ACANY’s
Care Connection team provides support to 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 Connection 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 legal guardian, or their representative. 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 involved when 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 the required training about all services funded under OPWDD. The Front Door staff will also provide people with a list of CCOs that provide services in their area so they can choose which CCO they would like to pursue services from.
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.
Apply for Medicaid
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 ACANY, the Care Connection 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 Connection 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)
A person must have an LCED uploaded in CHOICES dated within the 365 days prior to CCO enrollment. CCO enrollment staff will assist with obtaining an initial LCED from OPWDD. To obtain an LCED, the person must have a psychosocial and medical evaluation dated within the past 365 days, and a current psychological evaluation. If the initial LCED is due for annual redetermination during the enrollment process, CCO staff will assist with the redetermination.
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. All CCO enrollments occur on the first day of the month. Once OPWDD approves the request, a Care Manager will be assigned by the CCO.