Medicaid Mediation

Medicaid Mediation is used in Medicaid Disputes as a part of the appeals process.

Mediators are making a real difference in the lives of many of North Carolina’s neediest citizens by participating in a new effort to use mediation to address appeals contesting reductions or denials of services under the Medicaid Program.

It is no secret that health care costs overall are rising in North Carolina and that expenses associated with Medicaid, the federal health insurance program serving those with limited incomes, are growing. Our State’s population is aging and many of our elderly are poor. The economic crisis is also driving many individuals and families to depend on Medicaid for health care emergencies and other services as jobs and health insurance are lost and savings depleted.

The result has been an increase in both denials and requests for new services and in terminations, suspensions or reductions of services already approved.

Piedmont Mediation Center, Inc. (along with other mediation centers across North Carolina) schedules the mediation and it is held by telephone. Most sessions take about an hour. Mediation has been very successful. Not only are recipients accepting the offer to mediate nearly all of the time, but between 80-90 percent of the referrals are settling in mediation. Sometimes recipients struggle to explain their needs and they understand how hard it can be to communicate with a big bureaucracy. Mediation means that, for a time, they have the undivided attention of a representative of that bureaucracy and it is often the first time that they have really heard each other. Many times the denial or reduction is a result of a misunderstanding or the lack of documented need.

We are serving a fragile population that often struggles to be heard by the government agencies on which they depend. They are used to being shuttled from one telephone line to the next or from one person to another. They are so grateful for a process that they feel gives them a chance to be heard and to have their concerns acknowledged.