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���������� Note: The article below does not clarify that FIDA is not for all persons with dual eligibility in NYC and surrounding areas, but rather just for those who require long term services and supports for 1/3 or more of the year. That makes implementation different, as the individuals eligible are easier to identify and find because of greater historic utilization, but it also makes their treatment management unique and costly. These concerns are not the only ones surrounding FIDA implementation. Community based providers are concerned that contracts won’t mean referrals, or that current regulations will not comply with the inherent flexibility of this community-based model of support. Advocates are concerned that most-needed services will be cut or won’t be coordinated well by new payers, and are worried that the innovative approach of including chosen family and even peer specialists in the care management team will be misused. ���������� will keep our readers informed of changes made to this demonstration, which may be a bellwether for fully integrated plans for all persons with dual eligibility in the future.

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As FIDA debuts, Anxiety Rises

Crain’s Health Pulse; 12/8/2014

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���������� state began sending notices on Dec. 1 to potential enrollees in FIDA. As the ambitious, $15 billion program approaches its Jan. 1 launch, anxiety is high among health plans and providers.

“Conceptually and programmatically, it is a really good idea,” said Patricia Wang, chief executive of Healthfirst. “But it’s very important to get this right.”

Dual eligibles need extensive and costly medical care. FIDA’s goal is to better coordinate patients’ treatment and break down the silos between Medicaid and Medicare. The three-year pilot project hands over responsibility for roughly 138,240 dual eligibles to 22 managed care plans. The state initially is targeting 118,000 residents in ���������� City, Long Island and Westchester.

“Their care has been very fragmented,” said Patrick Pilch, national health care advisory leader at BDO Consulting. “Now you’re trying to coordinate it, and that is very challenging.”

Though ���������� insurers for now are backing the state’s latest health reform effort, they face the most risk and are especially nervous. Mere weeks before the launch, the state hasn’t set the rates it will pay the participating insurers. The state Department of Health did not respond to requests for comment.

“Plans are concerned. They want to make sure rates are adequate because the services required by this population are so complex,” said a spokeswoman for the ���������� Health Plan Association, who added that insurers have 10 days after the rates are announced to opt out of the pilot.

���������� is joining a handful of states that have created pilots to address health care costs of dual eligibles. Implementation hasn’t been easy. In California, health plans��dual eligibles.�� In some states,����their patients not to sign up.

The grimmest cautionary tale is from Massachusetts, which launched the country’s first dual eligibles pilot in October 2013.�� last month that fewer than 18,000 out of 95,000 potential members enrolled, and insurers were caught off guard about the extent of the health care needs of those who did. One health plan was losing $1 million a month at one point because so many members were admitted to psychiatric hospitals.

In ����������, hospitals and nursing homes welcome the pilot. But they fret over potential cash-flow problems.

“We are concerned that FIDA could negatively impact some providers, particularly safety-net hospitals that are unable to negotiate favorable contract terms,” said Kathy Shure, senior vice president of managed care and insurance expansion at the GNYHA.

“My members’ biggest fear is that there will be glitches in the new system and they won’t get paid,” said James Clyne, president and chief executive of LeadingAge NY.

Although patients can opt out of FIDA, advocates are concerned that people may not have access to the care they need. “You can’t trample on people’s rights in the name of putting everyone into managed care,” said the ���������� Legal Assistance Group’s Valerie Bogart.

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