United States - External Advocacy and Independent Ombudsman Services

Description

Wisconsin Statute section 46.281(1n)(e) requires the Department of Health Services (DHS) to contract for statewide ombudsman services for the Family Care program and the self-directed services option.
The Independent Ombudsman (IO) program provides advocacy services as delineated in §16.009(2)(p) to the following groups:
• Actual or potential enrollees of the Family Care or Family Care Partnership programs under the age of 60,
• Actual or potential participants of the Include, Respect, I Direct (IRIS) program under the age of 60, and
• Families or guardians of actual or potential enrollees/participants listed above.

In addition to long-term care ombudsman services, DHS seeks to contract for External Advocacy (EA) services for enrollees in the Supplemental Security Income (SSI) Medicaid program. These services are provided to the following groups:
• Actual or potential enrollees of managed long-term care and their families or guardians, and
• SSI-related Medicaid recipients.

For clarity, this form will refer to all these groups collectively as “Medicaid consumers.”
DHS seeks to award one contract to an entity that can provide parallel services under the IO and EA programs. These services will help Medicaid consumers navigate the Medicaid benefits system by:
a. Providing individual case advocacy, including
i. Helping Medicaid consumers obtain and maintain Medicaid benefits;
ii. Accessing needed services and supports;
iii. Filing complaints, grievances, appeals, and fair hearing requests;
iv. Representing Medicaid consumers at administrative hearings or in court; and
v. Facilitating informal resolutions for Medicaid consumers and their managed care providers.
b. Coordinating with DHS to conduct community outreach and education regarding the ombudsman and advocacy programs. Outreach activities may include, but are not limited to, attending town hall meetings for Department initiatives and participating in meetings with other advocates or managed care providers.
c. Coordinating with the Board on Aging and Long-term Care (BOALTC), which provides advocacy and assistance to managed long-term care enrollees/participants who are age 60 and older and their families or guardians.

Opportunity closing date

02 August 2024

Value of contract

to be confirmed