Ombudsman helps restore Medicaid coverage to man whose benefits were cancelled due to eligibility error

A building on West Monument Avenue that houses the Dayton-Montgomery County ombudsman's offices. CORNELIUS FROLIK / STAFF

A building on West Monument Avenue that houses the Dayton-Montgomery County ombudsman's offices. CORNELIUS FROLIK / STAFF

Editor’s note: The Dayton Ombudsman Office provides weekly columns to the Dayton Daily News to bring awareness to issues it sees in the community.

Last month the Ombudsman received a call from a man who was referred to our office by his case manager at a local managed care healthcare agency. His case manager was instructed to have the man call the Ombudsman by a local agency providing services to senior citizens. The man’s Medicaid benefits had been terminated, and the case manager was hoping we could intervene to help restore services. The man’s managed care services are dependent upon his eligibility and participation in Medicaid. Without Medicaid support, the managed care agency services would not be paid for and therefore would no longer be provided.

The man understood that his Medicaid benefits were terminated because he supposedly has a credit union account, which he does not have. The man stated he turned in proof that he doesn’t have an account, and he wondered what else he should do.

The Ombudsman sent an inquiry to the Montgomery County Department of Job and Family Services (MCDJFS), which determines eligibility for Medicaid. The response was that the agency was not aware the man had turned in verification that he does not have a credit union account because his case was stored in a section for closed cases. The staff person reviewed the case in light of this information and reinstated the man’s Medicaid back to the date when the case was closed. The Ombudsman contacted the man and his case manager at the managed care agency to give them the information that the problem was resolved. The man’s services were restored.

The Ombudsman Column, a production of the Joint Office of Citizens’ Complaints, summarizes selected problems that citizens have had with government services, schools and nursing homes in the Dayton area. Contact the Ombudsman by writing to us at 11 W. Monument Ave., Suite 606, Dayton 45402, call 937-223- 4613, or by electronic mail at ombudsman@dayton-ombudsman.org.

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