Addressing Complaints and Grievances in Medicaid Managed Care
Medicaid managed care contracts differ from commercial contracts, both in the federal and state legal requirements to which they are subject and in the populations contractors serve. They also differ in their grievance procedures. Under federal law, Medicaid managed care contracts are required to have state-approved internal grievance processes. Also, Medicaid beneficiaries have certain due process protections that commercial plan enrollees do not, in particular, the right to contest decisions through state fair hearings. These protections are designed to serve Medicaid beneficiaries, many of whom – because of low literacy and reading comprehension levels – may lack the skills necessary to advocate for themselves in a managed health care delivery system and may need assistance in developing and submitting grievances. Ten states that have incorporated numerous grievance procedures into their Medicaid managed care programs were included in this report.
| 1999.Feb_.trends.serving.people.hiv_.aids_.medicaid.managed.care_.pdf | 4.1 MB |
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
