Access to Innovations Waiver and “B(3)” Services
People with Medicaid should receive the medical and community-based services they need to stay healthy and safe. It is important to be able to find good providers and staff in the community to provide these services.
But sometimes services are approved and it is impossible to find someone to provide them. Additionally, service hours may be cut, or the MCO may deny requested services. When that happens, you may need to file a complaint with your LME/MCO.
How to file a complaint with your LME/MCO
There are several actions that you can take to advocate for the services you need. Refer to this step-by-step guide when you feel like you have tried everything and you need to file a complaint.
If possible, always make your requests in writing (an email is great) to make sure you have documentation of your complaint.
1. Report the problem in writing to your Care Coordinator
If you verbally report your problem, follow up the call with an email that summarizes what you talked about.
2. Contact the Customer Service and Community Rights Team at NC DHHS
3. File a Grievance with your LME/MCO
Put your grievance in the form of a letter or email. Grievances should always be in writing. The MCO is required to respond within 90 days. Additionally, the State must review the grievance as part of monitoring the MCOs.
Find your LME/MCO below for directions on how to file a grievance.
4. Send an email to key decision makers
Explain the problem that you (or a family member) are having finding a provider and/or receiving services, and how that lack of service is negatively impacting you. Send your email to the following individuals:
To the North Carolina Department of Health and Human Services:
The Chief Executive Officer (CEO), Chief Medical Officer (CMO), and Board of Directors of your LME/MCO (see below for their contact )
5. Tell your story to your North Carolina state legislators
Your state legislators may be able to advocate for you. It is important that policy makers hear your story so they know how the laws they write affect their constituents. Find your NC House and NC Senate representatives.
Contact info for each LME/MCO
Find your LME/MCO in the list below: We have included the contact information for some key people to send your complaint to along with information about filing a grievance.
5200 Paramount Parkway, Suite 200
Morrisville, NC 27560
Rob Robinson, CEO: rrobinson@AllianceHealthPlan.org
Dr. Robert MacArthur, CMO: BRMAcarthur@alliancehealthplan.org
View the current Board of Director members for Alliance Health.
To contact the Board of Directors, email the Executive Assistant, Veronica Ingram at vingram@AllianceHealthPlan.org and request that she forward your complaint to the Board members. You can also request the email addresses for the board members.
File a written grievance: Complaints@AllianceHealthPlan.org
514 East Main Street
Beulaville, NC 28518
Sarah N. Stroud, CEO: email@example.com
Dr. Sid M. Hosseini, CMO: firstname.lastname@example.org
View the Board Members for Eastpointe. Note: you need to scroll down to the bottom of the page to see the list.
More information about grievances, complaints and appeals.
Partners Behavioral Health Management
901 South New Hope Road
Gastonia NC 28054
Rhett Melton, CEO: email@example.com
Elizabeth “Bess” Stanton, CMO: firstname.lastname@example.org
View the current Board of Directors for Partners Behavioral Health.
You may send a copy of the complaint to TPyles@partnersbhm.org and request that Ms. Tammy Pyles (Clerk to the Board) share copies of your complaint with the board members or provide you with their email addresses.
File a grievance: Grievances@partnersbhm.org
Feedback form: https://www.partnersbhm.org/feedback/
1120 Seven Lakes Drive
West End, NC 27376
Victoria Whitt, CEO: email@example.com
Dr. Anthony Carraway, CMO: firstname.lastname@example.org
You may send a copy of the complaint to Sherry Bynum (Clerk to the Board) at email@example.com. Request that she shares your complaint with all board members or provide you with their email addresses.
Trillium Health Resources
201 W. First Street
Greenville, NC 27858
Joy Futrell, CEO: Joy.Futrell@TrilliumNC.org
Michael Smith, CMO: Michael.Smith@TrilliumNC.org
View the current Board of Directors.
You may send a copy of your complaint to Rita Joyner at Rita.Joyner@TrilliumNC.org. Request that she share a copy with all Board members or provide you with their email addresses.
200 Ridgefield Court, Suite 206
Asheville, NC 28801
Brian Ingraham, CEO: firstname.lastname@example.org
Dr. Richard Zenn, CMO: email@example.com
View the current Board of Directors.
You may send a copy of the complaint to the Board clerk at: firstname.lastname@example.org. Request that your complaint is distributed to Board Members or that they send you the email addresses for Board Members.