry.
    A single point of entry, or “no wrong door” approach, will make it easier to connect Iowans to experts who provide unbiased information and support in a specified area of need. The group proposed the expansion of the established LifeLong Links™ to serve as the statewide single point of entry for health care consumer information.

  4. Expand the Managed Care Ombudsman Program.
    The group also recommended expanding the Managed Care Ombudsman Program we just established, so we can serve all 57,000 Medicaid managed care members covered under the seven waivers or in institutional care.

  5. Expand the Current Legal Assistance Network.
    The group also believes Iowa's Medicaid members who will be served by managed care organizations may need legal assistance due to new rights. The Report recommends expanding the current legal assistance network to assist with appeals, grievances and state fair hearings.

The legislature has already begun work on the recommendations in the Report. Over the next few months, watch this newsletter or our website for more information. If you would like to learn more about the Office of the State Long-Term Care Ombudsman, our new Managed Care Ombudsman Program, or read the full report from the Health Consumer Ombudsman Alliance, please visit the links below.

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You can contact the Office of Long-Term Care Ombudsman at: 510 E 12th St., Ste. 2, Des Moines, IA 50319-9025 | (515) 725-3333 or (866) 236-1430 | Click here to find a local ombudsman near you.