08/01/2016

New York DOH Rethinking Dual Eligible Program

Due to poor enrollment, the NY State Department of Health (DOH) is reviewing its Fully Integrated Duals Advantage (FIDA) program designed to provide more coordinated care to people enrolled in both Medicare and Medicaid.

Data show 5,370 beneficiaries have enrolled, while 61,701 have opted out of the program. That sign-up count is down 14% from February, and DOH has indefinitely postponed expansion of the program to Westchester and Suffolk counties. The largest number of FIDA enrollees are in Brooklyn, at 1,620. That membership represents only 3.4% of those who are eligible for FIDA or a Medicaid managed long-term care plan in the borough.

There are 17 health plans still participating in FIDA after five insurers dropped out of the program last year. As of May, the Visiting Nurse Service of New York had 1,939 members, and Healthfirst had 1,058 enrollees, but aside from those two plans, sign-ups have been scarce. Six plans have attracted fewer than 50 members, including RiverSpring Health with just seven members.

In New York City and Nassau County, many eligible members have steered clear of the plans because they feared their drugs or doctors wouldn’t be covered. The program’s benefits include a single card for Medicare and Medicaid benefits and a care manager to develop a personalized care plan and coordinate treatment from various specialists and long-term care providers.