Project Abstract
The Illinois Department on Aging is pleased to submit this joint application for the funding opportunity: Support for Ombudsman and Beneficiary Counseling Programs for States Participating in Financial Alignment Model Demonstrations for Dually Eligible Individuals.
In January 2014, the Illinois Medicare-Medicaid Alignment Initiative (MMAI) began testing an innovative payment and service delivery model to alleviate fragmentation and improve coordination of services for Medicare-Medicaid enrollees. The Illinois Home Care Ombudsman Program, which is housed at the Illinois Department on Aging, within the Office of the State Long-Term Care Ombudsman, began to implement the Demonstration in May of 2014 and continues to assist MMAI beneficiaries in navigating the complexities of managed care by providing individual and systems level advocacy.
In Illinois, MMAI is 21 counties in northern and central Illinois. Currently 51,531 participants are receiving services under MMAI. The Home Care Ombudsman Program works to empower MMAI participants in resolving problems they have with their health care, behavioral health care, and long-term services and supports. Home Care Ombudsmen are knowledgeable in areas relevant to participant services including information about participants’ rights under Medicaid and Medicare programs, long-term services and supports, health and behavioral health services, accessibility and non-discrimination laws and regulations as they apply to access to medical plans, providers and benefit design. Home Care Ombudsmen inform CMS and other stakeholders regarding participant experiences and serve as skilled negotiators with experience in dispute resolution and problem solving.
MMAI inquiries and complaints will be routed through the Illinois Department on Aging’s, Senior Helpline and the Illinois Home Care Ombudsman general mailbox. The Deputy State Home Care Ombudsman will manage the Home Care Ombudsman Program and will assign cases and inquiries to one of the six Home Care Ombudsman staff members hired through personal services contracts at the State level. MMAI related calls will be assigned to the respective Home Care Ombudsman based on the geographic region of the participant. Designated staff will be assigned to cover Chicago, the Greater Chicago Region and the Central Illinois Region.
Home Care Ombudsman Program staff will also focus on raising awareness about the role of the Home Care Ombudsman, the availability of Ombudsman services among MMAI managed care organizations, Area Agencies on Aging, Care Coordination Units, Medicaid counselors, State Health Insurance Program, Aging and Disability Resource Centers (ADRC), Centers for Independent Living, Adult Protective Services, and other entities that focus on health, behavioral health, and long-term services and supports.
The budget request for the 45-month funding period is 1,821,966.90
Support for Ombudsman and Beneficiary Counseling Programs for States
Participating in Financial Alignment Model Demonstrations for Dually Eligible
Individuals
SHIP Project Abstract
In an effort to provide one-on-one counseling for health coverage to the older adults and
persons with disabilities, the Illinois Department on Aging’s (IDoA) Senior Health
Insurance Program (SHIP) assists beneficiaries to make informed decisions regarding
their options for receiving Medicare and Medicaid benefits as well as link them to other
long term care supports and services, the community ombudsman, and other federal
and state agencies when appropriate.
SHIP continues to partner with the statewide Aging and Disability Resource Centers,
Area Agencies on Aging, the Coalition for the Limited English Speaking Elderly
(CLESE), Federally Qualified Health Centers, Hospitals, Township Offices, and HUD
Service Coordinators to serve individuals in counties impacted by the Medicare-
Medicaid Alignment Initiative (MMAI). SHIP also collaborates with the State’s Medicaid
agency to implement new
