What is the process for new clients enrolled for services with CHCA?
An interview with Adriana Bautista and Maria Tavarez, CHCA’s Enrollment team
What are Client Enrollment Coordinators?
Client enrollment coordinators focus on creating a seamless enrollment experience for clients approved for home care services. With more than 12 years of experience together, Adriana and Maria make an excellent team and are passionate about helping our community members get the care they need.
We interviewed Adriana and Maria to help new clients know what to expect when getting enrolled with CHCA, here is what they had to say.
What can a new/prospective client expect when enrolling in-home care services with CHCA for the first time?
“Our experience has been the following - clients expect services as soon as possible and we work to make that happen. How? We are responsive if the client is calling with a question - we pride ourselves on providing prompt follow-up. We clearly articulate the expectations of enrolling in a Manage Long Term Care Plan (MLTCP) or the Consumer Directed Personal Assistant Program (CDPAP). We provide guidance on selecting a health plan that is most beneficial for the client. We know that this process can be complex and we are eager to make a personal connection because we are invested in the client’s care. The personal connection is important to create trust and demonstrate that we have the client’s best interest at heart. A client can also expect to see a smile in person or hear the smile over the phone.”
What are the steps of the enrollment process?
“There are various steps in enrolling for home care services. The process starts with CHCA verifying the client’s Medicaid eligibility or assisting them with enrolling into Medicaid, then we submit a referral to the health plan. We guide them through the paperwork required to complete the home care enrollment process and contact the clients' physicians to support the completion of documents. We assist the client in connecting with the New York Independence Assessor (NYIA), ensure nursing visits are completed, and deliver CDPAP orientations to clients and Personal Assistants. In addition, we support the clients in transitioning to a health plan partnered with CHCA. We maintain continuous communication with the client, and health plan throughout the enrollment period to make sure everyone is connected and up to date on the enrollment process.”
How long does it typically take from the first inquiry to receiving services?
“The enrollment period may vary depending on the circumstances of the client. Enrollment can take less than 30 days if the client has Medicaid, if they follow through with their enrollment steps diligently, and maintain communication with us. The enrollment process can take longer, up to 90 days, if we encounter situations such as a client not enrolled in Medicaid or a client having an exception code on their Medicaid plan. What are NY Medicaid Exception Codes? These are a set of codes used to identify specific circumstances or conditions that may require additional documentation or justification for services rendered. These codes help determine the eligibility and coverage of certain healthcare procedures or treatments. The process may also take longer if the client does not follow the required steps to enroll.”
Are there things the Client should prepare in advance to help speed up the process/ensure a smooth process?
“Yes, medical forms need to be completed by the client’s physician as soon as possible to determine if they may be eligible for home care services. Clients should also work proactively in removing Medicaid exception codes, this will allow for a much quicker enrollment process."
What roadblocks might Clients encounter in the enrollment process?
“ In addition to removing the NY Medicaid Exceptions codes and Medicaid eligibility, another roadblock that clients may encounter is limited nursing services. New York State is experiencing a shortage of clinicians, nursing visits to the clients may take longer than usual to complete.”
How do you help clients determine the best health plan for them?
“First we ensure the client’s primary care doctor is affiliated with the health plan. Many clients elect to stay with their doctor of choice, so it is important that they continue to receive services from them. Next, we assess the health plan and the potential benefits the clients may receive under a particular plan. We review and discuss the benefits with the client, ultimately the client makes the plan selection and we work to provide as much guidance as possible. We want our clients to feel comfortable, satisfied, and happy with the health plan they select."
Describe your relationship with CHCA's contracted health plans. What is your role with health plans?
“We work diligently to create a strong working relationship with our contracted partner. Consistent communication, responsiveness, and friendliness are key skills to ensure a cooperative process. Once the client selects the health plan, we quickly submit the referral and medical forms to the plan of choice. We communicate if the client has completed an assessment, and maintain consistent contact with the plan to inquire about enrollment status updates. We keep the plan updated on any demographic changes that might occur during the enrollment process. Throughout the years, we have built solid working relations with all of our partners.”
How is the process of enrolling clients in Consumer Directed Personal Assistant Services (CDPAP) different from Home Health Aide services?
“ If we are enrolling a client into CDPAP services, the client is the individual selecting their worker, the worker is not assigned through CHCA. Our job is to deliver a comprehensive orientation to help the client understand the program and New York State’s expectations for managing their worker (Personal Assistant). In addition, in our role as the CDPAP Fiscal Intermediary, we support the client in hiring the worker and ensuring that all necessary documents related to the hiring process are completed. In our traditional home health aide services, CHCA trains, hires, and assigns the workers. The Home Health Aide reports to CHCA.”
What do you enjoy most in your position as Client Enrollment Coordinator?
“We enjoy being able to help people get connected to home care services. Many times, we encounter a client that has no family member that can help guide them through this process, ask specific questions about benefits or even help them select the best plan for their needs.
We experience personal satisfaction by building a relationship with the individual and reaching the finish line with them. Once the client receives their authorization for services, we know that we have made a significant impact on that person, and witnessing their smile and gratitude makes us very happy.”