Medicare, Medicaid, Intellectual and developmental disabilities, integration, long-term services and supports, care coordination, integrated appeals, managed care
The New York FIDA-IDD demonstration was launched in 2016 in nine downstate counties and was the first comprehensive managed care demonstration exclusively serving individuals with intellectual and developmental disabilities (IDD) in the nation. Due at least in part to a lack of provider participation, less than 8 percent of eligible beneficiaries enrolled. Beneficiaries who did enroll reported high levels of satisfaction, especially with care coordination and the ease of obtaining durable medical equipment. The MedicareMedicaid Plan’s (MMP) assessment and care coordination model provided person-centered care planning that identified goals and helped to achieve them, improving enrollees’ quality of life. The MMP successfully used telehealth and care coordination to reduce unnecessary trips to the emergency department.
The low enrollment and enrollment of a frailer than expected population led to financial challenges for the MMP. The MMP was unable to spread start-up and administrative costs over a broad enrollment base, and expenditures for personal care and Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) services outstripped the capitation rate paid to the plan.
Overall, the demonstration had no impact on Medicare or Medicaid expenditures among all eligible beneficiaries over the first 4 demonstration years.
Centers for Medicare & Medicaid Services
HHSM-500-2014-00037i TO #7
Snow, Kimberly I. MHSA; Gattine, Elizabeth JD; Kandilow, Amy PhD; Toth, Matthew PhD; and Chepaitis, Amy PhD, "Financial Alignment Initiative: New York Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities: Preliminary Third Evaluation Report" (2023). Disability & Aging. 136.