Medicare Rights Center, Inc.

New York is 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. Unfortunately, FIDA had very low enrollment and received little support from providers. At the time of this grant, only 4,600 New Yorkers were enrolled in one of 17 FIDA plans, out of an estimated 840,000 residents considered dual eligible. Although FIDA was unsuccessful, the needs of dual eligibles that motivated the program did not go away. In 2017, NYHealth awarded Medicare Rights Center a grant to develop a meaningful replacement program to meet the initial promise of FIDA.

Under this project, Medicare Rights Center worked 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. It drafted a formal proposal to the New York State Department of Health and Centers for Medicare & Medicaid Services on the necessary components in a robust, consumer-oriented FIDA replacement, as well as compiled policymaker feedback to the formal proposal and determined next steps for ensuring continuing multistakeholder engagement and the desired FIDA replacement in 2020. Medicare Rights Center tracked project success through the ability of advocates and other stakeholders to unite around specific components of a FIDA replacement, as well as the willingness of policymakers to accept elements of the formal FIDA replacement proposal and sustain meaningful engagement with Medicare Rights Center and its partners beyond the grant period.