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Need long term care? What you should know about the CFEEC

The Legal Aid Society of New York, a former member of the ICAN network, wrote this guide to answer some common questions about New York’s Conflict-Free Evaluation and Enrollment Center.

What is the Conflict Free Evaluation and Enrollment Center (CFEEC)?

The Conflict Free Evaluation and Enrollment Center (CFEEC) decides if you can join a Managed Long Term Care (MLTC) plan.

The CFEEC is a program of New York State Medicaid. The CFEEC sends a nurse to your home to evaluate whether you need long term care services such as home care. The CFEEC is not related to any managed care plan. They can help you understand your options. The CFEEC evaluation only decides whether you are eligible for MLTC, not how many hours of home care you need.

Who needs a CFEEC evaluation?

You need an evaluation if you want to join an MLTC for the first time, if you have not been in a plan for 45 days or longer, or if your CFEEC evaluation has expired. You do not need a CFEEC evaluation if you are already receiving Medicaid home care outside of a managed care plan, or if you are already enrolled in an MLTC plan and would like to switch to a different MLTC plan.

Who can ask for an evaluation?

Everyone is welcome to schedule an evaluation and you don’t need a referral from your doctor. You can schedule your CFEEC evaluation while you are waiting for your Medicaid application to be approved. ICAN advocates can help you schedule an evaluation.

How do I schedule an evaluation?

Call the CFEEC at 1-855-222-8350. TTY: 1-888-329-1546. You may call anytime Monday – Friday, from 8:30 AM to 8:00 PM or Saturday, from 10:00 AM to 6:00 PM. Counselors speak all languages. The phone call and help are free.

When you call to make an appointment, think about a time that would be convenient for you to be evaluated. If you would like to have other relatives or caretakers with you when a nurse comes to evaluate you, ask them for their schedules. A CFEEC may last for about three hours in the morning or the afternoon. You should be able to make an appointment for a CFEEC evaluation within two weeks of your call (5 to 7 business days).

The CFEEC Counselor that helps you scheduled an evaluation will ask you for your full name, your address, your birth date, your Medicaid ID or Social Security Number (if you have one), and your phone number. The Counselor that is scheduling your evaluation may also ask you directions to get to your home (or nursing home) so the nurse will not get lost on their way to evaluate you.

You do not need to travel for a CFEEC evaluation.

CFEEC evaluations are conducted in your home (or hospital or nursing home) by a Registered Nurse.

What Should I Expect during a CFEEC Evaluation?

You can have family members or other caretakers with you.

The CFEEC nurse will ask you questions about the assistance you need and the care you are receiving now. If someone in your life is helping you right now with any kind of care, they can help explain to the nurse how they help, when they are available, and what you need.

The nurse will ask you questions about your Activities of Daily Living, or ADLs. This means the nurse will ask you personal questions about the kind of help you need to go to the bathroom, bathe, dress or change clothes, eat and prepare meals, walk (for example, if you use a walker or a cane), transfer in and out of your bed or a chair, and reposition yourself when you are laying down. The nurse will ask you and your caretakers if you need any reminders to do these tasks. If someone in your life is able to help you describe your needs, it is important that they have a chance to speak with the nurse during the CFEEC evaluation.

You can prepare for your CFEEC evaluation by gathering information.

The CFEEC nurse will want to know what kind of health insurance you have right now. You should have all of your health insurance cards with you to show the nurse. Let your CFEEC nurse know if you have applied for Medicaid but are still waiting for your Medicaid card. The CFEEC nurse will ask for the name and phone number of your primary care doctor.
The CFEEC nurse will ask about all of your medications. It might be helpful to have a list of all of the medications you take in order to show the nurse when they evaluate you.

What Happens After my CFEEC Evaluation?

After your evaluation, the CFEEC nurse will tell you if you qualify for Long Term Care.

You will also get a written decision in the mail. If you think you qualify and the nurse disagrees, you can request a Fair Hearing in order to appeal. ICAN advocates can help you with your appeal.

If you are approved for Long Term Care, you have a choice about how you receive your care.

There are three different types of Medicaid Long Term Care plans: Medicaid Managed Long Term Care (partially-capitated or simply MLTC), Program of All-inclusive Care for the Elderly (PACE), and Medicaid Advantage Plus (MAP). The letter you receive after your CFEEC evaluation will let you know which types of plans you can select. ICAN advocates can help you understand your options and deadlines.

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CFEEC Fact Sheet Printable English