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Old 05-01-2015, 11:18 AM
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Default More FIDA Opt-Outs Than Opt-Ins

Crain's Health Pulse; 4/23/2015

Nearly 32,000 people in New York City and Nassau County opted out of the $15 billion Fully Integrated Duals Advantage pilot program as of March 7, compared with only 749 people in the area who enrolled.

An additional 7,134 dual eligibles signed up for FIDA on April 1 through a system known as "passive enrollment," which automatically processes people who do not opt out of the program. On May 1, 8,677 people will be passively enrolled.

The program is meant to cut federal and state health spending by combining the benefits of Medicare Advantage plans, Part D prescription drug plans and Medicaid managed long-term care plans. The goal is better coordination of care for dual eligibles who need long-term care.

The state is looking for the 22 FIDA plans, many of which also offer Medicaid managed long-term care programs, to sign up some of the 139,000 state residents enrolled in those plans.

New Yorkers who opted out of FIDA might have done so to keep their non-FIDA network doctors, or to maintain coverage for drugs that weren't in a FIDA plan's formulary. There is a 90-day transition period after enrollment during which FIDA will pay for out-of-network doctors and drugs that are not covered. The state Department of Health has organized FIDA training for providers; about 4,300 have registered.

Last month, DOH halted FIDA enrollment on April 1 in Suffolk and Westchester counties because of concerns about plans' networks. Plans were asked to stop marketing efforts. They were told to stop accepting opt-in enrollments until they submitted updated network information to DOH at the end of April. In New York City and Nassau County, passive enrollment will not begin as scheduled on June 1 to give plans time to adjust. Enrollment restarts July 1 and runs through Sept. 1.

New York hopes to avoid some of the pitfalls experienced by Massachusetts' program, where enrollment was lower than expected and beneficiaries' health needs were greater than expected, Crain's reported in December. Massachusetts recently lowered its savings targets, Modern Healthcare reported yesterday. Nationwide, there are 1.7 million eligible residents, and only 20.1% had enrolled as of April 1.
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