Everyone with a CCC Plus Medicaid Waiver has chosen a Managed Care Organization or MCO, and you have been assigned a support coordinator from the MCO.
Many individuals who have the CCC Plus Medicaid Waiver are experiencing a cut in their Personal Care Hours. Personal care (attendant care) services fund a one on one person hired either
- directly by the person with a disability and their support team (called Consumer Directed Services) or
- a caregiving agency (called Agency Directed Services).
The reductions in the number of hours is being driven by the MCO’s to contain their costs. Without good documentation, you may be at risk of losing critical support, if you haven’t already.
If you are receiving this service, start gathering your paper work, and before you meet with your support team, make sure you have
- documentation of why you or the individual receiving waiver services needs the supports, what they are for and the hours needed, especially as it relates to safety needs.
- a calendar showing when support hours are needed and what they are
- letters of support from the individual’s physician, therapists or any others involved in the individual’s treatment that justify the supports.
Think about your request ahead of time. Talk with your support team before the meeting if you can; it includes the individual receiving the waiver, family friends, the individual’s support coordinator from the MCO, and your Service Facilitator if you use Consumer Directed Services.
If you are not happy with the number of authorized hours, you can request a review with the Managed Care Organization; if the concern is not addressed, a Department of Medical Assistance Services (DMAS) Appeal can be filed. This must be done within 30 days of the change or new authorization.
Important! Also contact the Long Term Care Ombudsman with your complaint. DMAS has put the Ombudsman positions in place to collect and report issues directly to them regarding CCC Plus Waiver Services.