|NASSAU COUNTY - FIDA ENROLLMENT BY PLAN||Enrolled 12/2017||
|Total ENROLLED IN FIDA Dec. 2017||344||169|
|GuildNet Gold Plus||101||X|
|Agewell New York||63|
|HealthFirst Absolute Care||50|
|VNSNY Choice FIDA Complete||32|
|ElderPlan FIDA Total Care||27|
|North Shore-LIJ FIDA LiveWell||21||X|
|Aetna Better Health||10||X|
|Plan Name - New York City||
|Total enrolled in NYC Dec. 2017||3,934||365|
|VNSNY Choice FIDA Complete||1,406|
|HealthFirst Absolute Care||933|
|GuildNet Gold Plus||469|
|ElderPlan FIDA Total Care||364|
|SWH Whole Health||135|
|ICS Community Care Plus||81||X|
|Aetna Better Health||27||X|
|FIDA Care Complete||26|
|Agewell New York||24|
|Village Care Max Full Advantage||18|
|North Shore-LIJ FIDA LiveWell||10||X|
All participants of closing FIDA plans received notices in October 2017 informing them of their options. There are two different groups of affected individuals, with two different notices, default actions, and deadlines:
Passively Enrolled – These FIDA participants were passively enrolled in FIDA before passive enrollment was discontinued in December 2015. See below. Their deadline to select a new plan is 12/31/2017. If they do not, they will be "intelligently assigned" to another FIDA plan. This means that an effort will be made to retain the same home care agency that contracted with the closing FIDA plan.
Opt-Outs – These FIDA participants were not passively enrolled, because they opted out, but then subsequently voluntarily enrolled in FIDA. Their deadline to select a new plan was 12/11/2017. If they did not, they will be auto-assigned to a partial-capitated MLTC plan and revert back to Original Medicare.
Do FIDA Members have Transition Rights to continue the same Services and Amount of Hours when they Move to a New FIDA or MLTC Plan?
Information from the State Dept. of Health is that all individuals who go from a closing FIDA plan to another FIDA plan will retain the 90-day transition rights outlined in the FIDA Final Model Three–Way Contract § 18.104.22.168 (Posted on MRT 101 webpage)
Suffolk County - As of December 2017, 111 people are in the Agewell NY FIDA plan - the sole plan in Suffolk County.
Westchester County - As of December 2017, 16 people are in these 2 FIDA plans:
|Agewell New York||6|
|HealthFirst Absolute Care||10|
When FIDA first expanded outside of New York City and Nassau counties to Westchester and Suffolk, only one plan -- Agewell FIDA -- was offered in those counties. Two new FIDA plans are available in Westchester County (since 7/1/17) -- Healthfirst and Riverspring. Agewell remains the only plan available in Suffolk. See complete list of FIDA plans , but note that the list will change in 2018 when 5 FiDA plans close (see December 2017 above).
Lists of all MLTC, Medicaid Advantage Plus, PACE and FIDA plans by region is available on NY Medicaid Choice website. (Scroll down to Health Plan Lists)(Note that FIDA list will change in 2018).
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.
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.
|FIDA Care Complete (Centers Plan)||25|
|Senior Whole Health||67|
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.
"Current FIDA Trends and Future Enrollment Opportunities"
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.
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:
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.
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.
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)
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.
for June 1st
Aug. 1, 2015
Sept.. 1, 2015
For Oct. 1, 2015
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)
* March 5, 2015 from Capital New York news article
|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)|
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)
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.
NYS Dept. of Health consumer webpage on FIDA - http://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:
(2) this fact sheet for advocates.
Dec. 19,2014 CMS posted New York Fully Integrated Duals Advantage (FIDA) Provider FAQs for providers and consumers
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.
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.
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).
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.
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.
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.
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.
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.
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.
Plus side of FIDA - COST.
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.
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.
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.
BUT Medicaid spend-down must still be paid to the FIDA plan, unless eliminated by using a pooled trust.
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.
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.
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