Empowering Health Care Consumers

Grantee Name

Medicare Rights Center

Funding Area

Empowering Health Care Consumers

Publication Date

December 2019

Grant Amount

$126,446

Grant Date:

October 2017 – March 2019

New York was one of 15 states originally selected to receive demonstration planning grants from the federal government to launch managed care demonstration models for people covered by both Medicare and Medicaid (known as dual eligibles).

The goal of the demonstration was to provide more coordinated care at lower cost to dual eligibles, often the most vulnerable and high-cost beneficiaries. Under its duals demonstration, New York State launched the Fully Integrated Duals Advantage (FIDA) program in select downstate counties in 2015. FIDA sought to help the 124,000 New Yorkers initially estimated to be eligible for the demonstration (out of about 840,000 total New York State dual eligibles). Unfortunately, FIDA had very low enrollment and received little support from providers. By 2017, only 4,600 New Yorkers were enrolled in a FIDA plan. Although FIDA was unsuccessful, the need persists for more coordinated coverage and care for New York State dual eligibles.

In 2017, NYSHealth awarded the Medicare Rights Center a grant to develop a meaningful replacement program to meet the initial promise of FIDA.

Outcomes and Lessons Learned

  • Built consensus among key stakeholders around FIDA successes, challenges, and what would be needed in a robust, consumer-oriented replacement.
  • Shaped the FIDA replacement by drafting a formal proposal to the New York State Department of Health (NYSDOH) and the Centers for Medicare & Medicaid Services (CMS) on needed replacement components.
  • Ensured continuing multistakeholder engagement for the desired FIDA replacement by compiling policymaker feedback into the formal proposal and determining next steps.
  • Participated in NYSDOH-convened stakeholder meetings and submitted comments to inform FIDA’s replacement.

Medicare Rights Center submitted the formal proposal to NYSDOH in May 2018, incorporating stakeholders’ feedback on FIDA’s replacement. Key recommendations for NYSDOH included:

  • Mandate voluntary enrollment for beneficiaries into the new model, with continuity-of-care rights.
  • Ensure timely access to all necessary providers and clear communication regarding out-of-network benefits.
  • Create incentives for effective and efficient person-centered care coordination and care management.
  • Develop and implement a shared data system with CMS to enable participant access to health records, claims, service authorizations, and care plans.
  • Mandate and participate in targeted provider outreach to explain the purpose of the new integrated care model and practical concerns.
  • Mandate meaningful provider and beneficiary engagement.

Medicare Rights Center also created a 61-point advocacy checklist to help ensure that FIDA’s replacement would be as responsive as possible to beneficiary needs. NYSDOH subsequently incorporated certain checklist items into its plans for FIDA’s replacement.

National interest in Medicare Rights Center’s advocacy approach continues to grow. California, Massachusetts, Michigan, Ohio, and Rhode Island have asked to see its FIDA replacement proposal, which Community Catalyst shared nationally in June 2018.

Since the close of this grant, NYSDOH has announced that Medicaid Advantage Plus (MAP) will be the product that most closely resembles FIDA from January 2020 onward. Medicare Rights Center is continuing its work to help ensure that MAP preserves beneficiary-oriented gains achieved under FIDA (e.g., an integrated Medicare and Medicaid appeals process). It also remains focused on educating New York State beneficiaries and professionals on dual-eligible health coverage options. If properly designed, MAP could generate higher enrollment and become an effective, consumer-friendly way for New York State dual eligibles to secure integrated coverage and care.

Co-Funding and Additional Funds Leveraged: Medicare Rights Center has received grants from the Altman Foundation ($75,000), the Fan Fox and Leslie R. Samuels Foundation ($160,000), and the van Ameringen Foundation ($225,000) to continue work in this area into 2021.