The CMS is launching a second demonstration for low-income and disabled New York state residents eligible for both Medicaid and Medicare. The first demonstration is struggling to keep enrollees, but the CMS recently said it will find a way to keep it afloat.
The new effort will be called Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities, the CMS announced Thursday.
The program will target duals in New York City, Long Island, Rockland and Westchester counties with intellectual and developmental disabilities who are in need of long-term support and services. As many as 20,000 people are eligible, starting after April 1, 2016.
The announcement comes nearly a year after Fully Integrated Duals Advantage, the state's first dual demonstration, launched. As many as 124,000 residents were eligible for FIDA, but as of Sept. 1, only 7,280 had enrolled and 57,375 have opted out. On top of that, nearly 400 people dropped out of FIDA between August and September of this year.
The CMS had recently pledged to help the state turn FIDA, which is budget neutral, around. The new demonstration is not a replacement, rather it will run in parallel with the original program, since people with developmental disabilities were not eligible for the initial demonstration.
“We look forward to working together to provide Medicare-Medicaid enrollees with intellectual and developmental disabilities an opportunity to experience more integrated benefits and coordinated care,” Tim Engelhardt, director of CMS' Medicare-Medicaid Coordination Office said in a statement.
Unlike FIDA, individuals can not be passively enrolled in the IDD demonstration. Passive enrollment means an individual is enrolled through no action of their own. The new effort also has a benefit package tailored to support individuals with IDD.
Experts have commented that the first demonstration has been unsuccessful because enrollees opted out based on fears that their healthcare would change significantly. Providers have also been concerned about rates.
Given the problems FIDA had getting off the ground, advocates are nervous about the new effort.
“Issues have emerged around the willingness of providers to participate in person-centered care planning, problems with reductions in the level of care, lack of awareness of the rights in healthcare of people with disabilities,” said Susan M. Dooha, executive director of the Center for the Independence of the Disabled, New York (CIDNY). “Planners looking at FIDA for people with intellectual disabilities and CMS should proceed with caution.”
Earlier this month, the CMS, which benefits if the program successfully lowers costs, said it would help FIDA by trying to attract providers, which in turn, could draw their patients and other beneficiaries looking for wider access to care.
A dozen states have rolled out three-year demonstrations to serve dual-eligibles, who often receive splintered care at extremely high costs. Most of the demonstrations are facing similar problems.
