Medicare Rights Center
Advancing Primary Care
November 2014 – October 2015
Dual eligibles—individuals who qualify both for Medicare and Medicaid—account for 15% of New York State’s Medicaid enrollees, but represent 45% of total State Medicaid expenditures.
Dual eligibles often require a complex array of services from multiple providers, which results in fragmented and uncoordinated health care delivery. In New York State, 840,000 residents were considered dual eligibles. Starting in January 2015, the Federally Integrated Dual Advantage program (FIDA) has provided a new opportunity to coordinate care for this costly and complex population. Under FIDA, participating health insurance plans would be paid on a capitated basis to provide a comprehensive package of services that covers physical and behavioral health care; long-term care supports and services; and prescription medications. Although health care providers were uniquely positioned to encourage participation in the new model, many were not fully aware that they were eligible to be a FIDA provider. NYSHealth awarded Medicare Rights Center (MRC) a grant to educate providers in New York City, on Long Island, and the Hudson Valley region about FIDA policies and eligibility.