FIDA Program Closing Dec. 31, 2019 - Watch for Notices of Options

• 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  

October- November 2019

The FIDA program is closing December 31, 2019.  Read about what will happen for the 2520 current FIDA members who are all in NYC, Nassau and Westchester Counties in this article.   New 60-Day notices that FIDA members received in late October and 30-Day notices that they will receive in late November are now posted in that article.

Also see this Tool Kit by the Medicare Rights Center, with Fact Sheets about options for FIDA members and information about the Medicaid Advantage Plus insurance plans that most FIDA members will be switched to.  

December 2017

FIVE FIDA Plans Slated to Close in 2018 -- affecting 534 Members of FIDA plans as of Dec. 2017 

• 5 FIDA plans are closing in January 2018, affecting FIDA members in Nassau County and NYC.  The five plans are Aetna, Guildnet (closing in Nassau County only), Fidelis, ICS, and North Shore -LIJ.

• As of December 2017, in NASSAU COUNTY, 169 out of 344 FIDA members are enrolled in plans that are closing in January 2018.  This is nearly one-half of all FIDA members in Nassau County.   Figures from NYS DOH monthly managed care enrollment. 

• As of December 2017, in NEW YORK CITY, 365 out of 3,934 FIDA members are in plans that will be closing in January 2018, as follows.  Figures from NYS DOH monthly managed care enrollment. 

• What happens to the 534 FIDA members in plans that are closing in Nassau County and NYC?

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 § 2.6.6.1 (Posted on MRT 101 webpage)

• Those who go from a closing FIDA plan to a regular MLTC plan are not entitled to transition rights.  DOH has confirmed that DOH MLTC Policy 17.02 does not apply to  closing (non-renewing) FIDA plans, only MLTC, Medicaid Advantage Plus (MAP) and PACE plans.  This is our understanding of DOH policy as of late December 2017.  Advocates have urged DOH to extend the same transition rights to these individuals as all other members of non-renewing plans.  See more about Transition Rights when MLTC plans close here.   
• Consumers may call the ICAN Ombudsprogram if their new plan does not continue the same services that they received in the FIDA Plan that closed.  Phone:  844-614-8800     

TTY Relay Service:  711   Website:   icannys.org      ican@cssny.org

• Status of FIDA In Westchester and Suffolk - Figures from NYS DOH monthly managed care enrollment. 

​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:

July 2017

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).  

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. 

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

• For a view of enrollment over time,  see this site - http://www.publicsignals.com/health-care-data/ - click on TRENDS in top chart and then filter by region of state, dual eligible status, type of plan or by a particular plan,  Also see below - DASHBOARD - Summary of enrollment in FIDA over time in this chart

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