Financial Alignment Initiative New York FIDA Combined Second and Third Evaluation Report

Document Type

Report

Publication Date

Spring 2021

Keywords

Medicare, Medicaid, integration, long-term services and supports, care coordination, integrated appeals, managed care

Abstract

The Medicare-Medicaid Coordination Office and the Innovation Center at the Centers for Medicare & Medicaid Services (CMS) have created the Medicare-Medicaid Financial Alignment Initiative (FAI) to test, in partnerships with States, integrated care models for Medicare-Medicaid enrollees. New York and CMS launched the Fully Integrated Duals Advantage (FIDA) demonstration on January 1, 2015, to integrate care for Medicare-Medicaid beneficiaries in the greater New York City area. The demonstration ended on December 31, 2019. Initially, twent-yone Medicare-Medicaid Plans (MMPs) participated in the demonstration. In the final year, six MMPs remained. MMPs received capitated payments from CMS and the State to finance all Medicare and Medicaid services.

Stakeholders supported the demonstration’s elements of streamlined care planning and service authorization processes, and its integrated appeals process allowing a single path to appeal both Medicare and Medicaid service decisions. However, due to a combination of design choices, environmental factors, and early implementation missteps, a large number of potential enrollees and providers opted out of participation.

Although New York and CMS addressed many of the issues, FIDA was plagued by its early negative reputation and declining enrollment throughout the life of the demonstration. Out of over 100,000 eligible beneficiaries, enrollment peaked in October 2015 at 8,833 and declined to 2,320 as of December 2019.

In this evaluation report for the New York FIDA demonstration, we describe demonstration implementation activity from 2017 through 2019, and the considerable planning activity during the final demonstration years to create an option to seamlessly transition FIDA enrollees into existing MAP plans aligned with Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) under the same MMP parent organization.3 We include findings from qualitative data for 2017–2019. Using qualitative data gathered throughout the demonstration (2015–2019), we also present overall demonstration successes, challenges, and lessons learned at the end of the report.

Funding Organization

Centers for Medicare & Medicaid Services

Grant Number

Contract #HHSM-500-2014-00037i TO #7

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