Beneficiary Counseling & Ombudsman Programs

SPOTLIGHT & RELEASES 

Ombudsman and one-on-one counseling programs have been part of the Financial Alignment Initiative since its inception to ensure robust beneficiary supports in the demonstrations. 

• Ombudsman programs provide beneficiaries with person-centered assistance to resolve problems. Ombudsman programs also inform states, plans, CMS, and other stakeholders about 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. 

On April 1, 2019, CMS released a notice of funding opportunity (NOFO) to continue its commitment to provide funding 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 up to an additional 45 months of funding for these two separate-but-related beneficiary support programs. The NOFO can be accessed by using the following link and searching for CFDA number 93.634: http://www.grants.gov/web/grants/search-grants.html.

More information about support for beneficiary counseling and ombudsman programs can be found in the latest Frequently Asked Questions (PDF). 

 

State Ombudsman & One-on-One Counseling Programs

Each demonstration includes an ombudsman program to help people solve problems related to their services. Information on each state's ombudsman program is available below, including links to one-on-one counseling programs that have received funding under the Financial Alignment Initiative.

California  
Demonstration: Cal MediConnect

Ombudsman: Health Consumer Alliance 

One-on-One Counseling: Health Insurance Counseling and Advocacy Program (HICAP)

Illinois
Demonstration: Medicare-Medicaid Alignment Initiative (MMAI) 

Ombudsman: Medicare-Medicaid Alignment Initiative (MMAI) Ombudsman   

One-on-One Counseling: Senior Health Insurance Program (SHIP)

Massachusetts 
Demonstration: One Care

Ombudsman: My Ombudsman    

One-on-One Counseling: Serving the Health Insurance Needs of Everyone (SHINE)

Michigan 
Demonstration: MI Health Link 

Ombudsman: MI Health Link Ombudsman 

One-on-One Counseling: Michigan Medicare/Medicaid Assistance Program

New York
Demonstration: NY Fully Integrated Duals Advantage - Intellectual and Developmental Disabilities (NY FIDA-IDD)

Ombudsman: Independent Consumer Advocacy Network (ICAN) 

One-on-One Counseling: Health Insurance Information, Counseling, and Assistance Program (HICAP)

Ohio
Demonstration: MyCare Ohio 

Ombudsman: MyCare Ohio Ombudsman 

One-on-One Counseling: Ohio Senior Health Insurance Information Program (OSHIIP)

Rhode Island
Demonstration: Integrated Care Initiative 

Ombudsman: Integrated Care Initiative Ombudsman Program 

One-on-One Counseling: Medicare-Medicaid Enrollment Supports (MME)

South Carolina
Demonstration: Healthy Connections Prime 

Ombudsman: Healthy Connections Prime Ombudsman Program

Texas
Demonstration: Texas Dual Eligible Integrated Care Project 

Ombudsman: Health and Human Services Commission (HHSC) Office of the Ombudsman

 

Ombudsman Technical Assistance Program

The Administration for Community Living (ACL) has been providing technical assistance to grantees since 2013. Staff provide one-on-one assistance designed to meet each grantee's individual needs. ACL staff also coordinates an in-person meeting with the ombudsman programs twice annually. 

For more information, visit ACL's Duals Demonstration Ombudsman Program Technical Assistance webpage.

 

Funding

Since 2012, the Department of Health and Human Services has made funding available to support options and one-on-one counseling services and develop independent ombudsman programs to support demonstrations through the Financial Alignment Initiative.

Ombudsman Funding

Funding amounts are based on the number of beneficiaries eligible for the demonstration. All ombudsman awards are made for 12-month budget periods. The amounts awarded to date are included below.

• California: $7,494,476 since September, 2013
• Colorado: $442,645 since September, 2014 (demonstration ended December, 2017)
• Illinois: $4,447,011 since December, 2013 (funding since 2017 reflects combined funding for ombudsman and one-on-one counseling)
• Massachusetts: $2,473,961 since May, 2014
• Michigan: $2,936,979 since March, 2015 (funding since 2017 reflects combined funding for ombudsman and one-on-one counseling)
• Ohio: $4,084,407 since March, 2014  (funding since 2017 reflects combined funding for ombudsman and one-on-one counseling)
• Rhode Island: $1,174,780 since September, 2015
• South Carolina: $1,618,985 since September, 2015
• Virginia: $924,237 since November, 2013 (demonstration ended December, 2017)
• Washington: $203,468 since May, 2014

Total = $24,358,305

One-on-One Counseling Funding

Funding amounts are based on the number of beneficiaries eligible for the demonstration. Since 2016, all ombudsman awards are made for 12-month budget periods. The award amounts included below reflect all funding regardless of the funding opportunity under which CMS made the award, except as noted.

• California: $3,500,000 since June, 2013
• Illinois: $394,932 since August, 2013 (Starting in 2017, awards made with ombudsman funding as shown above)
• Massachusetts: $1,195,000 since March, 2013
• Michigan: $630,000 since May, 2015 (Starting in 2017, awards made with ombudsman funding as shown above)
• New York: $1,043,354 since December, 2014
• Rhode Island: $866,504 since December, 2015
• Virginia: $793,462 since August, 2013 (demonstration ended December, 2017)
• Washington: $114,240 since December, 2012

• Total = $8,537,492

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