1. A Division of: Disability Policy Consortium

2. What is ? What is the ?
One Care Ombudsman Office

3. One Care Ombudsman Office

4. What is One Care?
One Care is a new health care insurance option for some adults with disabilities living in Massachusetts who are eligible to receive both Medicare and MassHealth services.
One Care is designed to improve the quality of health care while better managing overall costs.
One Care Ombudsman Office

5. One Care Coverage
One Care covers all of the services a person gets with Medicare and MassHealth. This includes medical, prescription drug, behavioral health and community support services.
One Care Ombudsman Office

6. One Care Services Provides a range of services, including:
 Behavioral health  Medical equipment
 Care coordination  Peer supports
 Community-based  PCA
 Dental services  Substance use
 Home care  Vision services
 Long term supports  Wellness supports
 And other services…
One Care Ombudsman Office

7. One Care Plans
Medicare and MassHealth have joined together with two health plans to offer One Care. These plans are:
Commonwealth Care Alliance
Tufts Health Plan
One Care Ombudsman Office

8. One Care Ombudsman Office

9. For more information on One Care go to:
One Care Ombudsman Office

11. What is an Ombudsman?
The One Care Ombudsman (OCO) helps individuals, including their significant others and representatives, to address concerns or conflicts that may interfere with their enrollment in One Care or their access to One Care health benefits and services.
OCO services are free.
One Care Ombudsman Office

12. Independent Agent
The One Care Ombudsman is an independent agent that is not connected to any health insurance company or plan.
One Care Ombudsman Office

13. Help Find Solutions
The OCO works with One Care members, each of the One Care plans and MassHealth to help resolve concerns; ensuring that persons with disabilities receive their benefits and exercise their rights in One Care.
One Care Ombudsman Office

14. Provide Information
OCO staff helps people get answers to their questions about One Care - from the enrollment process to specific benefits and rights.
One Care Ombudsman Office

15. Make Referrals
The OCO can refer individuals to information, problem resolution resources, including formal grievance and appeal processes and legal services.
One Care Ombudsman Office

16. Investigate
OCO staff dig a little deeper to understand the problem and find potential solutions.
One Care Ombudsman Office

17. Listen
OCO staff listen in order to understand an issue from all sides.
One Care Ombudsman Office

18. Discuss Options
The OCO helps One Care plan members resolve their problems by finding and reviewing their options.
One Care Ombudsman Office

19. Mediate
OCO staff often brings people together to identify and discuss potential solutions to One Care plan problems.
One Care Ombudsman Office

20. Maintain Confidentiality
The OCO will not reveal personal information without the individual’s permission unless there is a serious and imminent threat to health and safety of the individual or others.
One Care Ombudsman Office

21. Remain Neutral
OCO staff will not judge or decide who is right or wrong.
One Care Ombudsman Office

22. The OCO stays neutral
We do not serve in any other role that would compromise our neutrality.
We do not participate in formal investigations.
We do not play any role in a formal issue resolution process, such as the One Care grievance or appeal processes.
We do not make binding decisions or mandate policies.
One Care Ombudsman Office

23. The Grievance/Appeal Process
While the OCO cannot represent individuals in grievance or appeal proceedings, OCO staff can help One Care plan members find representation and understand what to expect during each step of the process.
One Care Ombudsman Office

24. Identify System-Wide Issues
The OCO identifies and tracks concerns and problems.
The OCO discusses big picture issues with MassHealth, One Care plans and the Implementation Council in order to improve existing services.
One Care Ombudsman Office

25. Who operates the OCO program?
The One Care Ombudsman is an independent office is a division of the Disability policy Consortium, a health care advocacy organization.
One Care Ombudsman Office

26. One Care Ombudsman Office

27. One Care Ombudsman Office

28. OCO Staff Director / Ombudsman Deputy Director / Ombudsman
Spanish Bilingual Ombudsman
Outreach Coord. / Ombudsman
Administrative Assistant
One Care Ombudsman Office

29. OCO Contact Information
Office: Malden, MA Phone: – toll free Dial 711 – MassRelay – Office Website: onecareombuds.org
One Care Ombudsman Office

30. OCO Office Malden, MA 11 Dartmouth, Ste. 301 Malden, MA 02148
Walk-in hours:
Monday 1-4 | Thursday 9-12
And by appointment
One Care Ombudsman Office

31. Accessibility MassRelay – dial 711 (Deaf / hard of hearing) to:
The OCO office is wheelchair accessible
Please call or
MassRelay – dial 711 (Deaf / hard of hearing)
to:
Arrange interpreter services in your preferred language and for the Deaf
Request OCO informational materials in Spanish, Braille, large print or electronically (PDF or Word document)
One Care Ombudsman Office