Educating Health Care Providers on Their FIDA Roles

Grantee Name

Medicare Rights Center

Funding Area

Primary Care

Publication Date

June 2018

Grant Amount

$192,586

Grant Date:

November 2014 – October 2015

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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. NYHealth 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.

Outcomes and Lessons Learned

Identified provider and provider group partners that helped vet, disseminate, and train providers on FIDA.
Developed the FIDA Provider Toolkit, which included presentations to help patients understand FIDA, handouts for providers, and connections to other resources.
Conducted an electronic survey, developed with provider and provider group input, to gauge provider knowledge and perceptions of the FIDA program.
Led the Coalition to Protect the Rights of New York’s Dually Eligible, as well as convened a roundtable of providers, insurers, advocates, and policymakers to submit comments to the New York State Department of Health on how to improve provider participation in FIDA.
Led in-person and Web-based trainings on FIDA for providers to introduce them to the program and describe the benefits and logistics of participation for them and their patients.

Despite these efforts, the FIDA program in New York State saw low enrollment among dual eligibles and received little support from providers. As of late 2017, only 4,600 New Yorkers were enrolled in 1 of 17 FIDA plans.

Although FIDA was largely unsuccessful, the needs of dual eligibles that motivated the program have not gone away. In September 2017, NYHealth awarded MRC another grant to develop a meaningful replacement program to meet the initial promise of FIDA. Under this project, MRC is working with advocates, providers, and consumers to build consensus among key stakeholders about FIDA’s successes and challenges, as well as what is needed in an effective replacement. Reflective of the earlier mistakes made, this FIDA replacement will need to meaningfully involve providers in design and implementation; properly create incentives for providers and plans to participate; and align quality measures with other programs wherever possible. MRC continues to play a role in working with the New York State Department of Health and Centers for Medicare & Medicaid Services on the necessary components for a robust, consumer-oriented FIDA replacement in 2020.

Co-Funding and Additional Funds Leveraged: N/A

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Educating Health Care Providers on Their FIDA Roles

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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.

Outcomes and Lessons Learned

Related Links

Improving Services for Dual Eligibles with Disabilities

Simplifying Rules for New York’s Dual Eligibles

Developing a Capitation Analysis for New York’s Dual Eligibles Program