When: Wednesday, November 5, 2014, 2-3 PM EDT
Since 2009, the number of states delivering Medicaid long-term services and supports (LTSS) through managed care has increased more than four-fold, so that presently, 28 states either operate a managed care long-term services and supports program, or intend to operate a program in the near future. This overlay of managed care in Medicaid LTSS raises new issue in how Medicaid consumers can — or cannot — access needed services and understand and exercise their right to appeal unfavorable managed care decisions.
Understanding the rules and options is crucial both for assisting individual clients and negotiating policy improvements.
This session provided an introduction to the governing federal regulations, and examined how various states and managed care organizations are handling notices, appeals, and fair hearings. Real-life examples from Florida, Kansas and New Jersey were used to illustrate promising practices as well as areas where beneficiary due process rights are at risk.
Gwen Orlowski, National Senior Citizens Law Center
Eric Carlson, National Senior Citizens Law Center