It’s no secret that New York State’s FIDA-MMP (Fully Integrated Duals Advantage Medicare Medicaid Plan) had a difficult first year. At ICS our experience was no different.
ICS members who are covered by both Medicare and Medicaid were bewildered by “passive enrollment” letters from New York State.
- Many doctors who belonged to practices with FIDA contracts had never heard of the plan and those who had didn’t necessarily like what they were hearing.
- Confusion reigned as members seeking medical appointments with doctors they had long relationships with were told their doctors didn’t accept FIDA.
Not surprisingly, many people who were passively enrolled in FIDA dis-enrolled as quickly as they could. By the end of 2015 a number of health insurance plans had pulled out of the program.
Despite these well-documented problems, ICS is sticking with the FIDA pilot because, as ICS Chief Operating Officer Regina Estela says, “The goals of FIDA are the right goals.” Providing better, more efficient, more cost-effective care that improves the health and wellbeing of high-needs, low income New Yorkers is a challenge that ICS is fully committed to meeting.
Fortunately, New York State officials have heard the complaints about FIDA loud and clear. For 2016, the State has changed a number of requirements that made the plan difficult to manage and navigate. With fewer onerous requirements and greater flexibility, patients, as well as doctors, can expect to see improvement this year.
What has changed?
First, and foremost, New York State has suspended “passive enrollment.” Under passive enrollment, when FIDA launched last year the State begin automatically enrolling people who are covered by both Medicare and Medicaid into a FIDA plan. In many instances, those patients were then told by their doctors and other health care providers that they could no longer see them. This happened for two reasons: some providers were not enrolled in FIDA; many others were enrolled in FIDA through the hospitals or large practices they are part of, but they didn’t know it. In both instances, the result was the same: alarmed, unhappy FIDA participants.
With passive enrollment now suspended, New Yorkers who are covered by both Medicare and Medicaid can make an informed choice to enroll in FIDA after learning about it and deciding it is the best plan for them. ICS members who are interested in FIDA – which really has many advantages – have been asked to first find out whether the doctors they prefer to see are in the ICS provider network, either by searching on our website or asking their care manager to find out. If someone is interested in FIDA and their doctor is not in our network, the ICS Provider Relations Department will work to enroll the doctor or other provider. Meanwhile, FIDA members can continue to see their same doctors for 90 days, while ICS works to get the doctor or other provider enrolled.
Another major improvement the State made for 2016 is to allow flexibility in the interdisciplinary team – the group of people the FIDA member chooses to involve in creating their care plan. Most significantly, doctors are no longer required to attend these meetings and FIDA members have much greater flexibility over who is on their team, when the team meets and how team members communicate.
Equally important, insurers like ICS who are part of the FIDA pilot project have been given much more flexibility to explain the plan and enroll new members. This is really important because FIDA is complicated and people who are eligible need and deserve help in understanding it so that they can make a well informed choice.
As a result, in 2016 we will be talking a lot more about the ICS FIDA plan. We feel strongly that FIDA is a great choice for many of our members because it features all of your homecare, healthcare and social service services under one roof, coordinated by a care manager who understand your needs.
Want to know more? Here are the top ten reasons to join ICS’s FIDA plan.