If you find yourself in a situation that your community services are going to change, or if your request for services is denied — there is something that you can do.

This is for Medicaid funded home and community-based supports only. The New York State Office of Temporary and Disability Assistance notes that you can have an administrative law judge review your concern if the Managed (Medicaid) Long Term care Insurance provider (MLTC) or the local Department of Social Services (LDSS) has changed your plan of care. This may be because your amount of services/benefit is to be changed (usually reduced) or eliminated. The fair hearing process works to have your side be presented and a judge will then make a determination regarding the services that have been reduced or removed. The services may be restored or the judge may determine that the decision is correct.

If a Medicaid managed care plan, such as an MLTC, made the decision about your services, you first have to file an internal plan appeal before you can request a fair hearing. If the plan denies your internal appeal, then you can request a fair hearing or a New York State External Appeal. If you get your services through the LDSS, then you don’t need to file an internal appeal first, so you can go straight to a fair hearing.

To apply for any of these appeals or fair hearings, you may need help. ICAN (Independent Consumer Advocacy Network) can help. ICAN is the New York State Ombudsman program for people with Medicaid who need long term care or behavioral health services. They assist New Yorkers with enrolling in and using managed care plans that cover long term care or behavioral health services. The web site notes several things that ICAN can assist with. You can check out their web site at https://icannys.org/ Legal Assistance of Western New York (LawNY) is a participant in the ICAN program, and is responsible for providing ICAN services to residents in 14 counties across western New York. ICAN can:

Answer your questions related to Medicare, Medicaid, long term care (for example, your home care or nursing home care), and your managed care plan.

¯ Help you decide what plan is right for you. Counselors can also help you solve problems with your Medicaid long term care services, including:

¯ Help you get more services from your plan

¯ Help you get services in your home instead of an institution

¯ Help you report problems with your care

¯ Help you solve problems with your managed care plan or providers like doctors, hospitals, and pharmacies. For example, we can help you apply for a fair complain or appeal.

Please note that ICAN may not provide legal representation for fair hearings. However, they can provide full assistance with internal appeals and external appeals. In addition, they can help you request and prepare for a fair hearing. Visit lawhelpny.org to look for free legal representation with fair hearings and other legal issues.

Applying for a fair hearing can be done by mail, fax, online or by phone. The request for a fair hearing goes to the Office of Temporary and Disability Assistance (OTDA).

¯ Telephone by calling 1-800-342-3334.

¯ Fax your request to (518) 473-6735.

¯ Online at http://otda.ny.gov/hearings/request/

¯ mail your request to: New York State Office of Temporary and Disability Assistance

Office of Administrative Hearings P.O. Box 1930 Albany, New York 12201-1930

Call NY Connects for more information on these situations. The Chautauqua County NY Connects program can provide Information and Assistance on available long-term services and supports options to individuals of all ages with disabilities, and caregivers. Information and Assistance is available in various ways including telephone access, face-to-face meetings in the community, or email. NY Connects can accessed through its statewide telephone number (800-342-9871), which connects callers with local offices by county. If you need to information for programs, services, benefits or entitlements, you can call the Chautauqua County NY Connects program. There is an online resource tool called the NY Connects Resource directory as well at www.nyconnects.ny.gov. There are NY Connects programs located with the Office for Aging Services (OFAS) and the Southwestern Independent Living Center (SILC). You can reach NY Connects by phone: 716-753-4582, email: ccnyc@chqgov.com Southwestern Independent Living NY Connects at 716-661-3010 or 716-490-7561. We are here to help and so is ICAN and LawNY www.LawNY.org)!

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