ueens Coordinated Care Partners LLC....Home Health Aid (HHA) / CDPAP Adult Day Care Program SUD Counseling/Program Medical/Medicaid Transportation Access-A-Ride Reduced-Fare MetroCard

Topic: Benefits & Entitlements

Problem: Active Need Benefits/Entitlements

SSI/SSDI (SSA) Public Assistance (HRA) SNAP (HRA) HEAP (HRA) Health Bucks Program Meal Delivery (Meals on Wheels, Gods Love We Deliver) HASA (HRA)

To Complete Application for ( SSI / SSDI ) in Next _______ Days. Tasks Responsibility Target Date

Review Eligibility and Application Requirements on SSA.gov. o Client o Care Manager Other:

Discuss Required Documentation Required to Complete Application. o Client o Care Manager Other:

Obtain Required Documentation: SS#/Card, Proof of Age, Income, Citizenship Status, Resources, Living Arrangement, Work History etc.

o Client o Care Manager Other:

Complete and Submit Application via ( Mail / In-Person ). o Client o Care Manager Other:

To Complete Application for ( Public Assistance / SNAP / HEAP ) in Next _________ Days.

Tasks Responsibility Target Date Create Account and Review Eligibility on mybenefits.ny.gov. o Client o Care Manager Other:

Discuss Required Documentation Required to Complete Application. o Client o Care Manager Other:

Obtain Required Documentation: SS Card, Proof of Income-Pay Stubs, Rent/Mortgage Receipt, List of Household Resources etc.


Complete and Submit Application via ( Online Web Portal / In- Person ). o Client o Care Manager Other:

Complete Application for Meal Delivery Program in Next ____ Days. Tasks Responsibility Target Date

Review Eligibility and Discuss Application Requirements. o Client o Care Manager Other:

Obtain Supporting Medical/Supportive Documentation. o Client o Care Manager Other:

Complete and Submit Application for _________________________. o Client o Care Manager Other:

Complete Application for HASA in the Next ________ Days. Tasks Responsibility Target Date

Review and Confirm Program Eligibility from Provider/Medical Doc. o Client o Care Manager Other:

Obtain Supporting Medical/Supportive Documentation (M11Q, W-488X, SSA4814) from ID Provider.


Submit Application to HRA via ( Fax / Mail / In-Person ). o Client o Care Manager Other:

________________________________________________

________________________________________________

________________________________________________

27 Queens Coordinated Care Partners, Inc.

Queens Coordinated Care Partners, LLC.

Topic: Education & Employment

Problem: Active Need Education/Employment GED College/Continuing Education ESL Program Library Card Workforce1 Access - VR HCBS: Employment Services HCBS: Education Support Services

To Link to _____________________________ in Next _______ Days. Tasks Responsibility Target Date

Research Available Programs and Program Eligibility/Requirements. o Client o Care Manager Other:

Complete and Submit ( Application / Referral ) for Program Admission. o Client o Care Manager Other:

Other: o Client o Care Manager Other:

To Link to _____________________________ in Next _______ Days.

Tasks Responsibility Target Date Research Available Programs and Program Eligibility/Requirements. o Client o Care Manager Other:



To Obtain Library Card in Next ___________ Days.

Tasks Responsibility Target Date Research Available Library Locations and Discuss Directions. o Client o Care Manager Other:

Visit Library _________ Times a ( Week / Month ). o Client o Care Manager Other:

To Link to HCBS: _________________________ in Next _____ Days. Tasks Responsibility Target Date

Complete HARP Eligibility Assessment. o Client o Care Manager Other:

Discuss HARP and Applicable HCBS. o Client o Care Manager Other:

Upload Assessment Data to UAS and Determine Eligibility for Services. o Client o Care Manager Other:

Submit LOSD Authorization Request to MCO. o Client o Care Manager Other:

Review LOSD Determination and Discuss Available Providers. o Client o Care Manager Other:

Submit Referral/Supporting Documentation to HCBS Provider. o Client o Care Manager Other:

Develop and Complete HARP Plan of Care. o Client o Care Manager Other:

________________________________________________

________________________________________________

________________________________________________



Topic: Supportive Services

Problem: Active Need Supportive Home Health Aid (HHA) / CDPAP Adult Day Care Program SUD Counseling/Program Medical/Medicaid Transportation Access-A-Ride Reduced-Fare MetroCard HCBS:

To Link to _____________________________ in Next _______ Days. Tasks Responsibility Target Date

Research Available Programs and Program Eligibility/Requirements. o Client o Care Manager Other:



To Link to _____________________________ in Next _______ Days.

Tasks Responsibility Target Date Research Available Programs and Program Eligibility/Requirements. o Client o Care Manager Other:



To Obtain Reduced-Fare MetroCard in Next ___________ Days.

Tasks Responsibility Target Date Determine Program Eligibility and Discuss Program Requirements. o Client o Care Manager Other:



To Link to HCBS: _________________________ in Next _____ Days. Tasks Responsibility Target Date

Complete HARP Eligibility Assessment. o Client o Care Manager Other:

Discuss HARP and Applicable HCBS. o Client o Care Manager Other:

Upload Assessment Data to UAS and Determine Eligibility for Services. o Client o Care Manager Other:

Submit LOSD Authorization Request to MCO. o Client o Care Manager Other:

Review LOSD Determination and Discuss Available Providers. o Client o Care Manager Other:

Submit Referral/Supporting Documentation to HCBS Provider. o Client o Care Manager Other:

Develop and Complete HARP Plan of Care. o Client o Care Manager Other:

________________________________________________

________________________________________________

________________________________________________



Topic: Housing Assistance & Services

Problem: Active Need Housing

NYCHA NYC Housing Connect Breaking Ground 2010e Supportive Housing Senior Housing LINC/SEPS Voucher SCRIE/DRIE Other:

To Complete Application for NYCHA in Next ____ Days.

Tasks Responsibility Target Date Create Account on NYCHA Self-Service Portal (selfserve.nycha)/ o Client o Care Manager Other:

Complete and Submit NYCHA Application via Web Portal. o Client o Care Manager Other:

Register for Online Access and Review Results/Application Progress. o Client o Care Manager Other:

To Complete Application(s) on NYCHousingConnect in Next ____ Days.

Tasks Responsibility Target Date

Create Account on NYC Housing Connect Web Portal. o Client o Care Manager Other:

Identify Applicable Listings and Submit Lottery Application(s). o Client o Care Manager Other:

Register for Online Access and Review Results/Application Progress. o Client o Care Manager Other:

To Complete 2010eSupportiveHousing Application in Next ______ Days.

Tasks Responsibility Target Date Review Eligibility and Required Supporting Documentation for Submission. o Client o Care Manager Other:

Obtain Required Supporting Documentation: Psychosocial Assessment, Psychiatric Evaluation, Physical/PPD Test (if applicable) etc.


Complete and Submit Housing Application to HRA. o Client o Care Manager Other:


To Complete Application(s) for _________________ in Next _____ Days. Tasks Responsibility Target Date

Research and Obtain Application and Instructions. o Client o Care Manager Other:

Review Housing Opportunity / Housing Program Eligibility. o Client o Care Manager Other:

Submit Application for ______________________________________. o Client o Care Manager Other:

________________________________________________

________________________________________________

________________________________________________



Topic: Legal Services

Problem: Active Need Legal

Eviction Prevention Immigration Status US Citizenship Creating a Will Do Not Resuscitate (DNR) Guardianship Criminal Justice Other:

To Link to ____________________________ in Next ________ Days.

Tasks Responsibility Target Date Research Available Legal Providers for _________________________. o Client o Care Manager Other:

Submit Referral / Application for ______________________________. o Client o Care Manager Other:



To Link to ____________________________ in Next ________ Days.

Tasks Responsibility Target Date Research Available Legal Providers for _________________________. o Client o Care Manager Other:

Submit Referral / Application for ______________________________. o Client o Care Manager Other:



To ___________________________________ in Next ________ Days.

Tasks Responsibility Target Date Other: o Client o Care Manager Other:



To ___________________________________ in Next ________ Days. Tasks Responsibility Target Date




________________________________________________

________________________________________________

________________________________________________



Topic: Medicaid Insurance

Problem:

To Complete Application Process to Apply / Reapply for Medicaid Insurance in Next ________ Days.

Tasks Responsibility Target Date Research Medicaid Insurance Information to Determine Application Process Category: https://www.health.ny.gov/health_care/medicaid/#apply


Contact NYS of Health: Health Plan Marketplace: (855) 355-5777. o Client o Care Manager Other:

Contact Managed Care Organization: _________________________. o Client o Care Manager Other:

Contact Medicaid Helpline: (800) 541-2831. o Client o Care Manager Other:

Contact HRA: (718) 557-1399. o Client o Care Manager Other:

Submit Application and Supporting Documentation. o Client o Care Manager Other:

Verify Medicaid Insurance via MAPP, ePACES etc. o Client o Care Manager Other:


Tasks Responsibility Target Date o Client o Care Manager Other:



Tasks Responsibility Target Date o Client o Care Manager Other:



________________________________________________

________________________________________________

________________________________________________

Access to Care & Services



Documents

ueens Coordinated Care Partners LLC....Home Health Aid (HHA) / CDPAP Adult Day Care Program SUD Counseling/Program Medical/Medicaid Transportation Access-A-Ride Reduced-Fare MetroCard