Managed Care Plans
Medicaid-funded insurance plans, such as MMCPs, MLTCs, and FIDAs, are served by attorneys in our Medicaid, litigation, and health law departments. From regulatory compliance, to maximizing member benefits and collecting co-payments, our experienced team of attorneys helps Medicaid managed care plans in all aspects of their operations.
The attorneys at Abrams Fensterman guide Medicaid Managed Care Plans through the complex landscape of federal and state laws and regulations that govern insurance companies generally, and the additional restrictions that apply to plans and members of plans that accept Medicaid funding. Our experienced attorneys customize compliance plans, and work with plan staff to monitor implementation of same. In the case of violations, we are available to defend the plan at every phase of the grievance and complaint process.
In order to thrive in this competitive market, managed care plans must maintain an appropriate and diverse member base. The attorneys at Abrams Fensterman are well-equipped to assist plans in all aspects of member management, including overseeing and defending the plan through every stage of an administrative or judicial appeal, involuntary disenrollments, and community-based service denials, reductions and discontinuances.
Establishing Medicaid Eligibility:
To maximize the available funding source, Medicaid managed care plans must aggressively pursue governmental benefits on behalf of their members. Erroneous Medicaid denials need to be challenged and appealed since plans are required to continue servicing members until a proper disenrollment is effectuated. Similarly, if the Department of Social Services miscalculates a member’s spend down, the plan will experience a monthly deficit until the budgeting error is corrected. Delayed, denied, and discontinued Medicaid reimbursement directly impacts the plan’s bottom line. The Medicaid department at Abrams Fensterman has handled many thousands of Medicaid applications and appeals, and has years of experience maximizing and preserving Medicaid coverage by assisting with recertifications, reinstatements, and rebudgetings. Where appropriate, our attorneys are also available to assist eligible members in enrolling in Pooled Income Trusts.
As with any business, managed care plans must sometimes pursue their members to collect unpaid balances. When dealing with Medicaid recipients, the primary source of a plan’s receivables is the member’s “spend-down” or income contribution. While a Medicaid recipient’s income is notoriously difficult to collect, the attorneys at Abrams Fensterman have years of experience representing health care providers in just these types of lawsuits. Using creative judicial remedies, and doggedly pursuing settlements, we have successfully resolved innumerable spend down cases.
For further information about our nursing home legal services, please contact our law firm in Long Island at 516-328-2300, New York City at 212-279-9200, Brooklyn at 718-215-5300 or Rochester, New York, at 585-218-9999, to schedule an initial consultation.