MM Curator summary
NC awards Legal Aid contract to help members navigate issues during the transition to managed care.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
The N.C. Department of Health and Human Services said Wednesday that Legal Aid of N.C. will provide Medicaid Managed Care ombudsman services for 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 help resolve issues within the Medicaid Managed Care delivery system. The ombudsman services will begin in the spring.
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 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.