Pod Cast Listings
Mitzi E. McFatrich the Executive Director for Kansas Advocates for Better Care shares with Joe a tool to assist with advocacy. KanCare and Your Plan of Care: Know Your Rights it deals with information about, "What you can do when needed services are reduced, eliminated or denied."
Mitzi shared that, "Our purpose in working with Justice in Aging (formerly the National Senior Citizens Law Center)to develop this resource came about for a few different reasons including a desire to be certain that adults who are older and/or have disabilities would have assistance to help them navigate a brand new system for how decisions are made and healthcare supports and services are determined and delivered, as well as assistance when a negative action was made about the supports and services needed through the state’s new KanCare Medicaid program. Some specific areas of concern included:
1) Transition of Medicaid funded healthcare and long-term care services and supports to 3 private, for profit managed care insurance companies which had not previously provided these types of services to adults with disabilities or who were older. We anticipated rightly that there would be difficulties for individual consumers in being approved for and receiving the amount and type of supports and services they need to function optimally in the setting they choose.
2) Lack of a KanCare Ombuds program which is able to advocate for KanCare/Medicaid beneficiaries who want help in filing or pursing a grievance in the event that the individual is dissatisfied with the services provided by the managed care organization, or, help in filing or pursing an appeal to the managed care organization or a state fair hearing request in the event that their services are terminated, reduced, or specific services are cut, or if the individual wishes to challenge the state agency which might have determined them ineligible for KanCare/Medicaid.
3) Who/Which organizations could be of help to individuals when a “negative action” or determination was made against the supports and services needed.
4) What an individual’s rights are to filing a grievance, appeal or state fair hearing and what legal parameters have to be followed to successfully pursue an issue.