New York’s Fully Integrated Duals Advantage Program: An Overview

Dual eligibles, those people who qualify for both Medicare and Medicaid, make up a disproportionate amount of federal and state health care spending.

Dual eligibles, those people who qualify for both Medicare and Medicaid, make up a disproportionate amount of federal and state health care spending.

New York State is no exception. More than 700,000 people in New York are simultaneously enrolled in both Medicare and Medicaid. The State has the highest annual cost per dual eligible, $30,384, which is double the national average of $15,459. 

Dual eligibles often have greater complex care needs versus the average Medicaid enrollee, which can present cost and service delivery challenges for managed care organizations. In recent years policy developments at both the Federal and State level have unveiled innovative, new mechanisms for improving care for duals. In light of challenges facing managed care organizations, New York State is implementing landmark Medicaid reforms developed by New York’s Medicaid Redesign Team. One such model is the Fully Integrated Duals Advantage Program or FIDA. FIDA is a significant part of a State demonstration proposal to integrate care for duals. FIDA could affect 150,000 New Yorkers.

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FIDA aims to fully integrate all service delivery for duals across the health care spectrum, including acute care, long-term care, and behavioral health, under a single capitation payment per beneficiary. Essentially, FIDA expands care management for the Medicaid population, and goes beyond what other initiatives have done to bring all service delivery under the same care management entity.

As the Western New York Law Center explains: 

FIDA plans will combine under one managed care plan:  (1) a  Medicare Advantage plan, (2) a Part D prescription drug plan, (3) a Medicaid Managed Long Term Care plan, and (4) a regular Medicaid card covering all other Medicaid services.   FIDA plans will cover not only Medicaid long-term care services, as MLTC plans do, but also cover ALL other medical care covered by Medicare and Medicaid.  In other words, a FIDA member will essentially trade in ALL of their insurance cards — Medicare (Original or Medicare Advantage), Medicaid, MLTC, Medigap, and Medicare Part D — and only have one health plan — their FIDA plan.

When does mandatory enrollment begin? The initial enrollment was schedule for July 1st 2014. That has since been pushed back to January 1st 2015.

For the most update to date information about the FIDA roll out, visit New York State’s Medicaid Redesign Team website.