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. The Cal MediConnect Ombuds 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 serve the following functions:
- Provide ombuds services to individuals enrolled in Cal MediConnect plans;
- Empower enrollees and their families;
- Investigate and resolve enrollee problems/complains with Cal MediConnect plans;
- Monitor ombuds efforts and track problems/complaints; and,
- Share ombuds best practices with CMS and other Financial Alignment Initiative states.
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.
Throughout the planning and implementation process, stakeholders will have the opportunity to provide input. The first stakeholder meeting on this topic will be announced via the CalDuals email list. Please join the list to make sure you get the latest updates.
Questions can be sent to info@calduals.org.
Obamacare has been a disaster already, which is even shocking to me. This MediConnect program will be horrific for the dual eligibles. My anecdotal evidence tells me that 98% of my patients don’t want any changes to their current Medicare services. My gut feeling says that this program will be delayed once again. Remember what my patient told me earlier this year, “just say no, no, no to the HMO.”
Obamacare has been a disaster already, which is even shocking to me. This MediConnect program will be horrific for the dual eligibles. My anecdotal evidence tells me that 98% of my patients don’t want any changes to their current Medicare services. My gut feeling says that this program will be delayed once again. Remember what my patient told me earlier this year, “just say no, no, no to the HMO.”