Medicaid Problem Reporting Form

• Continuity of care: We have received some reports of problems with continuity of care pertaining to consumers with long-term connections to medical, dental, or mental health providers who are not affiliated with the new Medicaid HMO network. Per the frequently asked questions (FAQs) developed by the NJ Dept. of Human Services: "Your HMO will ensure that your care continues after enrollment without interruption. Once you are enrolled, the HMO will do an assessment of your needs and any changes to your care plans or your providers will be discussed with you at that time. In most HMOs, you will need to use providers within the HMO's network. However, your doctors may already be in the network or may enroll as a provider in the HMO's network. If you have primary insurance with a private health plan or Medicare, you should follow that health plan's rules for choosing your providers for all covered benefits covered by that health plan."

 

• Continuity of care for prescription medications: Also from the Medicaid FAQs: "For Medicaid-only members, your HMO will ensure that your care [prescription medication] continues after enrollment without interruption until they do an assessment of your needs and services. Any changes to your medications will be discussed with you at that time."



• A question arose recently regarding the coverage for partial hospital and partial care services for people with the dual diagnosis of a developmental disability and mental health disorder. DDD clients who need these services will continue to receive them from Medicaid fee-for-service; these services are currently "carved out" from the Medicaid HMO system.

If families of children with special healthcare needs have problems related to these issues – or any other aspect of the Medicaid HMO system -- please fill in the attached form and either e-mail or fax it back to the Arc of NJ and SPAN, so we can forward it to Medicaid for resolution of the problem.

We are asking everyone to use this form when reporting Medicaid problems to us, and please be absolutely certain that they have the consumer or legal guardian's permission to transmit this information. There is a section at the bottom of the attachment for a signature to this effect.

Please share this e-mail and the attached form with families, staff and consumers in the special healthcare needs/disability community. Thanks.

Download Medicaid problem reporting form