Getting Started with a New Agency: What is a Life Plan, Care Manager, and Eligibility Requirements?
Meet Maria-Carmela Melendez, Central Enrollment Supervisor at AHRC Nassau/Citizens Options Unlimited 
Tell us a little bit about yourself
I started my career in the disability sector in 2008 as an FSS/community habilitation one-on-one DSP. From there, I became a Medicaid Service Coordinator through Citizens Options Unlimited.
I held this position for around eight years before moving back to FSS as a supervisor. Now, I work in the Central Enrollment department as a supervisor in the department. I work with Myriam Noel, Enrollment Coordinator.
We assist people to get the services they desire. We handle referrals and screenings as well as tours of our services. We work closely with OPWDD as the Liaison between the agency and OPWDD.
Who can receive services from AHRC Nassau and Citizens Options Unlimited?
Our agency welcomes adults, who have already aged out looking for services, transitioning from other agencies as well as young adults that recently graduated/aged out at 21.
How has care management changed?
Care Managers and Life Plans are completely separate from our agency now. In the past, it used to be that we had our own service coordination team in-house. Care coordination branched out into three separate organizations: Care Design, ACA, and Tri-County Care.
How does care management work now?
Eligibility through the OPWDD Front Door is the crucial first step to getting started with services. When a family contacts the front door, they are set up with a care coordination organization to begin the process of eligibility. Once eligible, they will be able to choose the Care Coordination Organization and a Care manager will be assigned.
Each person is able to choose which agency they would like to go with. You can always request a new care manager or care coordination agency.
What are the eligibility requirements?
OPWDD Eligibility Documents that are required are a Psychological, psychosocial evaluation, a current physical (Within the year), and proof that you had a disability prior to the age of 22 years old. With a Diagnosis of Autism an additional test may be required such as ADOS or CARS. You must also have Medicaid for health insurance.
What happens after you get a Care Manager?
Care Managers will help the person and family find supports and services that they are interested in through communication and based off of information from their Life Plan meeting. Care manager’s are the link to services and supports. They assist with getting services based off the person’s skills, interests, supports needed, and preferred location.
Once the care management portion of the process is set up, the process moves fairly quickly for people getting placed in services.
Care managers then connect families with disability agencies like Citizens Options Unlimited and AHRC Nassau. Once a manager and family determine the agency, they would like to be a part of, the care manager send the needed documents for review, sets up an appointment with Carmela or Myriam, who can then provide a tour, screenings, and a trial of services, if requested.
We offer both in person and virtual screenings.
What is a Life Plan?
Life Plans are person-centered; therefore, they are written in the first person.
Care managers and families do a Life Plan meeting every six months to ensure that the person supported is receiving the services they want, to track progress of goals and skills, and to request additional supports they are interested in.
Are there different service models and requirements for each?
- Residential services require that you are on the OPWDD Emergency Need List, which is submitted by Care Managers and includes a justification of why a residential placement is needed.
- Day Programs need a SARF approval for either site-based or PWW day program approval. Pre-Voc, SEMP, and Respite will also need a SARF approval.
- Self-Direction allows you to be in charge of your own services and provides you with an allocated budget based off your needs.
If you are interested in learning more about this process, please contact Carmela Melendez at 516.293.2016, ext. 5615 or mmelendez@ahrc.org or Myriam Noel at 516-293-2016 ext: 5509 or mnoel@ahrc.org or Centralenrollment@ahrc.org