What to Do When You Can’t Find a Provider
I have been approved for services through my local management entity / managed care organization (LME/MCO) but I can’t find a provider agency or my provider agency doesn’t have enough staff to fill my hours. What can I do?
- Ask your LME/MCO for the names of other provider agencies.
- You can use more than one provider agency if your provider is unable to fill all of your approved hours. Do not let the provider agency discourage you from reaching out to other agencies.
- If no provider agency will work with you or cannot provide staff, request that the LME/MCO offer enhanced rates or approve higher levels of staffing.
- Request that the LME/MCO expand its search outside of its own contracted providers to find willing providers that it may contract with. The LME/MCOs can do individual contracts or otherwise approve non-contracted providers.
- You can find your own staff. The staff may work through your chosen provider agency. Alternatively, Innovations, CAP/C and CAP/DA Waiver recipients are permitted to “self-direct” services and can use the Employer of Record model to hire and fire their own staff; this model cuts out the agency “middleman,” allowing you to pay staff a higher rate of pay – which might lead to more consistent staff.
- Even family members, in some circumstances, may be eligible to be paid to provide services.
- Your LME/MCO is responsible to develop and provide a sufficient work force to provide you with services. The LME/MCOs contract with provider agencies to provide medically necessary services to those in the catchment area served. In order to bring attention to your case, you can file a grievance with your LME/MCO.
- Alliance: https://www.alliancehealthplan.org/members/information/rights/filing-a-grievance/
- Eastpointe: https://www.eastpointe.net/members-and-families/complaints-grievances-and-appeals/
- Partners: https://www.partnersbhm.org/grievances-and-appeals/
- Sandhills: https://www.sandhillscenter.org/for-consumers/grievance-form
- Trillium: https://www.trilliumhealthresources.org/for-individuals-families/appeals-grievaces
- Vaya: https://www.vayahealth.com/get-involved/member-rights-responsibilities/grievances-and-complaints/
You can also reach out to NC DHHS for help. NC DHHS contracts with the LME/MCOs to provide services; however, DHHS is ultimately responsible to ensure that beneficiaries have access to the services they need.
If you have tried the above recommendations and/or want additional information on other ways that you can complain about the lack of providers, please see our fact sheet on filing a complaint with your lme/mco.