Important: Stay covered! Are you enrolled in Apple Health (Medicaid) coverage? Make sure your address and phone number are up to date so you can stay enrolled. Report a change.
Behavioral health organizations (BHOs) must demonstrate effective mechanisms for reviewing consumer complaints. Ombudsman (ombuds) services can help.
What is an Ombuds?
Ombuds are people with lived experience in behavioral health who know services well and can help people navigate and resolve problems. Behavioral Health Ombuds services are available throughout the state. Ombuds can assist resolve issues with behavioral health services in both mental health and substance use. Ombuds services are primarily for individuals receiving Medicaid services.
What do Ombuds do?
Ombuds can help people resolve:
- Complaints and grievances — any dissatisfaction with services, written or verbal.
- Appeals — a reconsideration of denials, reduction or termination of services.
- Administrative (Fair) Hearings — a formal court procedure when all other avenues have been unsuccessful.
Ombuds services are voluntary. If a person chooses to file a grievance themselves, the Ombuds can direct them to the right process.
An Ombuds can help a person understand how to advocate for themselves effectively, or advocate on their behalf. They can advocate for adequate resolution and assist in setting up meetings and negotiations. The goal is always to resolve issues at the lowest level possible.
In addition to assisting with complaints and grievances, Ombuds are also sources for community resource information and referrals for additional services.