Slide 1: My Ombudsman Discussion

Executive Office of Health & Human Services

October 2024

Boston, MA

Slide 2: Overview: My Ombudsman

•	My Ombudsman is an independent program available to all MassHealth members. 
•	My Ombudsman can help members with questions or who need help getting benefits or services from MassHealth or their MassHealth health plan. 
o	They can provide information about MassHealth benefits and rights, listen to concerns, and help address problems. 
o	My Ombudsman can also explain how to file a grievance or appeal, but they cannot represent members in these processes. 
•	In addition, My Ombudsman is tasked with documenting and analyzing data about member-level issues within and across MassHealth health plans and Fee For Service programs in order to assist MassHealth with:
o	better understanding the everyday experiences of members in accessing care and services, and 
o	identifying any potential trends or patterns to help improve the delivery of services for these members. 

Slide 3: My Ombudsman – Eligibility and Utilization

•	My Ombudsman is currently operated through a contract with the Disability Policy Consortium (DPC) 
•	It is a free resource available to any member, including members enrolled in:
o	An Accountable Care Organization (ACO)
o	A Managed Care Organization (MCO)
o	The Primary Care Clinician (PCC) plan 
o	One Care
o	Senior Care Options
o	PACE (Program of All-Inclusive Care for the Elderly), and
o	Members who receive their care via Fee for Services (FFS)
•	My Ombudsman currently has some multi-lingual ombudsman staff, and can also serve members who speak over 165 languages on-demand using a cultural interpreter line
•	Members can access My Ombudsman services via email, website, phone, videophone (for members who are Deaf or Hard of Hearing), or in-person
•	In addition to assisting members, My Ombudsman engages in community-based outreach and education 

Slide 4: Questions for Discussion

Over the coming months, MassHealth will need to conduct a procurement of the My Ombudsman contract, and is currently looking for general feedback or ideas regarding the program.  In particular:
•	How many people here have heard of My Ombudsman?
•	What has worked well with the My Ombudsman program?
•	What could be improved?
•	And/or, in general, what are the most important parts or characteristics of an ombudsman program to keep in mind moving forward?
•	Should potential bidders be limited to community-based organizations, as now?
•	Should MassHealth keep the name, “My Ombudsman”?

Slide 5: How to Access My Ombudsman Services

My Ombudsman
Need help with your MassHealth benefits? We’re here for you.

•	Phone: 855-781-9898
•	Deaf/Hard of Hearing: 339-224-6831
•	Email: info@myombudsman.org
•	Web: My Ombudsman 
•	Monday-Friday 9am-4pm

•	Nosotros hablamos Español
•	Nou pale Kreyol
•	We use ASL

•	We use an interpreter phone service for many other languages as needed