12/21/2015

New York DOH Targets Dual-Eligible Program Reform

The New York State Department of Health and CMS have approved several changes to a program aimed at coordinating care for people receiving both Medicare and Medicaid benefits following disappointing enrollment and pushback from health care providers.

The adjustments to the Fully Integrated Duals Advantage (FIDA) program address some of the biggest concerns of providers and insurers.

Health plans will now be afforded more latitude to attract new members to FIDA plans, with the ability to compare the product with other managed long-term care offerings in promotional materials. They can conduct marketing calls to individuals enrolled in other Medicare or Medicaid products within their company, and, if approved by DOH and CMS, they can send out educational materials to potential enrollees who have opted out.

About 57,000 people have opted out of the program. DOH said in a recent white paper that the exodus was a result of people being unclear on how FIDA could benefit them and fearful they might lose their current doctors.

FIDA plans had signed up just 7,540 members as of Nov. 1—well below DOH's goal of 80,000 to 100,000 enrollees in the downstate area.

Five plans so far have left or announced they will leave the program: Empire BlueCross BlueShield, HealthPlus, ArchCare, EmblemHealth, Montefiore HMO and Integra. DOH has said the 17 remaining plans are still adequate to give consumers choice.