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Empire Justice Letter to CMS in Support of NY's Super Waiver Proposal

Cynthia Mann, Director
Center for Medicaid and CHIP Services
7500 Security Boulevard, MS S2-26-12
Baltimore, MD 21244

Via Electronic and Postal Mail

Dear Ms. Mann,

I am writing on behalf of Empire Justice Center, a statewide non profit law firm focused on improving the law for all New Yorkers through systems change advocacy as well as individual representation, to voice our particular support for a component of New York State’s 1115 Waiver application.

As a legal services provider and Steering Committee member of Medicaid Matters NY, we are very pleased to support New York State’s recent request for an amendment to the New York Partnership Plan which includes a new program that would provide independent, individual and systemic advocacy on behalf of people with disabilities and chronic illnesses that are newly enrolled in Medicaid Managed Care and other new models of care management.  Referred to in the waiver amendment application as “Ombudsperson Program – Supporting Choice,” on page 68 in the section titled “Long Term Transformation and Integration to Managed Care,” this new initiative addresses the need for an advocacy program specializing in consumer education, community training, and advocacy services tailored to meet the unique needs of these populations.

This program is designed to expand and target advocacy services to reach a group of people numbering as many as 1.5 million who will be entering managed care for the first time in the next few years.  It is intended to drive resources to the various groups in local communities that serve the newly mandated populations in order to strengthen their capacities and competencies and target help for this new wave of people as they enter and adjust to various managed care programs.  In addition to strengthening local capacity, the emphasis is on improving disability literacy and accommodations in managed care settings, while recognizing the complexity of the work involved in serving those with multiple and profound needs.

Recipients would benefit from: learning how to access services in a managed care environment; help in securing a change in or restoration of benefits, services, or supports; advocacy to obtain accommodations for their disabilities; and the fruits of systemic advocacy addressing patterns such as improper notices, inadequate networks or accommodations, or unlawful care management practices.  Further, recipients in managed care generally would benefit from the ability to access an enhanced information and referral system with automated guidance by telephone as well as general advice and referrals from well trained advocates situated in their own communities.

There are various programs and services currently provided to the target population that offer similar components contemplated by the program design.  There is not, however, sufficient capacity within the current disability and legal services networks to provide the proposed level of service without a significant increase in resources.

This proposal seeks to replicate a similar program in Wisconsin that has a proven record of successfully providing assistance and advocacy to people with disabilities in Medicaid Managed Care.

On behalf of the interests of the Medicaid beneficiaries we represent, we strongly urge full support of this proposal.

Sincerely,

Trilby de Jung
Senior Health Law Attorney

August 27, 2012