Health assistance programs for Medicaid patients were initially created to help people in finding the appropriate managed care programs for them. They help Medicaid patients in staying qualified for the Medicaid program and in working out issues and difficulties patients encounter with health care services. They give Medicaid patients, and providers, guidance and education on updates about the program. They also review and gather information regarding Medicaid patients’ problems that can assist policymakers, Medicaid agencies, and health plans in resolving these issues. Health assistance program responsibilities vary from training patients and providers, to looking into complaints and finding resolutions, and essentially representing Medicaid patients in grievances and fair hearings. Other states have health assistance for Medicaid patients that include focused programs that help mental health patients and others that require special health care.
If Medicaid patients or applicants encounter any problems when they are trying to qualify for the program and have concerns regarding their ineligibility, or experience difficulties getting appropriate health care services, federal law requires states to have health assistance programs in place to handle these issues. These health assistance programs must educate Medicaid patients of the investigation and make sure that they will be represented.
There are around 20 states that have health assistance for Medicaid patients. Some of these are operated by government agencies and there are others that are managed by nonprofit organizations that have contracts with state Medicaid offices to supply health assistance for Medicaid patients. Almost half of these health assistance programs provide representation for Medical patients in formal complaints hearings, even though most of these health assistance for Medicaid patient programs have few lawyers in their teams.
For health assistance programs that are dedicated in defending Medicaid patients right to due process, they make sure that patients are aware of the process in filing complaints, hearing requests and appeals. They inform Medicaid patients how long these processes take and what happens in every step of the process. They also help Medicaid patients by referring them to agencies or groups that provide legal assistance services for their representation in courts if needed. They actively participate and assist Medicaid patients in collecting medical documentation and records, as well as other evidence in order to get ready for their defense. Health assistance for Medicaid patients tries its best to resolve complaints through informal resolution attempts and presenting these as evidence if these do not work. And if legal proceedings are actually done, they go with the Medicaid patients to the hearings or appeals and sometimes actually act as legal representatives for the Medicaid patient in a grievance, appeal, or fair hearing.
Although there are federal guidelines that give Medicaid patients the right to represent themselves in grievances hearings and appeals, studies reveal that they are more successful if they are given specialist advice about policies that can be used for the case and data or facts that are applicable to those policies.
A number of states require Medicaid insurance plans to have a directory of health assistance for Medicaid patients in denial of care notifications so that patients will know where they can get help. There are states that have legal assistance offices that serve as health assistance groups from Medicaid patients.