A new Medicaid program call Fully Integrated Dual Advantage (FIDA) program is being offered to New York seniors. It provides many benefits but there is a catch….
My 97- year -old mother- in- law, Lillian has been receiving her medical care through original Medicare since she turned 65. It covers her doctor visits, lab tests, and prescription drugs. When she turned 90 she started to need assistance with dressing and eating. Since she has limited income and assets, she qualified to receive home care through a Managed Long Term Care Plan (MLTC), a private agency that is paid by Medicaid.
Lillian is one of approximately 800,000 New York State residents classified by the government as “Dual Eligibles,” that is individuals 65 years or older who receive both Medicare and Medicaid benefits. Beginning last month (January) New York City’s dual eligibles received letters from the State Department of Health introducing them to a new government health care program that can replace their current Medicare/Medicaid services. If one of your relatives received one, do not ignore it.
The new program, called a Fully Integrated Dual Advantage (FIDA) program offers a full spectrum of government health care services, including doctor and hospital visits, all prescription medicines, and home or nursing home care all through one provider. The program will roll out in April 2015. The letter claims FIDA will simplify medical care. One advantage of the new plan includes medical visits with no payment deductibles, no copayments, and no plan premiums Another advantage is the introduction of an Interdisciplinary Team (IDT) that will oversee the enrollee’s health care. The IDT will consist of the enrollee and a trusted friend or relative, the doctors, the home care aide and a FIDA plan care manager.
After this brief introduction to FIDA benefits, the letter asks all recipients if they would like to disenroll from their current Medicare/Medicaid plan and enroll in a FIDA plan. They have 90 days to decide. They will receive written periodic reminders: one 30 days after receiving the original announcement and one after 60 days. But there is a catch.
If a recipient does not respond in the indicated time period, the New York State Department of Health will assume the candidate wants to be in a FIDA plan and will “passively enroll” him in one of the 22 available plans. In other words, a candidate must actively respond to the inquiry and indicate that he prefers to remain in his current plan, (that is, opt out of a FIDA plan) or the government will assume he wants to enroll. The State will then arbitrarily assign him to a plan.
Although the new FIDA’s offer several benefits that could simplify care, there are some downsides to consider as well. One disadvantage is the limited provider network. In original Medicare, members can use any Medicare doctor registered in the United States. In FIDA plans, new enrollees are limited to doctors and other medical services in their program network. Another disadvantage is in drug coverage. New enrollees will be restricted to medications covered by their new plan. That means a person must check that their FIDA plan will cover his prescriptions or he will not receive them or must pay for them out of pocket.
A final disadvantage concerns secondary medical coverage. Many people who enroll in traditional Medicare have secondary coverage through an employee-sponsored, union-sponsored, or a Medigap program. Under FIDA the registrant will lose his secondary coverage. This might not impact the enrollee but could impact family members if they are covered as well. If this is the case the applicant should check his current policy to determine if this change will cause the family to lose their coverage.
If a dual eligible decides to enroll in a FIDA program, he still has time to make adjustments. An enrollee can continue to use his current providers for at least 90 days after enrollment or until a care assessment has been completed under the new plan. After the time period has expired, FIDA will no longer pay for the doctor unless she agrees to participate in the new plan.
On a positive note, enrollment in a FIDA plan is reversible. Anyone who enrolls in a FIDA plan, either passively or actively, can elect to leave and switch to another plan or return to the original if he is not satisfied with the service. Participants can disenroll at any time. However the change will not be immediate. A plan does not go into effect until the first of the following month, so at most a person would have to wait 30 days.
When my mother-in-law received her introductory letter, the whole family sat down and discussed the advantages and disadvantages. After much deliberation we decide that Lillian should remain in her current plan. Her current doctors know her and visit her at her home and she loves her home attendants. Why change a good thing? We called the phone number listed on the introductory letter and opted out of a FIDA plan.
We do not want to rock the boat. New programs are often welcome, and simplicity is often a good reason to change. FIDA might offer advantages for some Medicaid recipients who receive home care. But in our case, we worked hard to get Lillian a staff of trusted professionals and dependable services. We do not want to risk the unknown. We are happy with her current coverage.