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by: Joseph A. Bollhofer, Esq.


FOR PERSONS ON BOTH MEDICARE AND MEDICAID:            

The New York State Department of Health is starting a new optional program in New York City and Nassau County on January 1, 2015. It is scheduled to expand to Suffolk and Westchester counties in the spring. It is called Fully Integrated Duals Advantage (FIDA) (“duals” as in “dually eligible for Medicare and Medicaid”).            

Under this plan, all services for those receiving care at home or in a nursing home will be provided under one “managed care” plan; there will be only one ID card. Letters began going out to all “duals” in early December. They may sign up for a FIDA plan by choosing from a list of approximately a dozen managed long term care companies.            

While this option sounds attractive in that there is the potential for a more coordinated approach to care, the letters being sent do not disclose that members will be limited to using in-network providers and prescription drugs that are on the chosen plan’s formulary.            

The letters also do not make it clear that duals may “opt out” of FIDA, nor do they disclose what happens if no option is selected. Future written “reminders” will be sent, which are expected to state that duals will be automatically assigned to a FIDA plan that is affiliated with their managed long term care plan unless they opt out.            

Whether the FIDA plan is better or worse than the current Medicare and Medicaid system remains to be seen. Suffolk and Westchester “duals’ can expect to receive these notices in March or April, 2015. A more detailed explanation can be found at www.wnylc.com/health/news/33.  


The rules regarding Medicaid eligibility are extremely complex, and many alternatives exist. Since each particular case has its own unique facts, the reader is cautioned that the above summary cannot be considered legal advice and should consult with an appropriate legal advisor. Please also note that the monetary figures stated herein are applicable to applications filed in 2014, and might vary in later years. 
Copyright 2014 Joseph A. Bollhofer, Esq.    

Editor’s Note: Joseph A. Bollhofer, Esq., is an attorney who practices law in the areas of elder law, Medicaid, estate and business planning and administration, and real estate. He is a member of the Elder Law, Real Property, and Surrogate’s Court Committees of the Suffolk County Bar Association and of the Elder Law and Real Property Law Sections of the New York State Bar Association. He has been serving area residents since 1985 and is admitted to practice law in New York and New Jersey. His office is located at 291 Lake Ave., St. James, NY. (584-0100). For reprints of this article and others concerning Medicaid, Elder Law and Estate Planning, send a request to info@bollhoferlaw.com or visit www.bollhoferlaw.com