In this time of accelerated change in so many of the areas where services are provided to people disabilities, my job is systems advocate is to do my best to update you on the changes so that you can be appropriately prepared. And for this newsletter, I got a doozy when it comes to Medicaid services.
Previously, if you had a disagreement with the service that Medicaid was providing, you had the right to go directly to an impartial fair hearing. These hearings, led by hearing officers employed by the state, assured you a fair hearing of your issue whether it be the need for increased aide hours or approval of therapies, to use two common examples. Starting in May 2018, fair hearings are only available to Medicaid recipients who have attempted to use the appeal process within their Managed Long Term Care or Manage Care Organization plan. (The old system does still apply if you’re not using a MCO or MLTC - called “Medicaid fee-for-service”).
It’s very important that you keep track of communications you get from your plan about changes to your services. The new system has a very short window to assure that your services continue while you appeal (called “Aid Continuing”) - 10 days from the day the letter sent by your plan is dated.
Like every change in state policy, there are some loopholes and exceptions. If you have a concern about fighting for services you need, contact the advocates here at ILNC. We keep track of these things and can give you the most current information.