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Publications > Integrating and Improving Care for Dual Medicare-Medicaid Enrollees: New York’s Proposed Fully Integrated Duals Advantage (FIDA) Program

Integrating and Improving Care for Dual Medicare-Medicaid Enrollees: New York’s Proposed Fully Integrated Duals Advantage (FIDA) Program

Published: 2012

See the related press release.

This report from the Medicaid Institute at United Hospital Fund focuses on an important extension of New York’s landmark Medicaid reforms—the proposed Fully Integrated Duals Advantage program, or FIDA. The FIDA program’s focus—beneficiaries who are enrolled in both Medicare and Medicaid, commonly referred to as “duals”—is one of the most complex and challenging populations to serve effectively. Duals present unique issues for state policymakers because Medicaid is not the primary payer for their acute care services, or for many of their initial episodes of care in skilled nursing facilities or home health care.

Integrating service delivery, managing care across the full spectrum of covered services, and operating under a single capitation payment—all part of the proposed FIDA program—will pose substantial challenges to, and require significant adaptation by, beneficiaries, providers, and managed care plans.

Two important goals of the FIDA program are to improve the coordination of care for duals and to better control spending. In New York, duals account for an estimated $24 billion in Medicaid spending and an estimated $12 billion in Medicare spending.

(Updated November 21, 2012, to correct an error in Footnote 4 on page 1. Further updated November 28, 2012, to correct an error in the eligibility threshold cited on pages 9 and 10.)

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Integrating and Improving Care for Dual Medicare-Medicaid Enrollees: New York’s Proposed Fully Integrated Duals Advantage (FIDA) Program Integrating and Improving Care for Dual Medicare-Medicaid Enrollees: New York’s Proposed Fully Integrated Duals Advantage (FIDA) Program  (174K) [download]


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