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
