Significant Changes for Community Medicaid & MLTC Recipients

January 16, 2015
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For New York residents enrolled in Medicare and Medicaid and who receive home care services from a Managed Long Term Care (MLTC) or Medicaid Advantage Plus (MAP) program, you should have received or will receive a letter from the NYS Department of Health regarding a Fully Integrated Duel Advantage Plan (FIDA) enrollment.

FIDA Plans will combine all of your health plans under one plan.  One managed care plan will host your Medicare Advantage Plan, Part D prescription drug plan and your MLTC plan and all Medicaid services.  IT IS NOT MANDATORY TO ENROLL, however if you choose not to enroll you MUST OPT-OUT. Otherwise you will be Passively Enrolled into a plan that is chosen for you.

The Timeline:

NYC and Nassau County-

December 2014 and Announcement Notice was sent to all MLTC & MAP members about voluntary enrollment or Opting-Out of a FIDA Plan.

January 1, 2015 begins voluntary enrollment.  A 90-day Notice was sent out to plan members stating that they may OPT OUT and that they will be passively enrolled if they do nothing. Passive enrollment will begin on April 1, 2015.

February 1, 2015 – 60 Day Notice will be sent out of your right to OPT OUT

March 1, 2015 – 30 Day Notice will be sent out of your right to OPT OUT

Beginning April 1, 2015 – Those who did not OPT OUT will be passively enrolled and automatically assigned to a FIDA plan. Passive enrollment will take place from April through August 2015.

Suffolk and Westchester-

March 2015 – Announcement Notice

April, May & June 2015 – 90 day, 60 day & 30 day Notice to Opt Out.

July 1, 2015 – Passive enrollment begins for those who did not Opt Out.

HOW DO I OPT OUT? Call 1-855-600-FIDA (1-855-600-3432) Monday through Friday 8:30am – 8:00pm and Saturday 10:00am – 6:00pm.

You can disenroll or switch to a different FIDA plan at any time. The next month you will be back on Traditional Medicare or your Medicare Advantage Plan. You also may switch to a different FIDA plan. Contact that plan to discuss enrollment.  If you disenroll from FIDA make sure you enroll in an MLTC plan and Part D prescription drug plan.

Things to Consider:

  • Are your Doctors “In-Network?”
  • Are your Prescription Drugs on the plans Formulary?
  • Other Health Coverage such as Retiree Plans and Medi-Gap insurance.
  • Cost Analysis

If you have any questions, please do not hesitate to call Tully Law, P.C. at (631) 424-2800 and we can help guide you through the process.

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