New York and CMS Announce Partnership to Coordinate Care for Medicare-Medicaid Dual Enrollees

  • Aug 26 2013

Today, CMS issued a Press Release announcing that it is conducting a demonstration project with New York State known as the Fully Integrated Duals Advantage (FIDA) demonstration.  Under this capitated demonstration, approximately 170,000 New Yorkers who are people eligible for Medicaid and Medicare in NYC, Long Island and Westchester County will be able to join a health plan that includes all the benefits of under Medicare (Parts A and B, and Part D)  and Medicaid and additional support for care coordination and community living.  Those who are eligible can opt in starting in July 2014 for community based individuals and October 2014 for individuals living in nursing homes. 

Under the FIDA demonstration, New York and CMS will contract with Medicare-Medicaid plans to coordinate the delivery of covered Medicare and Medicaid services for these participating Medicare-Medicaid dual-eligible enrollees.  CMS has identified as a priority improving the care for low-income seniors and the disabled who are dually eligible for Medicare and Medicaid.  For more information, a CMS released a Fact Sheet and the complete Memorandum of Understanding between New York and CMS detailing the FIDA demonstration is available here.

This is significant because it is one of the first tangible steps by CMS and New York toward tackling the State’s estimated 700,000 plus dual eligible population, which includes the State’s costliest and most complex Medicaid beneficiaries. The dual eligible population has greater care needs than the average Medicaid enrollee and typically requires a wide range of services from multiple providers.  Since managed care has little experience in serving this population, dual eligibles and their advocates have expressed concern about potential restrictions and provider access difficulties under managed care. A demonstration project like FIDA gives CMS and New York the opportunity to learn how to effectively coordinate and enhance care for this costly and complex population. Three-way capitated contracts between the dual eligibles, New York and CMS such as those proposed under the FIDA demonstration allow for a more integrated and robust care model.

This post was prepared by Kurt Bratten and Carla Williams.

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Posted in: Long Term Care, Medicaid, Medicare, Nursing Homes



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