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.