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CDPAP Does More With Less As It Enrolls Nearly 10,000 Patients Into Personalized Care Programs

New York’s Consumer-Directed Personal Assistance Program (CDPAP) has enrolled, in its nearly three decades of operation, around 10,000 patients into personalized care programs, generating significant benefits for such individuals and reducing costs typically associated with such services.

Over this period, the program has witnessed significant expansion, eligible to almost anyone who is in need and eligible for Medicaid, and has consequently generated benefits through cost-savings and care-enhancements.  Seeking a more-personal, personal care system in which persons in need of care or their representatives can choose or designate their own care workers, programs such as CDPAP offer a rare combination of improvements in quality and increased fiscal responsibility.

As the Consumer-Directed Personal Assistance Associate of New York State (CDPAANYS) has stated, ‘consumer-driven models of financing and delivering services permit the person needing service greater choice and control’ while simultaneously ensuring efficient funding of these patients’ care.

Indeed, due to its unique structure, the CDPAP is not only highly personalized, and in many cases better, care; one of the reasons this program is such a celebrated innovation is because New York’s CDPAP not only does more, but ‘does more with less’.  Within this context, it is important to briefly understand the cost-effectiveness of this program as it accomplishes a rare feat of improving services as well as fiscal responsibility.

How, then, has New York managed to deliver a highly personalized, fiscally-responsible safety net for many disabled or elderly individuals? This program is highly structured and emphasizes a key set of requirements for entrants.  By utilizing federal, state, and local funds and distributing these funds as needed for each case, there have been noted savings to Medicaid funding from this program.

The Department of Health, for instance, estimated the savings in hourly costs for personal care to be $2.16, which obviously adds up quickly.  Furthermore, by eliminating ‘middle men’, ensuring personal care, and orchestrating Medicaid reimbursement, the cost-sharing within CDPAP is equitable, eliminates unnecessary agents, and, thus, benefits all parties involved.

Similarly, the NY Education Department argues that, in addition to the benefits of ‘self-direction’, decreased costs are a leading factor in the increasing emphasis on consumer-directed personal assistance programs, with lower costs per hour of service leading to New York saving Medicaid funds and consequently capable to ensuring adequate coverage across the board.

With a combination of caps on expenditures and costs to Medicaid as well as the ‘slightly lower Medicaid rate payable…than is paid to home care services agencies’, there is no doubt that New York’s CDPAP is among the stand out consumer-directed personal assistance programs in the country.

As a representative of the benefits to be derived from such programs, thus, any understanding of New York’s program can only expand the awareness and utilization of personal care programs.  Whether in New York, California, or Arkansas, consumer-directed programs which ensure personal home care in a cost-effective manner have consistently proven successful.

With growing enrolment and amidst great uncertainty surrounding the continued funding of Medicaid and similar programs, particularly at the federal level, New York’s CDPAP stands out as a distinct safety net for those in need of such personal care.  By developing a cost structure that decreases state, federal, and individual costs, the CDPAP developed by New York is effective, efficient, and fiscally responsible; few programs can claim that and even fewer can say that they, at the same time, improve patients’ quality of care.

Everything You Need To Know About FIDA

What Is FIDA?

FIDA stands for Fully Integrated Duals Advantages. It is a program that combines Medicare and Medicaid services together with Long-Term Management Care (MLTC) services to create one large, cohesive plan. The aim of FIDA is to organize and improve the coordination and quality of both Medicare and Medicaid services while still allowing the recipient flexibility in controlling their personal services.    

Who Is Eligible?

People who receive Medicare Part B are entitled to the benefits of Medicare Part A, are eligible for Medicare Part D and MLTC, and who receive full Medicaid benefits are eligible for FIDA. They also must:

  • Be over 21 years of age.
  • Live in the Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk or
    Westchester Counties.
  • Require community-based long-term care for more than 120 days OR be eligible but not receiving facility-based or community-based LTSS.

People who are eligible for FIDA are not required to enroll in FIDA. It is not a mandatory program. Recipients of FIDA can withdraw at any time, with no effect on their prior Medicare and Medicaid services.

What Does it Change?  

Recipients of FIDA must use doctors and providers approved by their FIDA plan’s network. But, recipients are allowed a transition period of 90 days from time of enrollment in which they can still see their current provider or doctor. Exceptions to this are:

  • If a recipient is part of a nursing facility that does not participate in their FIDA plan, then they are allowed to stay in that facility while still receiving FIDA.  
  • If the recipient is receiving behavioral health services prior to enrolling, then they are allowed to continue it until the treatment is complete, but it cannot exceed over 2 years.
  • If the recipient gets permission from their FIDA plan to continue seeing a non-FIDA provider.

FIDA plans also cover prescription drugs, nurse care support and home coverage, personal care, behavioral health, and adult social daycare.  

Where can I learn more about FIDA plans?

To learn more about FIDA plans and whether it’s a good choice for you or a loved one, visit Alphacare.com.
Sources: health.ny.gov and cms.gov  

10 Things You Might Not Know About Managed Long Term Care

Managed Long Term Care, or MLTC, is a plan that arranges long term services for homebound chronically ill or disabled people, and is covered by the New York Medicaid Program.

1) The New York State Department of Health reviews, approves, and lists all MLTC insurance plans in New York.

2) There are three types of MLTC programs in New York: PACEMLTC Partial Capitation Plans, and Medicaid Advantage Plus.

3) PACE, or Program of All-Inclusive Care for the Elderly, covers all Medicare and Medicaid programs, and requires members to be over 55 and eligible for nursing home admission.

4) FIDA (Fully Integrated Duals Advantage) participants get all their covered Medicare and Medicaid services from one plan, including long term services and supports (LTSS) and prescription drugs.

5) MLTC Partial Capitated plans only cover Medicaid long term care services, not primary medical care services.

6) Medicare Advantage Plans are NOT the same as Medicare Advantage Plus. Medicare Advantage Plans do provide primary medical care paid for by Medicare and/or Medicaid.

7) Medicare Advantage Plus provides both Medicare and Medicaid primary medical care and long term medical care.

8) MLTC does NOT affect other Medicaid and Medicare services.  Any services, coverage, and benefits covered by Medicaid and Medicare will not be lost if you receive MLTC.

9) Eligibility for MLTC includes people who meet the age requirement, are either dual or non-dual eligible, and requires community or home-based long term care services for over 120 days. Dual eligibility is when an individual is eligible for both Medicare and Medicaid coverage.

10) CDPAS (Consumer Directed Personal Assistance Services) is a statewide Medicaid program that allows patients who are eligible to receive home care from a family member who can actually be paid for their services.

Source: NYS Department of Health

If you have questions about Managed Long Term Care, our friends at AlphaCare would be glad to answer them for you.  Click Here to Submit Your Question(s).

-Nikkia Rivera

What is Managed Care?

Managed Care is a term that is used to describe a health insurance plan or health care system that coordinates the provision, quality and cost of care for its enrolled members. In general, when you enroll in a managed care plan, you select a regular doctor, called a primary care practitioner (PCP), who will be responsible for coordinating your health care. Your PCP will refer you to specialists or other health care providers or procedures as necessary. It is usually required that you select health care providers from the managed care plan’s network of professionals and hospitals. There are many different types of publicly-funded managed care programs in New York State serving residents in all age groups and various income levels.

Managed care plans pay the health care providers directly, so enrollees do not have to pay out-of-pocket for covered services or submit claim forms for care received from the plan’s network of doctors.  However, managed care plans can require co-pays paid directly to the provider at the time of service.

There are many different types of managed care plans. Most managed care plans certified by the New York State Department of Health offer health education classes or other programs to help enrollees stay healthy. Depending on the type of managed care plan you join, there may be additional services, such as transportation, available to you.

Source: Medicaid.gov

Managed Long Term Care: What is it and Do I Qualify?

Managed Long Term Care (MLTC) is a system that streamlines the delivery of long term services to people who are chronically ill or disabled and who wish to stay in their homes and communities. These services, such as home care, social day care or adult day care, are provided through managed long term care plans that are approved by the New York State Department of Health. The entire array of services to which an enrolled member is entitled can be received through the MLTC plan the member has chosen.

As New York transforms its long term care system to one that ensures care management for all, enrollment in a MLTC plan may be mandatory or voluntary, depending on individual circumstances.

MLTC Eligibility:

  • At least 21 years of age
  • Enrolled in Medicaid
  • Able to stay safely at home
  • In need of at least one of the following services for more than 120 days from the enrollment date:
    • In-home Nursing Services
    • In-home Therapy
    • Adult Day Care
    • Consumer Directed Personal Assistance Services (CDPAS)
    • In-home Personal Care Services
    • Private Duty Nursing

MLTC Services and Support can include:

  • Extended Care Services such as:
    • Dental Care
    • Eye Exams & Glasses
    • Hearing Exams & Hearing Aids
    • Rehabilitation Therapy
    • Foot Care
    • Nutritional Counseling
  • Coordinated Services & Supplies:
    • Prosthetics & Orthotics
    • Medical Equipment
    • Home Safety Improvement
    • Transportation to Health Appointments
    • Chore Service & Housekeeping
    • Delivered Meals
    • Care Coordination
  • Personally Dedicated Health Professionals:
    • Nursing
    • Personal Care and Social Workers
    • 24-7 On-call Services & Emergency Response Systems
    • Consumer Directed Personal Assistance Services (CDPAS)

Source: NYS Department of Health