Home & Community-Based Services Eligibility (HCBS/LTSS Eligibility)

Blended rates are a clear incentive for managed care organizations to proactively identify and stabilize members with Home & Community Based Services (HCBS). Finding members that are eligible sooner leads to more resources for the plan to deliver care, avoided unnecessary nursing facility care, and prevented admissions.

Rank-Ordered Lists of Those Eligible for Additional Services (e.g., Nursing Facility Level or ADCMI)

Cyft AI produces highly accurate models featuring:

  • All available data including ADLs, free-text notes, and social determinants
  • Empirically validated with your data — not one size fits all
  • Tailored to and fully integrated with existing workflows and systems
  • Models get better with experience

Progress Reports With Real-Time Feedback

Know the Impact Your Team is Having and Spot Opportunities for Improvement

  • Engagement rates compared to baseline
  • Unable to contact and reasons why

  • Conversion rates by location and care manager

  • Overall program performance

Our Clients Typically Plan To:

  • Outreach to 50 to100 members per month who are most likely to be Nursing Facility Level of Care (NFLOC). In some states, this is known as being Nursing Facility Clinically Eligible (NFCE) or Nursing Home Certified (NHC).

  • Conduct in-home assessments using instruments such as the MDS or interRAI.

  • Submit the forms to the state to receive a determination.

All of our Medicaid and Duals clients have achieved a significant, positive return on investment with this solution. Contact us to receive a complimentary HCBS Opportunity Report specific to your market.

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