Managed long term care (MLTC) is a special type of insurance that only covers long term care. In New York state, residents must go through a process to enroll in an MLTC program if they are on Medicaid. The process has two parts. The first part is called the Conflict-Free Evaluation and Enrollment Center (CFEEC). This article covers what the Conflict-Free Evaluation and Enrollment Center program is, who needs to be evaluated, and what happens after the evaluation is complete.
What Does the Conflict-Free Evaluation and Enrollment Center Do?
The CFEEC helps people determine if they are eligible for MLTC through an evaluation. They also help determine the type of plans that may work the best for you. It is not associated with any one plan. The CFEEC contracts with MAXIMUS and they send out a nurse to your home to conduct an evaluation. This evaluation determines whether or not you meet the requirements for MLTC.
Anyone may request an evaluation. If you are waiting for Medicaid to approve your application, you can still arrange for an evaluation. Generally speaking, people need an evaluation if they’ve been on an MLTC plan for less than 45 days or it is their first time receiving MLTC. Once the CFEEC completes your evaluation, you have 75 days to enroll in an MLTC plan.
Why Do I Need to Have an Evaluation?
New York state is required to evaluate all Medicaid-eligible recipients who want to enroll in an MLTC plan or are required to enroll in one if they meet certain criteria for community-based long term care (CBLTC). This requirement exists because the evaluation determines how much care you’ll need using the independent standards set by the evaluation. It helps streamline your enrollment in an MLTC plan.
How do I Request an Evaluation and is there a Cost?
Before receiving an evaluation, you must call the CFEEC to make an appointment with a counselor by calling 1-855-222-8350. Schedule the appointment according to what works best with your schedule. Appointments are typically available in the morning or in the afternoon during the week. Weekend appointment times are limited. The call is free. The nurse conducting the evaluation will travel to your home so there’s no travel or extra cost involved.
What Happens During the Evaluation?
A registered nurse with the CFEEC program will come to your home and they will ask you about the care and assistance you are receiving now. Plan to spend three hours on your appointment. If you have a caregiver or someone else that helps you care for yourself, they can be present during the evaluation and tell the nurse how they help you with tasks daily.
The nurse will ask questions about activities of daily living or ADLs. These include things like:
- Getting Dressed.
- Brushing Your Hair and Teeth.
- Your Ability to Make Food.
- Feeding Yourself.
- How You Walk.
- Transfer Between Your Bed and a Chair.
- Reposition Yourself in Bed.
Anyone else who is familiar with your needs should speak with the nurse during the evaluation.
Do I Need to Bring Anything to the Evaluation?
Yes. Your nurse will need to see all health insurance cards during the evaluation so make sure you have them ready for them to view. If you applied for Medicaid but don’t have your card yet, tell the nurse this as well.
If you are taking any medications, have them out for the nurse to review. You should also be prepared to give them the name and contact information for your primary physician.
You may want to have an idea of which MLTC plan you want to enroll in. Choosing a plan before your evaluation appointment is not required but it helps with the next part of the enrollment process.
What Happens After the Evaluation Is Over?
Once the nurse finishes the evaluation they will tell you if you passed and ask if you have a particular plan in mind. It is beneficial if you do because the nurse can set up an evaluation appointment with your plan provider. If the nurse determines that you do not qualify and you think you do, it is your right to request a Fair Hearing to appeal the decision. You will also receive a decision in the mail.
If you are eligible for MLTC and did not choose a plan at the evaluation appointment, the CFEEC can help walk you through the plan options available and figure out which one works best. Since there are many plan providers, this will save you from having to call them all yourself.
What If My Circumstances or Eligibility Changes?
The evaluation you undergo is based on your circumstances as they are. If they change, you may be required to go through a new evaluation. There may be certain situations where you need to unenroll from MLTC. If you are unenrolled from an MLTC plan for 45 days or more, you will need a new evaluation.
If you need more help with enrollment in the Conflict-Free Evaluation Program, feel free to contact Xtreme Care at 718-461-9602 or email us at [email protected]