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The State of California was recently awarded a Federal grant from the Centers of Medicare and Medicaid Services (CMS) to support and establish a program to perform ombudsman services for Cal MediConnect. This program will be an important consumer protection for all Cal MediConnect enrollees, ensuring that individual issues can be addressed. These services will be in addition to existing appeals and grievances processes.
The program will be housed within the Department of Managed Health Care (DMHC). Its independence from the Department of Health Care Services (DHCS) during implementation is a critical element of its creation, ensuring that there is a third-party charged with assisting enrollees and providing feedback to DHCS on one of its programs.
From January to February 2014, DHCS and DMHC ran a rigorous RFP process to select a primary independent entity that would be responsible for administering ombudsman services specific to the needs of Cal MediConnect beneficiaries, their family members, and caretakers. The chosen primary entity is the Legal Aid Society of San Diego. The Legal Aid Society of San Diego, and a number of experienced subcontractors throughout the demonstration counties, will be available to provide ombudsman services to Cal MediConnect beneficiaries. The Legal Aid Society of San Diego, and all their subcontractors, are highly experienced in providing ombudsman services. The Cal MediConnect Ombudsman will be operational starting April 1, 2014.
Below are links to important information, policy documents, and additional reading to help in understanding the Cal MediConnect Ombuds Program.
- Cal MediConnect Ombuds Program Informational Guide (November 2013)
- Cal MediConnect Ombuds Program RFP (2013)
- Cal MediConnect Ombuds Program: Appendix 1 (2013)
- Cal MediConnect Ombudsman Services RFP (August 16, 2016)
- Medi-Cal Managed Care Office of the Ombudsman – Helpful information about the current Medi-Cal Managed Care Ombudsman program. Please use this information to get an idea of how an Ombudsman program functions.
- The Department of Managed Health Care’s Consumer Assistance Program – Learn about DMHC’s Consumer Assistance Program, the program that the Cal MediConnect Ombuds Program was modeled after.
Please join our email list to make sure you get the latest updates on the Cal MediConnect Ombuds Program, including updates when policy documents are released and opportunities to give feedback on the program.
Questions can be sent to firstname.lastname@example.org.