Support for Ombudsman and Beneficiary Counseling Programs for States Participating in Financial Alignment Model Demonstrations for Dually Eligible Individuals - The Support for Ombudsman and Beneficiary Counseling Programs for States Participating in Financial Alignment Model Demonstrations for Dually Eligible Individuals funding will ensure that the ombudsman program serving beneficiaries of Massachusetts’ Financial Alignment Demonstration (One Care), will continue its work to empower beneficiaries throughout the current demonstration period (expected to go through December 31, 2020). Support from this grant will also enable ombudsman services to continue through the anticipated implementation of a new Massachusetts Medicare-Medicaid Integration Demonstration – Duals Demonstration 2.0 (Duals Demonstration 2.0), to begin January 1, 2021. Duals Demonstration 2.0 will encompass both One Care and Massachusetts’ Senior Care Options (SCO) program.
One Care is an option for dual eligible individuals, ages 21-64 and living with disabilities to receive integrated, coordinated Medicare and MassHealth benefits through a single health plan under three-way contract with MassHealth and CMS. One Care is currently available across 9 (of 14) counties and 1 partial county. SCO serves dual eligible individuals ages 65 and over through a coordinated care model currently operated by Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs), and is available statewide (except for two Cape island counties). As of May 1, 2019, 24,210 individuals were enrolled in One Care, and 55,389 in SCO (of approximately 200,000 dual eligibles) and enrollment grows monthly. MassHealth also anticipates significant growth in both under Duals Demonstration 2.0.
MassHealth will continue providing ombudsman services as described in this grant through its integrated My Ombudsman (MYO) program, which provides services to demonstration beneficiaries, and those enrolled in other MassHealth managed care programs. The Disability Policy Consortium (DPC), who previously served as the One Care Ombudsman, operates MYO. DPC is an independent organization with a strong history of cross-disability advocacy, and many staff are themselves individuals living with disabilities. Through MYO, MassHealth offers a no-wrong door approach to ombudsman services for demonstration beneficiaries, with greatly enhanced capacity for outreach and improved abilities to educate and serve the demonstration populations. This approach also enables MassHealth to integrate analysis of data related to demonstration beneficiaries with data from other programs to better identify and address potential systemic concerns impacting the demonstration, and/or that may be related to specific populations, providers, or services across programs.
MYO staff provide culturally competent, accessible, and person-centered services, and serve four primary roles: (1) empowering beneficiaries by providing person-centered education related to beneficiary rights, Medicare and Medicaid benefits and quality of services; (2) conducting outreach; (3) investigating and resolving complaints related to beneficiaries’ rights and access to person-centered, integrated care; and (4) collecting, analyzing, and reporting data, as well as coordinating with other stakeholders, to identify trends and make recommendations for improvement.
MassHealth’s contract with DPC requires that they comply with all terms and conditions of the cooperative agreement awarded under this grant, including ensuring that funds received will be used only to fund activities for demonstration beneficiaries. MassHealth will draw on its considerable experience managing federal grants (including the previous grants to support Demonstration Ombudsman programs) to ensure full compliance with, and participation in, all required grant activities. As now, under the Assistant Secretary’s leadership, staff in the MassHealth Policy Unit will oversee the project, develop and submit reports, and collaborate with CMS and other states. The total budget requested under this grant is $2,336,746 over a 45 month project period.
