Medicaid Managed Care Ombudsman Programs

Programs that help to solve problems to ensure that members enrolled in a Medicaid Managed Care program receive all medically necessary covered services for which their plans are contractually responsible. The office of the Ombudsman serves as an objective resource to resolve issues between Medicaid managed care members and managed care health plans, helps members understand their rights regarding services, care and access to managed care, connects members with local resources that can help them including patient rights services, assists members with urgent enrollment and disenrollment problems, and educates members on how to effectively navigate through the Medicaid managed care system.