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
Copyright 2014 Joseph A. Bollhofer, Esq.
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
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