The Fully Integrated Duals Advantage (FIDA) program provides managed care for New York residents who are enrolled in Medicare and Medicaid (dually eligible individuals) and in need of long-term care services and supports. FIDA is one of several demonstration programs across the country with the goal of providing better and more coordinated care for dually eligible individuals while reducing health care expenditures where possible. If you are enrolled in FIDA, one plan is responsible for providing and paying for all your health services. This means that FIDA plans will cover the full range of your health and long-term care needs, including doctor office visits, hospital stays, Medicare Part D drug benefits, mental health care, Medicaid long-term care from home health aides, adult day health care, dental care, nursing home care, and transportation.
You are eligible for a FIDA plan if you fulfill all of the following:
- Are 21 years or older
- Are dually eligible for both Medicare and Medicaid
- Require long-term care services and supports for more than 120 days (this includes anyone currently enrolled in a managed long-term care (MLTC) plan)
- Live in a county in New York State where FIDA is available (currently the counties of New York City, Nassau, Suffolk, and Westchester)
Note: If you qualify for Medicare due to the End-Stage Renal Disease (ESRD), you may join the FIDA program.
The FIDA program is meant to help simplify coverage and improve care for dually eligible individuals who have ongoing long-term care needs. If you enroll in a FIDA plan, you will still have Medicare and Medicaid, but the way you get your care will change. Before you decide to join a FIDA plan, know that you will have to use health professionals and pharmacies that participate in your FIDA plan’s network. This means that you may not be able to visit your old doctors or preferred pharmacies if they are not in the FIDA plan’s network.
Under FIDA, you will:
- Have one plan and one insurance card to provide all your Medicare and Medicaid benefits.
- Be assigned a plan care manager to facilitate your care and make sure you get the care you need.
- Have the option to receive coordinated care from a team of health care providers (sometimes called an Interdisciplinary Team or Interdisciplinary Care Team), which will include you, your care manager, and optional other providers and family members. This team will develop a personalized care plan that identifies all your health and long-term care needs and recommends care to address them.
- Have the right to appeal to the FIDA plan if you disagree with care decisions made by your team of doctors and health professionals.
If you want to learn if you meet the above eligibility requirements, are not yet receiving Medicaid managed long-term care, and are interested in joining a FIDA plan, you first must contact the Conflict-Free Evaluation and Enrollment Center (CFEEC) at 855-222-8350. CFEEC will send a nurse to your home to perform a conflict-free evaluation. The nurse will assess your long-term care needs and tell you by the end of your evaluation if you are eligible to join a FIDA plan.
After completing this conflict-free evaluation, you have 75 days to join the FIDA plan of your choice. After 75 days, your evaluation expires and you must schedule a new visit from the CFEEC to be reassessed.
Note: The CFEEC does not determine the services or level of care you will receive after enrolling in a FIDA plan. The plan you choose will make its own care determinations based on your specific needs.
Remember, enrollment in FIDA is not required and you can switch FIDA plans or disenroll from your FIDA plan at any time and enroll in another type of (MLTC) plan. To disenroll from your FIDA plan, call New York Medicaid Choice at 888-401-6582, TTY 888-329-1541.
If you are experiencing problems with the CFEEC assessment, coverage under your FIDA or MLTC plan, or need help navigating your options, please contact the Independent Consumer Advocacy Network (ICAN) at 844-614-8800.