Greetings – Here are some Medicaid updates from the Evelyn Frank Legal Resources Program, with links for where to find more information.
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FIDA "Auto-Enrollment" starts April 1st!  Get informed!

Seniors and people with disabilities who are "dual eligibles" -- who have both Medicare and Medicaid - and who receive Medicaid managed long term care (MLTC) services and live in New York City and Nassau County have big changes coming.  Enrollment in Fully Integrated Duals Advantage (FIDA) plans will become automatic on April 1, 2015 for about 7,100 MLTC members, and for about 30,000 more over the next four months. Those who will be automatically assigned to a FIDA plan are those MLTC members who have not “opted out” or chosen to voluntarily enroll in FIDA.  

Over 100,000 MLTC members in NYC and Nassau Co. received a series of notices explaining FIDA and the right to opt out since late December 2014.  Click to see the 60-day notice and 30-day notice being sent to 70,000 people who have not yet opted out or enrolled voluntarily.  The notices inform them which FIDA plan they will be assigned to if they don't choose and enroll in a plan or affirmatively OPT OUT of FIDA.

So far, about 31,000 have opted out of the demonstration.  They will remain in their MLTC plans for Medicaid home care and other Medicaid services, and keep their separate Medicare coverage - either Original Medicare plus a Part D plan OR a Medicare Advantage plan. Those in FIDA will have ONE PLAN for all Medicare and Medicaid coverage.

Which FIDA plan will you be assigned to?  You will be assigned to the FIDA plan that is sponsored by the same company as your MLTC plan.  Four MLTC plans are not connected to a FIDA plan.  Their members will be assigned to a different FIDA plan that contracts with their home care agency. (CLICK HERE FOR LIST OF 21 FIDA Plans - New York City)   (FIDA Plans - Long Island)  

Will all 70,000 people who have not OPTED OUT of FIDA be assigned to a FIDA plan on APRIL 1st?  NO. The first 7100 people will be enrolled in FIDA on April 1st.  In each following month, another 7000 - 8000 people will be auto-assigned to FIDA plans.  Schedule is posted here (scroll down to FIDA Dashboard) and is based on birthday for people receiving SSI, and date Medicaid authorization expires for everyone else.

WHAT ABOUT SUFFOLK AND WESTCHESTER COUNTIES?   FIDA is a Demonstration program that will be in NYC, Nassau, Suffolk, and Westchester.  So far, it started only in Region 1 - NYC & Nassau.  Region 2 covers Suffolk and Westchester.   FIDA enrollment in these counties -- whether voluntary or "passive" auto-enrollment -- and all mailing of notices -- has been indefinitely postponed, in order for more doctors and other providers to join the provider networks of these plans.  This was announced by the State on Feb. 27, 2015.  Since FIDA is an expanded type of Medicare Advantage plan that covers ALL Medicare and Medicaid services, including those otherwise covered by Part D and MLTC,  it is critical for members to have access to an adequate network of physicians, hospitals, clinics, home care agencies, pharmacies, and other medical providers.

HOW TO LEARN ABOUT FIDA:

 

1.       Live Trainings Available on MLTC and the new FIDA program - by NYLAG Evelyn Frank Legal Resources Program

Thursday, Mar. 26, 2015 at 5:30pm- Spanish language  presentation  - Paula Arboleda - Sunnyside Community Services:   43-31 39th Street, Sunnyside, NY 11104 -- RSVP to Shyvonne Noboa, 718 784-6173 ext 440, by email snoboa@scsny.org, or contact Nelly Vidal at 718-784-6173 ext 480.   (Presentation will be taped and available online - stay tuned for info and an upcoming RUSSIAN language live presentation or webinar)
 
Mon., April 20, 2015  2 PM - 5 PM - NYLAG Evelyn Frank Program on MLTC and FIDA - CLE Credit available  ---  Download announcement and registration hereMUST RSVP --   Location:  NYLAG - 7 Hanover Square, 15th floor, NY NY 10007 /RETURN COMPLETED RSVP form: E-mail EFLRP-CLE@nylag.org  or  fax 212-714-7482.  For questions please email or call  212-613-7310

Contact NYLAG to schedule presentations to groups of family caregivers or professionals  about MLTC and FIDA - learn difference between the two programs, how they impact Medicare services like choice of doctors, who must enroll in MLTC or FIDA, how to decide whether to enroll in FIDA or to opt out, and consumer rights to get services from both plans.  CONTACT Peter Travitsky at ptravitsky@nylag.org (depends on availability)
 

2.      NYLAG Caregiver Fact Sheet on FIDA available for download here

Please note these are not yet updated to announce indefinite postponement of FIDA in Westchester & Suffolk

3.    Online information and webinars 

Click here for NYHealthAccess article on FIDA  and News Updates on FIDA
Links to more fact sheets and taped webinars on FIDA and MLTC
 

4.   Contact NY Medicaid Choice - click here

NY Medicaid Choice is the State's FIDA and MLTC enrollment broker.  Call to ENROLL, to OPT OUT of FIDA, or for information:     1-855-600-FIDA  (1-855-600-3432)  TTY:    1-888-329-1541    
Monday to Friday  8:30 am to 8:00 pm and Saturday from 10:00 am to 6:00 pm. 
If member cannot speak on the phone or you are opting out on their behalf, FAX an authorization for you to speak for them to 1-917-228-8601

NYS OFFICIAL FIDA brochures in 6 languages posted here - and scroll down to bottom of page for FIDA plan lists in NYC and Nassau  County
 

5.   Contact ICAN - the statewide OMBUDSPROGRAM for FIDA and MLTC


The Independent Consumer Advocacy Network (ICAN) has a network of non-profit organizations helping people choose whether or not to enroll in FIDA and also help with Managed Long Term Care problems.
  •  NYLAG Evelyn Frank Legal Resources Program is part of the ICAN network.   1-212-613-7310   E-mail :  eflrp@nylag.org
  • Community Services Society is central ICAN headquarters              1-844-614-8800   E-mail:  ican@cssny.org      (contact CSS to learn about entire ICAN network statewide)        

New Permanent Nursing Home Residents Now Required to Join Managed Care or MLTC plans- Started Feb. 2015 in NYC and Starts Elsewhere April 1st

CMS has now approved the requirement that people who first become permanent residents in nursing homes after  Feb. 1, 2015 will be required to join a "mainstream: Medicaid managed care" or MLTC plan.  "Mainstream" plans are for Medicaid recipients who do not have Medicare and do not have a spend-down. MLTC is for adult dual eligibles who need Medicaid home care.

The definition of a "permanent" nursing home resident is still somewhat unclear, but someone entering a nursing home solely for short-term rehab is NOT required to enroll in an MLTC or managed care plan.  Someone who was not in an MLTC or mainstream Medicaid managed care plan before does  NOT have to join one of these plans in order to enter a nursing home. Once they are in the home and are considered "permanent," generally after they have done the 5-year Medicaid lookback application and it has been approved, they will be required to enroll in a plan. 

What if Medicare is paying for short-term rehab stay?  Most MLTC members have Medicare, and Medicare generally pays for at least the initial part of a short-term rehab stay.  NYS DOH has confirmed that MLTC plans may NOT limit their members' choice of rehab facility to those facilities in the MLTC plan's network.  They must allow them to go to any rehab facility - and if the member does not have a Medigap policy, the MLTC plan must pay the Medicare coinsurance.  SEE DOH Q&A Aug. 16, 2012  - Question 42 on page 7.  However, after Medicare coverage ends, if the member stays in the nursing home permanently, they will need to switch to a different MLTC plan that includes that nursing home in its provider network.

Where?  This new requirement started in NYC on February 2015 and will begin in Nassau, Suffolk and Westchester in April 2015, with other counties rolling out in July and October 2015. See schedule here.    Unlike FIDA, this is not a "demonstration" only downstate.   This is statewide.  

MLTC Schedule for Expanding to Upstate Counties – and other MLTC Updates

As of March 9, 2015  the "front door" is closed in one more county - Cattaraugus -- following four other counties where the front door closed on January 5, 2015 (Genesee, Orleans, Otsego, Wyoming).  This means that in NYC and all but 13 upstate counties, it is MANDATORY to enroll in an MLTC plan for most adult dual eligibles seeking long-term home care (more than 120 days) (see list here - scroll down to Roll-Out Schedule). 

In mandatory counties adult dual eligibles seeking home care:
  1. Apply to their local Medicaid program for Medicaid. Once approved --
  2. REQUEST A "CFEEC" - In NYC, Long Island, Westchester and as of March 1, 2015 -- 20 more counties - they must call NY Medicaid Choice  Conflict Free Evaluation & Enrollment Center (CFEEC) at 1-855-222-8350 to certify that they need long-term home care services.  This is a 3-hour in-home assessment.   Click here for a list of counties requiring the "CFEEC". 
  3.  After the CFEEC gives thumbs-up for MLTC enrollment, or in counties which do not yet require a CFEEC, contact an MLTC plan directly to enroll.  They will send a nurse to the home to do an assessment.  Lists of MLTC plans by region in the state with contact info – http://nymedicaidchoice.com/program-materials - look at Long Term Care plan lists

Troubleshooting Delays Enrolling into MLTC plans - Problems with Mysterious Eligibility Codes and Spend-down


Advocates have observed many problems and delays enrolling in MLTC plans, even once Medicaid is approved - especially for people with a Medicaid spend-down or people in nursing homes trying to enroll in an MLTC plan to return home.

If a consumer is approved for Medicaid with a spend-down, Medicaid needs to be "activated." in order to enroll in an MLTC plan, unless the applicant presented enough medical bills to "meet" his or her spend-down.  See more about spend-down here.   In NYC, download the Conversion Form that MLTC plans must fax to HRA in order to activate Medicaid and enroll in an individual who has a spend-down or other “code” that is preventing enrollment.  Can only be used after Medicaid application is accepted.  See HRA FAQ for MLTC plans here. 

Download this Guide to Troubleshooting MLTC Enrollment problems here. 

NEW STATE CONTACTS TO FILE COMPLAINTS ABOUT MLTC OR FIDA:

NYS DEPT. of HEALTH MLTC and FIDA COMPLAINT LINE  1-866-712-7197  or
e-mail mltctac@health.ny.gov 

CFEEC COMPLAINTS (if fail to schedule assessment in 7 days, etc.)  CF.Evaluation.Center@health.ny.gov

Send a copy of your complaint to the ICAN OMBUDSPROGRAM:
 ican_complaints@cssny.org  
 
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