NCDHHS Awards Contract for Medicaid Managed Care Ombudsman Services

Raleigh

RALEIGH — The North Carolina Department of Health and Human Services announced today that Legal Aid of North Carolina (Legal Aid) will provide Medicaid Managed Care Ombudsman services for the state’s Medicaid beneficiaries.

Legal Aid will partner with the Charlotte Center for Legal Advocacy and Pisgah Legal Services to educate and inform beneficiaries about the state’s move to Medicaid Managed Care through outreach events, a public website and a toll-free phone number. The Ombudsman will also help beneficiaries resolve issues within the Medicaid Managed Care delivery system. The Ombudsman services will begin in spring 2021.

“The Ombudsman will be an excellent resource for individuals and families to provide answers to specific questions or concerns they may have as the state transitions to Medicaid Managed Care,” said Deputy Secretary for NC Medicaid Dave Richard. “With its deep understanding of the Medicaid program and strong history of advocating on behalf of beneficiaries we are excited that Legal Aid will serve in this important role.”

As the Ombudsman, Legal Aid will work collaboratively with community-based organizations and government agencies to assist beneficiaries with issues impacting their health. The Ombudsman will be available to address specific Medicaid-related questions from beneficiaries, make referrals to applicable resources and assist in resolving issues with managed care. In addition, the Ombudsman will help track crucial information regarding access to care for ongoing reporting and analysis. This will help identify trends across Medicaid Managed Care to ensure timely attention to potentially systemic issues.

The Ombudsman services provided by Legal Aid are not a replacement for the Grievance and Appeals processes required of each Prepaid Health Plan, nor do the services replace the right of a member to appeal through any State-administered appeals system. These services are distinct from North Carolina’s existing Long-Term Care Ombudsman Program that assists residents of long-term care facilities.

More information about Medicaid Transformation can be found on the Medicaid website at medicaid.ncdhhs.gov/transformation.

 

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