Choices for Care - High/Highest (CFC) Go Back

Percentage of Choices for Care clinical eligibility determinations pending more than 30 days

15%Q1 2018

Story Behind the Curve

Clinical eligibility is one of the first steps for Choices for Care (CFC) eligibility when a person applies for services. The time in which clinical (and financial) eligibility is determined can have a direct effect on a person’s access to services. Currently CFC regulations require that clinical eligibility be determined within 30-days of receiving the person’s CFC application. Though the Department of Children and Families has responsibility for processing the long-term care Medicaid financial eligibility and that process can frequently be delayed due to the complicated and time-consuming process, DAIL only has control over the timeframe for which clinical eligibility is determined.

Factors that typically affect the time-frame for processing clinical eligibility include: 1) timeframe for receiving the CFC application from the Department for Children and Families, Economic Services Division, 2) complications in reaching the person to schedule a clinical assessment, 3) timeframe to receive verification of clinical information from other healthcare professionals when needed, 4) current workload of the Long-Term Care Clinical Coordinator (LTCCC) nurse, 5) LTCCC position vacancies and time-off

Some events in 2014 that contributed to the length of clinical determination include:

  • Two LTCCCs positions became vacant in August 2014 (Hartford and Bennington offices). The Bennington position was filled in January 2015. The Hartford position was filled in June 2015.
  • In October 2014, the LTCCC supervisor position became vacant as a result of a promotion. As of July 1, 2015, the position was eliminated due to the labor savings part of the SFY16 legislative budget process.
What Works

Having the ASD clinical team fully staffed directly affects the timeframe. Using the SAMS database to track clinical eligibility timeframes by regions helps the supervisor and LTCCC staff monitor trends and identifies areas of need.

  • The person applying for services.
  • Adult Services Division (ASD) clinical and supervisory staff.
  • Economic Services Division (ESD) benefits specialists and supervisory staff.
  • Area Agency on Aging and Home Health Agency Case Management staff.
  • Other healthcare professionals involved in the clinical eligibility.
Action Plan
  • The LTCCC supervisor and program manager continue utilizing SAMS database to monitor workflow.
  • Maintain full staffing ratios whenever possible.
  • Use temporary staff to backfill vacant position when able.
  • Temporarily reassign clinical staff to help fill the priority work tasks left by vacant positions when able.
  • Communicate regularly with stakeholders when delays occur.
  • Increase process efficiencies through the increased use of the SAMS database for assessments, care plans and approvals. This includes requiring 100% participation by CFC case management and home health agencies.
Scorecard Result Program Indicator Performance Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy