My Ombudsman is an independent program that empowers individuals, including their families and caregivers, to access their services provided by MassHealth and its managed care plans.
To accomplish this goal, My Ombudsman:
Answers concerns or questions
Works cooperatively with the health plans, MassHealth, and other stakeholders
These steps ensure members can access their benefits and the rights they have as a MassHealth member.
Who does my ombudsman Serve?
My Ombudsman serves MassHealth members, as well as their family members and caregivers, who are enrolled in an Accountable Care Organization (ACO), the Massachusetts Behavioral Health Partnership (MBHP), a Managed Care Organization (MCO), a One Care plan, a Program of All-Inclusive Care for the Elderly (PACE) organization, or a Senior Care Options (SCO) plan and are seeking assistance accessing behavioral health (BH), long-term services and supports (LTSS), and other integrated health services.
What Does My ombudsman Do?
My Ombudsman helps resolve members' issues and conflicts in a variety of ways. My Ombudsman:
Provides information. My Ombudsman staff members answer questions about MassHealth health plans, including information about specific benefits, member rights, and how to access services.
Investigates. My Ombudsman staff members talk to all relevant parties to understand concerns, discuss options, and build solutions.
Mediates. My Ombudsman staff members can bring together people who want to solve problems.
Discusses options. My Ombudsman can help individuals find and consider options for addressing their concerns.
Explains grievance/appeal process. If the member chooses, My Ombudsman staff members can work with members and their plan to try to resolve a concern before filing a grievance or an appeal. While My Ombudsman cannot represent a member in grievance or appeal proceedings, staff members can explain how to file an appeal and what to expect during the appeal process.
Makes referrals. My Ombudsman can refer individuals to information and problem resolution resources, including formal grievance and appeal processes and legal services.
How Are My Ombudsman Services Provided?
Listening. My Ombudsman staff listen in order to understand an issue from all sides.
Maintaining confidentiality. My Ombudsman will not reveal personal information without the individual’s permission unless there is a serious and imminent threat to health and safety of the individual or others.
My Ombudsman Stays Neutral.
My Ombudsman staff will not judge or decide who is right or wrong or make decisions.
My Ombudsman will not serve in any other role that would compromise their ability to be impartial.
My Ombudsman will not represent a member in a grievance or appeal proceeding.
Who Operates the My Ombudsman Office?
My Ombudsman is an independent office operated by the Disability Policy Consortium (DPC) through a contract from MassHealth. DPC is an organization of disability activists who share a common goal of equal opportunity for all individuals.