If you’re a New York state resident, and you need long term care (e.g., assistance with activities of daily living such as cleaning, bathing, grooming, etc.), you might need to join a managed long term care plan (MLTC). To be deemed eligible for an MLTC, you will first need to be evaluated by the Conflict-Free Evaluation and Enrollment Center (CFEEC).
If all of that sounds a bit confusing, don’t worry. In this article, we will break it all down in a simple way, so it’s easy to understand. We’ll discuss what CFEEC is, how it relates to long term care, how a CFEEC evaluation works, and how to get started with the process.
What is CFEEC (Conflict-Free Evaluation and Enrollment Center)?
The CFEEC is a program run by the New York State Medicaid. Their purpose is to evaluate if you need long term care at your home, at a nursing home, or adult daycare.
For example, if you have a disability or illness that makes daily living activities (such as eating, bathing, dressing, etc.) challenging for you, then you might need long term care.
Several health insurance providers in New York cover long term care. These plans are known as managed long term care (MLTC) plans, and they have to be approved by the New York State Department of Health.
The CFEEC evaluates if you need long term care so you can qualify for an MLTC plan. They are called conflict-free because they are not affiliated with any of the insurance providers. Their only purpose is to evaluate your care needs.
What is managed long term care (MLTC)?
To help you understand if a CFEEC evaluation is right for you, let’s take a more in-depth look into what an MLTC is.
Managed long term care (MLTC) is a system that handles the process of delivering care to people who need care services on an ongoing basis. Having access to long term care at one’s home often helps people with disabilities or illnesses remain in their homes and communities instead of having to live in an institution.
So, if you need assistance with daily living, you would sign up with an insurance provider who will cover your care expenses. And since the NY Health Dept. approves the plans, Medicaid would pay your premiums.
Is managed long term care (MLTC) a part of Medicaid?
If you’re eligible for MLTC, you will join a private health insurance plan approved by the New York State Department of Health, but your premiums would be paid for through New York’s Medicaid program.
What does MLTC cover?
The care services you receive through an MLTC plan will depend on your specific needs. When you join a program, you will be assigned a care manager who will work with you and make sure you get the care you need.
Here are some of the services that are typically covered by Medicaid MLTC:
- Home care services, including CDPAP
- Physical therapy
- Occupational and speech therapy
- Adult daycare
- Medical supplies
- Transportation to medical appointments
- Nursing home expenses
- Dental care
If you’d like more in-depth information about all the MLTC programs, you can check out this guide from the NY Dept. of Health.
Who qualifies for MLTC?
If you answer yes to all of the following questions, then you must join an MLTC plan, if you want Medicaid to cover your care expenses.
- Are you a New York resident who is 21 years of age or older?
- Are you currently enrolled in Medicaid?
- Are you currently enrolled in Medicare?
- Do you need long term care (for more than 120 days), either at your home, at a nursing home, or an adult daycare center?
Who needs a CEEFC evaluation?
If you qualify for the criteria mentioned above, then you’ll need to join an MLTC to have your care expenses paid for through Medicaid. The first step in joining an MLTC is getting evaluated by CFEEC.
You need a new CFEEC evaluation if:
- You want to join an MLTC for the first time.
- If you’ve not been in an MLTC for 45 days or longer.
- If your previous CFEEC evaluation has expired.
You don’t need a new evaluation if you’re already enrolled in an MLTC, and you’re looking to transfer to a different MLTC plan.
How does a CFEEC evaluation work?
The CFEEC will send a registered nurse to your home or nursing home to evaluate whether you need long term care services. The nurse will inquire about the kind of assistance that you need. They might ask about your ability to complete activities of daily living (ADL) like bathing, dressing, meal preparation, and if you can walk without assistance, and others. These questions, along with others, will help the nurse determine whether you need long term care through MLTC.
After completing the evaluation, your CFEEC nurse will inform you if you’re eligible for long term care through an MLTC plan. You will also get a copy of your decision in the mail.
How does CEEFC work with MLTC?
CFEEC is not affiliated with any of the MLTC plan providers. They will evaluate your needs for care, and they can also discuss your options with you based on your specific needs.
If you’re approved by CFEEC, you can then choose your preferred plan after discussing the available options with your doctor, family members, and any other care providers.
Do I currently need to be on Medicaid for a CFEEC evaluation?
You do not need to be currently enrolled in Medicaid to be evaluated by CFEEC. However, you should apply for Medicaid before you request an evaluation, to expedite the process once you’re approved for an MLTC. If you’ve already applied for Medicaid and you’re waiting for your card, you should let the CFEEC nurse know.
You should also have your current health insurance available during the evaluation.
How do I get started with a CFEEC evaluation?
You don’t need a referral from your doctor to schedule a CFEEC evaluation. You can call CFEEC at 1-855-222-8350 (TTY: 1-888-329-1546) to get the process started. You will be asked to provide your name, date of birth, address, SSN, or Medicaid ID during the call. If you have additional questions, check out the NY Department of Health’s FAQ sheet.