The importance of Ombudsman programs in supporting the transition from medicare-medicaid plans to dual special needs plans

IF 3.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Disability and Health Journal Pub Date : 2025-07-01 DOI:10.1016/j.dhjo.2025.101774

Falguni Basnet , Colin Killick , Leslie Diaz , Sabrina Felteau

引用次数: 0

Abstract

In this paper, we examine the critical role of Ombudsman programs in facilitating the transition from Medicare-Medicaid Plans (MMPs) to Dual Special Needs Plans (D-SNPS) for dual-eligible members. As states implement this federally mandated transition, Ombudsman programs serve as essential supports for the dual-eligible population who are navigating complex healthcare changes. Through analysis of Ombudsman programs in California, Massachusetts, Rhode Island, and Michigan, we highlight how these services address beneficiary concerns, resolve access issues, and provide valuable insights to policymakers. We emphasize the importance of maintaining and potentially expanding Ombudsman programs during and after the transition to ensure person-centric, high-quality care for dual-eligible members.

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监察员项目在支持从医疗补助计划向双重特殊需要计划过渡方面的重要性。

在本文中，我们研究了监察员计划在促进从医疗补助计划（MMPs）到双重特殊需要计划（D-SNPS）的双重资格成员过渡中的关键作用。随着各州实施这一联邦授权的过渡，监察员计划将为双重资格人群提供必要的支持，这些人群正在应对复杂的医疗保健变化。通过对加利福尼亚州、马萨诸塞州、罗德岛州和密歇根州监察员项目的分析，我们强调了这些服务如何解决受益人的关切，解决获取问题，并为政策制定者提供有价值的见解。我们强调在过渡期间和之后维持并可能扩大监察员计划的重要性，以确保为双重资格成员提供以人为本的高质量护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Disability and Health Journal HEALTH CARE SCIENCES & SERVICES-PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

CiteScore

7.50

自引率

6.70%

发文量

134

审稿时长

34 days

期刊介绍： Disability and Health Journal is a scientific, scholarly, and multidisciplinary journal for reporting original contributions that advance knowledge in disability and health. Topics may be related to global health, quality of life, and specific health conditions as they relate to disability. Such contributions include: • Reports of empirical research on the characteristics of persons with disabilities, environment, health outcomes, and determinants of health • Reports of empirical research on the Systematic or other evidence-based reviews and tightly conceived theoretical interpretations of research literature • Reports of empirical research on the Evaluative research on new interventions, technologies, and programs • Reports of empirical research on the Reports on issues or policies affecting the health and/or quality of life for persons with disabilities, using a scientific base.