LIFEPlan CCO NY’s Care Connections team supports prospective members and families during each step of the enrollment process, which can be complex and lengthy. Every person who applies for CCO services is assigned to a dedicated Care Connection Specialist to navigate the process. Care Connections Specialists can also provide linkage to Family Support Services and other systems of care if needed.
Please keep in mind that once a person begins the enrollment process, the CCO must communicate directly with them, their advocate, or their legal guardian. CCO enrollment staff can only discuss a specific person’s enrollment with provider agencies if the person makes the request directly and signs a consent to authorize information sharing.
The length of time it takes for a person to enroll in a CCO depends on factors including, but not limited to:
- Age, particularly children under eight years
- OPWDD eligibility
- Medicaid status
The following is a general list of the steps to enrolling in a CCO. The order will vary depending on each person’s circumstances.
Contact the Front Door at OPWDD
All people seeking CCO enrollment must start by contacting the Front Door at the OPWDD Regional Field Office for their area to express their interest in services. They will participate in a phone assessment with Front Door staff and must complete a required training about all services funded under OPWDD.
Determine OPWDD Eligibility
Every person enrolling in a CCO is required to have OPWDD eligibility. To be eligible, OPWDD must determine the person has a qualifying disability. The disability must be diagnosed by a medical professional, be present before the person’s 22nd birthday, cause a substantial handicap to their adaptive abilities, and be expected to be permanent. Detailed information on the OPWDD eligibility requirements and process is available on their website.
At the time of CCO enrollment, the person must have active Medicaid through their local district. If the person is under age 18 and not eligible for Medicaid based on family income, they must first apply for an HCBS Waiver with a qualifying service. OPWDD does not consider Respite or Self-Direction to be qualifying services for HCBS Waiver.
At LIFEPlan CCO NY, the Care Connections Specialist will assist the person with applying for Medicaid and HCBS Waiver, if applicable. If the HCBS Waiver application is denied by OPWDD, the child cannot enroll in a CCO at that time. If that occurs, the Care Connections Specialist can connect the child to Family Support Services or other systems of care that may be more appropriate.
Level of Care Eligibility Determination (LCED)
The person must have an LCED uploaded in CHOICES which is dated within the 365 days prior to CCO enrollment. CCO enrollment staff will assist with obtaining an initial LCED from OPWDD if the member does not have one or if their LCED is expired. To obtain an LCED, the person must have a medical evaluation, social/developmental evaluation, and psychological evaluation with Full-Scale IQ and Adaptive Composite dated within the past 365 days.
Submit Request for Enrollment
Once a person has obtained OPWDD eligibility and Medicaid, the CCO’s enrollment staff will submit a request for enrollment via CHOICES. Once OPWDD approves the request, a Care Manager will be assigned by the CCO.