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Nov. 25, 2014: After a 6-month delay, the State Dept. of Health began sending Notices this week to over 110,000 adult "dual eligibles" in NYC and Nassau County who are in Managed Long Term Care (MLTC) plans or Medicaid Advantage Plus plans. The notices explain that they may voluntarily enroll in a new FIDA plan --Fully Integrated Dual Advantage. These insurance plans combine in one HMO a Medicare Advantage plan, an MLTC plan, and a Medicare Part D plan. As an HMO, medical care and long-term care must be from providers in the plan's network. This is in contrast to Original Medicare, which allows a beneficiary to see any provider who accepts Medicare.
FIDA is a demonstration program that will roll out first in New York City & Nassau County (Region 1) and beginning in March 2015 in Westchester and Suffolk Counties (Region II). It will not be implemented statewide, unlike mandatory enrollment in MLTC for adult dual eligibles who need home care. Notices will roll out over a few months based on the date of the individual's Medicaid renewal (see DOH Policy & Planning update dated Oct. 16, 2014 with schedule).
Read more about FIDA here and download a Consumer Fact Sheet on FIDA. The State has not yet shared a copy of the notices now being sent, but the State's earlier draft of the notice is posted here, along with suggested edits to the notice by NYLAG and other consumer advocates.
There will be 22 FIDA plans -- all of which are sponsored by companies that also sponsor MLTC plans. Download a list of FIDA plans showing which MLTC and Medicaid Advantage Plus plans they are affiliated with. Only 3 of the 25 MLTC plans in NYC are not becoming FIDA plans. See list.
NYLAG anticipates that December 1st will also mark the start of marketing by MLTC plans to recruit their members to enroll in their affiliated FIDA plans. The next four months are a period of "voluntary enrollment," through April 1, 2015, in which MLTC members in NYC and Nassau will receive a series of notices from the state's contractor, New York Medicaid Choice, telling them that they may, before April 1, 2015:
- Enroll in a FIDA plan of their choice (this can be done even now - with enrollment effective January 2015, or in January effective February 2015 and so on)(NOTE that one must enroll by contacting NY Medicaid Choice - not with the FIDA Plan directly)
- OPT OUT of FIDA entirely, and choose to keep their current MLTC plan and Medicare coverage (whether Original Medicare or Medicare Advantage), and that -
- IF THEY DO NOTHING - they will be "passively enrolled' into a FIDA plan on or after April 1, 2015. For over 96% of all MLTC recipients, whose MLTC plan is affiliating with a FIDA plan, this is an automatic assignment to the affilated FIDA plan. The relatively few members of 3 MLTC plans NOT becoming FIDA plans - HHH Choices, Extended, and UnitedHealth, - should be "intelligently assigned" to a FIDA plan that allows them to keep some of their providers - but we don't know how this will be determined.
HOW DOES ONE OPT OUT?
After December 1st in NYC and Nassau County, client can call New York Medicaid Choice to OPT OUT.
CALL 1-855-600-FIDA (1-855-600-3432) Monday to Friday 8:30 am to 8:00 pm and Saturday from 10:00 am to 6:00 pm. TTY: 1-888-329-1541
ALERT: People receiving MLTC services may feel pressured to enroll in a FIDA plan, or may not fully understand how FIDA is different than MLTC. They may not understand that FIDA Is a voluntary program but that if they do nothing they will be automatically enrolled in FIDA beginning April 2015. They may not understand that they can no longer use their Original Medicare card once they are in a FIDA plan, as they will be restricted to providers in the plan's network. They may hear about the 90-day transition period -- during which they may still see out-of-network providers, and not understand that this out-of-network access ends after 90 days.
NEWS that current NURSING HOME RESIDENTS will NOT be passively enrolled into FIDA plans! Originally, 55,000 nursing home residents in the FIDA Demo area were also supposed to receive the same notices along with MLTC members, and be passively enrolled on the same schedule. DOH announced in October that only NEW people who first become PERMANENT NH residents in 2015 will be passively enrolled into FIDA --but not til August 2015. We believe that only people who have approved for Institutional Medicaid after the 5-year lookback has been approved will be subject to passive enrollment. They will first receive letters giving them at least 90 days to select a FIDA plan on their own or to OPT OUT, and only at the end will be passively enrolled. However, DOH has not clarified whether current NH residents are ALLOWED to enroll in FIDA "voluntarily," which could make them vulnerable to marketing efforts to enroll them without fully understanding their choices.
We are especially concerned for those with limited English skills, or who have cognitive impairment.
We urge you to reach out to your current dual-eligible clients who receive long term care services AND/OR their families. Assure them that they cannot lose their care if they choose to opt out of FIDA. Explain that they have time -- until mid-March 2015 in NYC and Nassau - to decide whether to enroll in FIDA or to opt out But if they rush and enroll now, they will be enrolled as of January or February 2015. Help them find out if their preferred providers are participating in any FIDA plan.
For more information on FIDA:
NEW: Statewide Ombudsprogram for Medicaid Long Term Care To Launch December 1st
- "ICAN" or Independent Consumer Advocacy Network -- new ombudsprogram will be run by the Community Service Society under contract with the State.
- TEL. 1-814-614-8800
- This new program, just being built, will bring together consumer advocacy organizations from throughout the State, including EFLRP-NYLAG, to assist consumers navigating these complex new systems for providing Medicaid long-term care services, including:
- FIDA (in downstate Demo area)
- MLTC - statewide
- Mainstream managed care - help with accessing personal care, CDPAP and other long term care services for those who do not have Medicare and are required to enroll in Medicaid managed care plans. (See Statewide directory listing plans by county)
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*****PLEASE NOTE CORRECTED ADDRESS****
Last day for "Earlybird Rate"
New York Chapter of Professional Geriatric Care Managers (NYPGCM)
& the
Evelyn Frank Legal Resources Program, New York Legal Assistance Group (NYLAG)
are pleased to announce:
Everything You Want to and Need to Know About Changes in Medicaid Managed Long Term Care and the New "FIDA" Duals Demo Starting in 2015
Presented by Valerie Bogart, ESQ, Director
Evelyn Frank Legal Resources Program, NYLAG
December 3, 2014
1:00 pm-5:00 pm
Location: American Jewish Committee
165 East 56th Street, NYC, NY 10022
(Original posting had wrong address)
or Online Webinar
Refreshments will be served and
handouts will be provided
CLE credit available
Approved for 4.5 NASW CEUS
Limited Space Available
Payment and registration must be postmarked
by November 25, 2014 to qualify for the
pre-registration rate
DOWNLOAD REGISTRATION FORM
Cost (same for live and webinar):
NYGCM members: $100 pre-registered
Non-members: $125 pre-registered
Attorneys in private practice: $125 pre-registered
Public interest attorneys, attorneys & non-attorneys in non-profits, government, full-time law students and academics: $75 pre-registered
At the door registration (if available): $150
The New York Legal Assistance Group has been certified by the New York State Continuing Legal Education Board as an Accredited Provider of continuing legal education. This course will provide 3 credits in Areas of Professional Practice. This course is appropriate for both newly admitted and experienced attorneys. However, newly admitted attorneys may only get CLE credit for participating in person, not via webinar.
Financial scholarships, which may reduce or waive tuition, may be requested by those indicating unemployment or other financial hardship. To receive our financial hardship policy or our Financial Scholarship Application, please email noberhei@optonline.net. Your application must be received two weeks before the seminar date. This policy is intended to make our programs accessible to those facing financial hardship.
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Anyone approved for Medicaid in New York City or Nassau County who is seeking Managed Long Term Care will need to first contact NEW YORK MEDICAID CHOICE and request a CFEEC assessment. If that assessment conducted by a nurse in the client's home, hospital or nursing home, finds the person eligible for MLTC, then the person can enroll in an MLTC plan.
- Region 3 – February 2015: Westchester & Suffolk
- Click here for FAQ with schedule for rest of state and other information. Also see NYHealthaccess.org.
TIP 1: A family member, social worker or other advocate familiar with individual's functional needs should be present for the assessment.
TIP 2: Have a list of individual's medications, diagnoses, and primary functional impairments ready to give to the assessor. This can be from the treating physician, a geriatric care manager or other reliable source.
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