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FIDA: 3 plans exit FIDA 2017; FIDA extended 2 years to 2019, Suffolk & Westchester Scheduled for 2017

09 Nov, 2016
  • CONTACT:    NY Medicaid Choice for information or to Opt Out  1-855-600-FIDA  (1-855-600-3432)   TTY:    1-888-329-1541             FAX authorization to opt out someone else  1-917-228-8601      Monday to Friday  8:30 am to 8:00 pm and Saturday from 10:00 am to 6:00 pm. 
  • ICAN - NYS Ombudsprogram for MLTC and FIDA.  Click here for info.
  • Complaints to State DOH: 1-866-712-7197  or e-mail mltctac@health.ny.gov  

November 2016

  • Nov. 9, 2016 - NYS DOH announced that CMS approved extension of the FIDA Demo two additional years through 12/31/19.   Originally it was a three-year demonstration.  Also, the letter from Andrew Segal, DOH Director, Division of Long Term Care announced that the expansion to Suffolk and Westchester Counties is expected in 2016.  Download announcement letter here.

  • Three FIDA plans will close as of January 2017, which will affect 360 FIDA enrollees:  
  1. AlphaCare             36 enrollees
  2. WellCare             155 enrollees
  3. CenterLight          169 enrollees

Note that these are not the 3 plans with the smallest enrollment, at least as of May 2016.   The 17 current plans in order of enrollment are as follows.  The highlighted plans are the ones that are closing. 

Plan Enrollment
RiverSpring 7
VillageCareMax 24
FIDA Care Complete (Centers Plan) 25
North Shore 28
AlphaCare 36
AgeWell 41
Aetna 52
Senior Whole Health 67
WellCare (closing) 155
ICS 161
CenterLight (closing) 169
MetroPlus 179
Elderplan 289
Fidelis 318
GuildNet 822
Healthfirst 1,058
VNSNY 1,939

At this link download the CMS Close-Out Letter for Plans that Non-Renew a Contract effective on or before January 1, 2017. The purpose of this memorandum is to provide FIDA plans (Medicare-Medicaid Plans  or MMPs) with  requirements for leaving the market.  Individuals who do not actively choose a plan will be auto-enrolled into one of  the other 14 FIDA plans. Plans should have notified their beneficiaries by Oct 1, 2016.  At this link scroll down to see the enrollment in each FIDA plan as of May 2016, by plan and by county.

July 2016

  • NYS has increased its public reporting of FIDA enrollment data. As of May 2016 FIDA enrollment has dropped to 5,370 from 6,252 in February 2016.   On the MRT 101 webpage, you can download:

"Current FIDA Trends and Future Enrollment Opportunities"

  • 07.06.16 - as of May 2016 includes FiDA enrollment by county/borough, by plan, number of opt-outs by borough/county, and, for each month beginning January 2016 through June 2016:
    • number of voluntary and involuntary disenrollments
    • number of people who transferred from one FIDA plan to another
    • number of "new to service" FIDA enrollees - who did not switch from another FIDA plan
  • 01.29.16

March 2016

  • Enrollment update:    This chart shows the monthly enrollment in every FIDA plan from February 2015 - February 2016.  The total enrollment in February 2016 is 6,252.  The plan with the highest enrollment is VNS Choice FIDA (2,294 members).   Source is Integrated Care Resources Center, initiative of CMS (see last page of PDF)

  • A year into the NYS FIDA Demonstration as well as duals demonstrations in other states, some organizations have been doing evaluations of these demonstrations.  See this Issue Brief of Justice in Aging: The Duals Demonstrations:  A First Glimpse of Lessons Learned.

December 9, 2015 - State Announces Reforms in FIDA

As announced on Dec. 9, 2015,  "To enhance the ease and value of FIDA, the NYS Department of Health (DOH) and the Centers for Medicare and Medicaid Services (CMS) have reformed the program, with specific attention to improved flexibility for Participants, Plans, and providers."  These changes were explained further in a webinar held on Dec. 22, 2015 - download 12/22/15 presentation here.

The primary changes described in this Summary of FIDA Reforms involve:

  1. The Inter-Disciplinary Care Team (IDT) - the reforms make participation of the member's physician and other individuals optional, rather than mandatory, making it more flexible.  The mandatory participation of primary care physicians had met with resistance because of the extensive time required to meet and develop a plan of care.  There is also more flexibility on when and how the IDT meets and decides the care plan.  See the Revised IDT Policy.  

  2. Marketing and Enrollment -"Passive enrollment" is suspended until further notice.  This means that current and future MLTC members will not receive notices from New York Medicaid Choice, the State's enrollment broker,  telling them that if they did not "opt out" of FIDA, they would be automatically enrolled in a FIDA plan.  At the same time,  the companies offering FIDA plans have more flexibility to do marketing to members of their MLTC plans, consistent with Medicare Marketing Guidelines.   This includes:

    • sending approved educational materials to MLTC members who have opted out of FIDA,

    • making marketing calls to anyone enrolled in their MLTC or Medicare Advantage plans or any of their other Medicaid or Medicare managed care plans,

    • enrolling new members into their FIDA plans directly, unlike in the past, when individuals could only enroll in FIDA by calling New York Medicaid Choice, the independent enrollment broker under contract to the State Dept. of Health.

  3. ADA - Changes in how physicians, labs, and other health care providers "attest" to whether their facilities and services comply with the Americans with Disabilities Act (ADA)

  4. See other changes in marketing rules, plan rates of payment and other program features here

  5. Roll-out to Region II (Westchester and Suffolk Counties) postponed til Mid-2016 - FIDA started with Region I in New York City and Nassau Counties in January 2015.   It was supposed to expand to Region II - Westchester and Suffolk Counties - earlier in 2015.  See original schedule here.  The State has now said it will not expand to those counties until mid-2016.

FIDA DASHBOARD - Region 1 - NYC, NASSAU

 When   Number
FIDA Announcement letters mailed Dec. 2014, with follow up letters sent to about 43,000 who had not opted out nor have been passively enrolled as of about late May or early June 2015 100,000
FIDA ELIGIBLES enrolled in an MLTC, PACE, FIDA or MAP plan in NYC, Nassau, Suffolk or Westchester as of May 2016 (data posted here) 126,102
FIDA  ENROLLMENT  - See chart with breakdown by plan through 2/2016    Also see May 2016 figures here
11/1/2015 7,540

10/1/2015 (includes 3.700 scheduled for passive enrollment for 10/1/2015) Summary of enrollment as of 10/1/15 in FIDA and MLTC by plan posted here - PDF - Excel

 9,163

9/1/2015 (includes 1,020 passively enrolled 9/1/15) 7,280
 8/1/2015 (includes 2,701 passively enrolled 8/1/15) 7,676
 7/ 1/2015 (includes 2,599 passively enrolled 7/1/15) 6,368
 6/ 2/2015 4,407
May 1, 2015  (of the 4,158 enrolled as of April 1st, as of 4/18th 1,101 have disenrolled for 5/1, but up to 3,733 more will be passively enrolled for May 1st,  Data from CMS = 7,215 - download plan data here 7,215
4/1/15 (all but 700 were passively enrolled) 4,158
7/2015 7,382
9/2015 8,303
12/2015 7,093
2/2016 6,252
5/2016 5,370
TOTAL OPT-OUTS as of 3/7/2015  31,901
as of 4/18/2015  41,906
as of June 2, 2015 47,702
as of August 1, 2015 54,287
as of September 1, 2015 57,375
as of May 2016 61,701
Number Passively Enrolled 
April 1, 2015  
3,400
 
 May 1, 2015  
3,152

for June 1st 

 0
(delayed)

July 1st:

2,599

Aug. 1, 2015

2,701

Sept.. 1, 2015

1,020

For Oct. 1, 2015

3,731 projected 
After January 2016 - PASSIVE ENROLLMENT SUSPENDED

SOURCE:  NYS DOH Policy & Planning Update - MLTC & FIDA - DOH Update 10/16/2014., Monthly updates since Jan 2015 through September  2015  (on file with EFLRP - eflrp@nylag.org)

CMS data posted here. (This is national enrollment for all Medicare Advantage plans - Summary of enrollment as of 10/1/15 in FIDA and MLTC by plan posted here - PDF - Excel - based on the NYS DOH enrollment data and  CMS data)

See May 2016 data here

* March 5, 2015 from Capital New York news article 

SNAPSHOT OF STATEWIDE ENROLLMENT IN ALL LONG TERM CARE PLANS

Enrolled June 2016 Number of Plans
MLTC 151,525    32           (23 in NYC)
FIDA 5,377    17 as of 2016 (down from 22)
PACE 5,542       9           (2 serve NYC)
Medicaid Advantage Plus 5,759       7          (all serve NYC)
TOTAL 168,409

Data from  NYS DOH managed care enrollment data  (Oct 2015) and CMS Medicare Advantage enrollment data (Oct.2015) and DOH "FIDA and MLTC Update - June 2016" (on file with NYLAG EFLRP)(Most of the monthly DOH "Policy and Planning" updates re FIDA, MLTC, and managed care are posted on the Leading Age NY website)

 

FIDA PLANS 

Five of the original 22 FIDA plans won't be offering FIDA coverage in 2016: ArchCare, EmblemHealth, Integra, Montefiore HMO and the most recent plan to pull out, Empire BlueCross BlueShield HealthPlus.  See Crain's article Nov. 22, 2015. 

As of Sept.15,2015 -  Per NY MedicaidChoice lists, there are now 18 plans.  Three plans have dropped out of FIDA - Montefiore, EmblemHealth, and Archcare.  See also DOH list with contact info. 

FIDA Plans by Region list of FIDA plans (updated)    

NY MedicaidChoice plan lists and CMS lists,  -- Plan telephone and web information is posted on the New York Medicaid Choice site - click here and scroll down to bottom for list of FIDA plans.  

On-Line Information on FIDA

NYS Dept. of Health consumer webpage on FIDAhttp://www.health.ny.gov/health_care/medicaid/redesign/fida/ 

NYS Dept. of Health "MRT" FIDA page (policies, procedures, webinars) http://www.health.ny.gov/health_care/medicaid/redesign/mrt_101.htm 

Also see these fact sheets on FIDA: 

(1) consumer-friendly FIDA Fact  Sheet aimed to help family members   (Spanish version)   (Russian version)  

(2)  this fact sheet for advocates.  

Dec. 19,2014 CMS posted  New York Fully Integrated Duals Advantage (FIDA) Provider FAQs for providers and consumers 

For more on FIDA see this article 

 Whether or not to enroll in FIDA - some considerations:

  1. Some of these considerations may not be so clear from the State's 60-Day notice and 30 Day Notice sent to MLTC members

  2. The FIDA plan will replace the member's previous coverage  - They will no longer have Original Medicare & Part D drug plan or Medicare Advantage plan, and will no longer have an MLTC plan.  All is replaced by one FIDA plan.

  3. PROVIDER NETWORKS - Are your preferred physicians, home care agency, hospitals and other medical providers in the FIDA plan's network?  If not, you may have to stop using those providers. Note that if you don't join FIDA, you still must be in an MLTC plan for Medicaid home care and other long-term care services -- and your Medicaid providers of dental care, podiatry, eyeglasses, optometry, hearing aides, and audiology must be in the MLTC plan network.  But MLTC plans DON'T cover Medicare primary and acute medical care - so if you opt out of FIDA, you would still use your Original Medicare (red white and blue) card for most medical care, with no network restrictions.

    1. 90-Day Grace Period/Transition Period - For the 1st 90 days of enrollment, the FIDA plan is required to allow you to see your doctors, even if they are out of network. However, your doctor/provider must be willing to accept the plan's terms - for payment and the plan's rules on authorizing services. (See above re whether Guildnet is making promises it cannot keep by saying you can keep your doctor if you join its FIDA plan). 

    2. Behavioral health services are subject to a longer transition policy.  FIDA plans must continue covering non-participating behavioral health providers for an ongoing “episode of care” for up to 2 years.

    3.  Guildnet Gold Plus FIDA is "point of service" which allows members to see out of network providers, and will pay those providers,  as long as those providers are willing to accept Guildnet's terms, which is not a given.

  4. Prescription drugs -  Medicare beneficiaries may choose how to receive their Medicare Part D prescription drugs - through a stand-alone Part D Prescription Drug Plan (PDP), a Medicare Advantage plan, or FIDA.  Whichever one you select, you want to be sure the plan includes your drugs on it's formulary, at the strengths and dosages you need.  

    1. CAUTION:  Unlike stand-alone Part D Prescription Drug Plans (PDP)s and Medicare Advantage plans that include Part D ("MA-PDs"), the formularies for FIDA plans cannot be searched via the Medicare Planfinder website  However, the FIDA plans are required to post them on their own websites.   

  5. Medigap - Medicare supplemental coverage - If you have a Medigap plan to "wrap around" your Original Medicare benefits, paying your out of pocket Medicare costs such as the annual or hospital Medicare deductibles and coinsurance, that Medigap plan won't do much good when you have FIDA.   This is because there are no out-of-pocket costs with FIDA - not even the monthly Part B premium.  You might be tempted to drop your Medigap policy if you join FIDA and save money, since the monthly Medigap premium is costly.  That's fine - but CAUTION - if you later decide to disenroll from FIDA and return to Original Medicare, you will not be able to buy a Medigap policy.  This is because of a federal law that bans insurers from selling Medigap policies to Medicaid recipients, since it is essentially duplicate coverage.  However,  if a Medicaid  or QMB recipient already has a Medigap policy, she may renew it or replace it with a different policy.   42 USC 1395ss(3)(3).  So - if you do join FIDA you might consider keeping your Medigap policy active for awhile, while you "test drive" FIDA and see if it meets your needs.

  6. Retiree health coverage -  If you or your spouse have retiree health coverage that supplements Medicare, be sure to ask the benefits administrator before you enroll in FIDA.  Enrolling in FIDA may result in TERMINATION of your retiree health coverage, depending on the type of coverage.  This may affect not only you but your spouse or other dependents who may rely on this coverage. 

  7. Plus side of FIDA - COST.

    1. No premiums - but still must pay $104.90 Part B premium if not eligible for the Medicare Savings Program (MSP)     May use a pooled trust to qualify for MSP.   In MAY 28, 2015 - NYS DOH  clarified that the Part B Premium must still be paid by FIDA members not otherwise eligible for a  Medicare Savings Program.  Click here for more info.  

    2. SPEND-DOWN CAUTION - The notice does not mention that you must still pay the Medicaid spend-down to the plan, if you have one.  As with MLTC, FIDA members may continue to use pooled trusts (supplemental needs trusts)  to eliminate their spend-down and avoid this billing.

    3. No deductibles or copays, This includes $0 copays for all covered prescription drugs - less than the standard copay charged to Medicaid recipients through "Extra Help" Part D subsidy. 

    4. BUT Medicaid spend-down must still be paid to the FIDA plan, unless eliminated by using a pooled trust. 

  8. Potential Plus Side of FIDA - coordination of all Medicaid and Medicare coverage under a single health plan, with a care planning team that better coordinates Medicaid and Medicare services and transitions to and from the hospital, etc. 

  9. RIGHT TO OPT OUT or DISENROLL-  No MLTC member is required to sign up for FIDA at all.  Everyone has the right to opt out of FIDA, but if they did not opt out by a specified date, they were assigned to a FIDA plan.   If passively enrolled, they may disenroll and switch back to MLTC any time, but must also enroll in a Part D plan  or a Medicare Advantage plan that covers prescription drugs. 

For questions about FIDA call:  

  • NY Medicaid Choice 1-855-600-FIDA  (1-855-600-3432)   Monday to Friday  8:30 am to 8:00 pm and Saturday from 10:00 am to 6:00 pm. TTY:    1-888-329-1541  Website www.nymedicaidchoice.com

  • ICAN (Independent Consumer Advocacy Network) - the Ombudsprogram for FIDA, MLTC and Long Term Care, funded by the State and administered by the Community Services Society 

1-844-614-8800   Monday-Friday, 8:00 am – 8:00 pm      Website: www.icannys.org    Email: ican@cssny.org 


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