Last Updated: June 2006

The Advocate’s Guide has been developed for use in the Managed Care Consumer Assistance Program and is part of a training curriculum tailored to meet the needs of community-based organizations that directly assist consumers with managed care issues. The Guide is for social workers, case workers or anyone providing consumer assistance to their clients. Consumer materials are available from our Community Based Partners and/or our website: www.nycmccap.org

The New York City Managed Care Consumer Assistance Program (NYC MCCAP), funded by the City of New York (administered by the New York City Department of Health & Mental Hygiene, Division of Health Care Access& Improvement) and coordinated by the Community Service Society (CSS), is designed to: 1) educate New Yorkers about the basics of managed care and their rights as consumers; 2) provide navigational assistance and help with resolving disputes; and 3) collect performance data. Towards these ends, NYC MCCAP has established, trained and provides technical assistance to a network of community-based organizations (CBOs) to provide direct services to managed care consumers. The program will serve managed care consumers in all payer groups:  Medicaid, Medicare, Family Health Plus, Child Health Plus and the commercially insured.

NYC MCCAP has identified its target audience to be:

1. recent immigrants (within the past five years);
2. non-English-speaking New Yorkers;
3. individuals with low incomes;
4. individuals with chronic illnesses, physical or cognitive disabilities, mental illness or substance abuse problems.

NYC MCCAP invited community-based organizations through an RFP process to apply for grants to perform General Consumer Education and Assistance or Specialized Consumer Assistance.

The agencies that received an award for MCCAP services in FY2006 are:

User Guide

The Advocate’s Guide is broken up into different chapters mainly according to Health Insurance Payer (Medicaid, Medicare, Family Health Plus, Child Health Plus, Commercial Insurance, etc.). There is a table of contents in the beginning of the manual and a table of contents within each chapter.

Chapters are written in a "Question and Answer" format making it easy for the reader. For example:

Q. Why should I use this manual?

A. It is a comprehensive tool developed to assist all managed care consumers with their managed care questions.

Within each chapter, the user will find information about: who is eligible for different managed care programs, choosing a health plan, using a health plan, accessing special services, and solving problems that may arise in managed care. At the front of each chapter is a detailed “Table of Contents” and at the end of each chapter are resources for further assistance as well as a chapter index for easy referencing.

The Appendices of this manual include: a glossary of terms, information about The Patient’s Bill of Rights and other resources for consumer assistance.

It is recommended that the user read through an entire chapter before seeking additional assistance. Please note that the Advocate's Guide was last updated in October 2008. For the most up to date information (particularly regarding current income levels explained in Chapter 4B and 7) please contact NYC MCCAP via our Helpline at (212) 614-5400 or via email in the "Contact Us" section of this website.

You will be able to find this manual on the NYC MCCAP website at www.nycmccap.org. If you have any questions about this Manual, please call NYC MCCAP at 212-614-5400.