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Funding to Support Ombudsman Programs

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09/30/16 - Updated funding opportunity announcement (FOA) information. 

On September 30, 2016, CMS released a funding opportunity announcement (FOA) to support demonstration ombudsman programs and one-on-one counseling services in states participating in the Medicare-Medicaid Financial Alignment Initiative. This announcement will provide eligible states with an additional two years of funding for these two separate-but-related beneficiary support programs:

  • Ombudsman programs provide beneficiaries with person-centered assistance to resolve problems. Ombudsman programs also inform states, plans, CMS, and other stakeholders regarding trends and identify areas for improvement within the demonstrations. 
  • One-on-one counseling programs, such as State Health Insurance Assistance Programs (SHIPs) and Aging and Disability Resource Centers (ADRCs), conduct outreach and provide education and assistance to beneficiaries regarding their insurance options. 

This FOA is a continuation of the support for both ombudsman and one-on-one counseling programs that has been part of the Financial Alignment Initiative since its inception to ensure robust beneficiary supports in all demonstrations. 

The FOA can be accessed by using the following link: http://www.grants.gov/web/grants/search-grants.html and search for CFDA 93.634. 

Frequently Asked Questions updated 10/18/16

Information for Beneficiaries

Each demonstration includes an "Ombudsman Program" to help people solve problems related to their services. You may search for your state's ombudsman program below:

California  
Demonstration: Cal MediConnect
Ombudsman: Health Consumer Alliance
http://healthconsumer.org/

Colorado
Demonstration: Accountable Care Collaborative (ACC)
Ombudsman: Medicare/Medicaid Advocate                                                                                                          https://disabilitylawco.org/

Illinois
Demonstration: Medicare-Medicaid Alignment Initiative (MMAI) 
Medicare-Medicaid Alignment Initiative (MMAI) Ombudsman                                                                           https://www.illinois.gov/aging/ProtectionAdvocacy/LTCOmbudsmen/Pages/default.aspx

Massachusetts 
Demonstration: One Care
One Care Ombudsman 
http://www.onecareombuds.org/

Michigan 
Demonstration: MI Health Link
MI Health Link Ombudsman 
http://mhlo.org

New York
Demonstration: New York Fully Integrated Duals Advantage (FIDA) Demonstration
Ombudsman: Independent Consumer Advocacy Network (ICAN)
http://www.icannys.org/

Ohio
Demonstration: MyCare Ohio
MyCare Ohio Ombudsman 
http://aging.ohio.gov/services/ombudsman/

Rhode Island
Demonstration: Integrated Care Initiative
Integrated Care Initiative Ombudsman Program
http://ripin.org/healthcareadvocate/ 

South Carolina
Demonstration: Healthy Connections Prime
Healthy Connections Prime Ombudsman Program
http://www.healthyconnectionsprimeadvocate.com/

Texas
Demonstration: Texas Dual Eligible Integrated Care Project
Health and Human Services Commission (HHSC) Office of the Ombudsman
https://hhs.texas.gov/about-hhs/your-rights/office-ombudsman 

Virginia
Demonstration: Commonwealth Coordinated Care (CCC) 
Commonwealth Coordinated Care (CCC) Ombudsman
http://www.elderrightsva.org/

Washington
Demonstration: HealthPath Washington
Ombudsman Program Washington State Department of Social and Health Services
http://www.waombudsman.org/

Background

On June 27, 2013 the Department of Health and Human Services released a Funding Opportunity Announcement through which states can apply for funding to develop independent Ombudsman Programs to support demonstrations through the Financial Alignment Initiative.

Previous Awards Made

All Ombudsman awards are made for twelve month periods. Amounts awarded to date are below.

  • California - $3,000,000 (Year 1, $708,366; Year 2, $1,145,817; Year 3, $1,145,817) (September 2013 date of first award)
  • Colorado - $442,645 (Year 1, $210,760; Year 2, $231,885; Year 3, $231,885) (September 2014 date of first award)
  • Illinois - $1,398,678 (Year 1, $267,556; Year 2, $565,561; Year 3, $565,561) (December 2013 date of first award)
  • Massachusetts - $554,675 (Year 1, $159,084; Year 2, $395,591) (May 2014 date of first award)
  • Michigan - $303,667 (March 2015 date of first award)
  • Ohio - $723,224 (Year 1, $272,354; Year 2, $479,927; Year 3, $479,927) (March 2014 date of first award)
  • Rhode Island - $165,623 (September 2015 date of first award)
  • South Carolina - $246,493 (September 2015 date of first award)
  • Virginia - $924,237 (Year 1, $245,079; Year 2, $339,579; Year 3, $339,579) (November 2013 date of first award)
  • Washington - $203,468 (May 2014 date of first award)

Ombudsman Technical Assistance Program

The Administration for Community Living (ACL) operates the Office of Dual Demonstration Ombudsman Technical Assistance Program to support CMS state grantees that are designing and implementing an ombudsman program to support the implementation of their financial alignment model. 

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