New Yorkers who have Medicare and Medicaid have a few options for coverage of long-term care services, which can include assistance getting out of bed, eating, dressing, bathing and other personal care needs. New Yorkers with both Medicare and Medicaid may enroll in a Managed Long Term Care (MLTC) plan in order to get long-term care services covered. New Yorkers who reside in New York, Kings, Bronx, Queens, Richmond, Suffolk, Nassau, or Westchester counties have two options: those are MLTC plans and Fully Integrated Dual Advantage (FIDA) plans. For more information about MLTC and FIDA plans, see this recent post on the Medicare Rights Blog.
New Yorkers who are dually eligible – meaning they have both Medicare and Medicaid – must take two steps in order to get long-term care services:
Step 1: Schedule an evaluation with the Conflict Free Evaluation and Enrollment Center (CFEEC)
Call the CFEEC (1-855-222-8350) to schedule an evaluation. You can schedule an evaluation even if you’re waiting for your Medicaid application to be approved. Scheduling the evaluation as soon as possible after submitting the Medicaid application helps to prevent delays to enrolling in an MLTC plan and receiving long-term care services. A nurse from the CFEEC will come to your home (or nursing home or hospital, depending on where you currently live) to evaluate your eligibility for long-term care services. The nurse from the CFEEC is not from an insurance company and does not decide how many hours of care a person should receive. Instead, the nurse determines whether you meet the New York State Medicaid eligibility requirements for personal care and confirms that you’ll need long-term care services for at least 120 days.
During the CFEEC evaluation, the nurse will ask you for your health insurance information, the name of your primary care doctor, and a list of medications you take. You can have a loved one, caregiver, or authorized representative at the evaluation with you to help you answer these questions. The nurse will also ask questions about your long-term care needs. You should be prepared to tell the nurse the assistance you need with things like household chores, bathing, grooming, dressing, walking, getting out of bed, and using the bathroom. You can also ask your representative to talk to the nurse about your needs.
Step 2: Schedule assessment(s) with MLTC and/or FIDA plans
In order to get your long-term care services covered, you need to enroll in an MLTC or FIDA plan. The nurse who assesses your needs during the CFEEC evaluation will give you a list of MLTC and FIDA plans. If you already know that you might want a certain plan, you can ask the nurse to help you contact the plan to schedule an assessment.
You can schedule assessments with as many MLTC and/or FIDA plans as you wish, but be sure to enroll in a plan by the 20th of the month in order to start receiving long-term care services by the 1st of the following month. For example, if you schedule an assessment with an MLTC plan on July 3, and schedule an assessment with another plan on July 17, you should enroll in one of the plans by July 20. This way, your long-term care services will start on August 1.
You should be prepared to tell the MLTC or FIDA plan about your long-term care needs in detail, including how much time it takes you to complete certain tasks (for example, how long it usually takes you to eat, bathe, and get dressed; what time you eat your meals; etc). Just as with the CFEEC evaluation, it is a good idea for a loved one, caregiver, or your authorized representative to be with you during your MLTC or FIDA assessments, if possible. Your representative can talk to the plan about your long-term care needs and help make sure you get the number of personal care hours you need. After the MLTC or FIDA plan assessment, the nurse who completed the assessment will tell you how many hours of care you would get each day if you enroll in that plan. If you are satisfied with the number of hours, the nurse can help you enroll in the plan and fill out any paperwork.
If your long-term care needs change anytime after enrolling in a plan, you can call your plan to request another assessment and a change in the number of hours you receive. You can also change your MLTC or FIDA plan at anytime.
For more information and assistance with MLTC and FIDA, please contact the Independent Consumer Advocacy Network (ICAN) at (844) 614-8800. ICAN is the New York State Ombuds program for Managed Long Term Care and provides free and confidential assistance.
The Medicare Rights Center’s Coalition to Protect the Rights of New York’s Dually Eligible (CPRNYDE) tracks changes New Yorkers with Medicare and Medicaid and long-term care experience, and we would like to hear your story. CPRNYDE works with consumers directly and ensures their voices are heard by policymakers.