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DOH Webinar Describes MLTC Plan Responsibilities for Community First Choice Implementation

The Department of Health (DOH) held a webinar on March 21, 2018 to provide managed long term care (MLTC) plans and other Medicaid managed care plans with directions concerning the implementation of the Community First Choice Option (CFCO). Plans are required to evaluate all enrolled members for CFCO eligibility between April 1, 2018 and June 1, 2018. Eligibility for CFCO is based on three criteria:

  • Medicaid eligibility;
  • Score of 5 or higher on the UAS community assessment; and
  • Residency in the member's own home or the home of a family member. 

DOH will handle the first prong of the CFCO eligibility determination – Medicaid eligibility. However, plans are required to assess members based on the remaining two criteria. Notably, MLTC members residing in an adult care facility do not qualify for CFCO. Plans must send the file of CFCO-eligible members to New York Medicaid Choice.

When a member is identified as eligible, plans must update the member's care plan at the next scheduled assessment by determining and authorizing appropriate CFCO services. According to the webinar slides, ineligibility for CFCO does not preclude enrolled members from receiving CFCO services. LeadingAge NY is seeking more information about permissible utilization of CFCO services by members who are not CFCO-eligible.

New CFCO benefits will be incorporated into the MLTC program in July. According to DOH, guidance on these new benefits will be provided.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124