We filed a successful appeal so that John could continued to receive the nursing care he required.
Managed Care & Granite Advantage Program
What is Medicaid Managed Care?
New Hampshire’s Medicaid programs are primarily administered by one of the state’s Managed Care Organizations (MCOs). In a Medicaid managed care system, Medicaid recipients are provided health care coverage from a company under contract with the state. MCOs agree to provide Medicaid benefits to recipients in exchange for a monthly payment from the state.
Visit the NH DHHS website for more information about MCOs and how to apply for coverage.
New Hampshire’s Medicaid expansion program in known as Granite Advantage Program. The affordable Care Act created a new Medicaid eligibility group for low income adult up to 138% of the federal poverty level (FPL). More information about Granite Advantage is available here.
Know Your Rights
As a member of a Medicaid managed care plan, you have the right to file a grievance or an appeal if you are dissatisfied with your plan in any way. Each MCO has its own internal grievance and appeals process. New Hampshire requires that you appeal to your MCO before requesting a fair hearing with the State. Each MCO has a member handbook with information about its grievance and appeals process.
For more information on the grievance and appeals process see Managed Care Appeals and Grievances.
We helped Tom develop a plan to make sure that he would be fully supported during future visits to the hospital.
We helped to successfully appeal Ryleigh’s ineligibility decision for a children’s Medicaid program.
We helped Charles qualify for services so he could receive supports at home. When Charles’ service hours were later reduced, we stepped in again and successfully had them restored.