New York’s Struggling Dual-Eligible Program to End in 2019

After several years of low enrollment and health plans dropping out, New York’s Fully Integrated Duals Advantage Program is ending in December 2019. Enrollment in the program ends in June 2019.

The managed care demonstration for about 170,000 dual-eligibles in the New York City market had experienced a high opt-out rate since launching in January 2015. Under the FIDA demonstration, the state and the Centers for Medicare & Medicaid Services contracted with managed care organizations to coordinate services for participating Medicare/Medicaid enrollees. The demonstration tests an innovative payment model and service delivery model to improve care coordination, enhance quality, and reduce costs for both state and federal government.

The pieces were in place to transition Medicaid and Medicare recipients to a dual-eligible program. But few provider incentives and lack of consumer education attributed to the slow start of the program. Even after changes were made to make the dual-eligible program a more attractive healthcare option for consumers and providers, the program never took hold.

After starting the demonstration with 23 MCOs, the plans were dropping out of the program as fast as consumers opted out. At the end of 2018, only six health plans remained, enrollment fell below 4,000, and more than 60,000 people opted out of the program. In October 2018, four more plans closed as of Jan. 1, 2019. The plans AgeWell NY, GuildNet Gold, MetroPlus, and VillageCare Max, have a total enrollment of 893 members.  In 2017, Independence Care System, North Shore-LIJ Health Plan, Aetna, AlphaCare, CenterLight, Wellcare, and Fidelis stopped offering plans.

Despite the challenges, the state remained committed to the program and launched a second FIDA managed care program in April 2016 targeting 20,000 residents in New York City, Long Island, and Rockland and Westchester counties, and expanded the first FIDA demonstration to Westchester and Suffolk counties in mid-2017.

The state Department of Health had sought input from providers, patients, and insurers on whether the struggling program should be extended through 2019. But the Medicaid Managed Care Advisory Review Panel, which is the legislatively mandated oversight body for the state’s Medicaid managed care program, decided at its December 2018 meeting that the program required a lot of resources and staffing for a very small population and it would sunset at the end of 2019. The panel also said it would conduct a program review after it ends, according to Health Management Associates.

While other states have had some success with dual-eligible demonstrations, New York is a Medicaid expansion state and already had several comprehensive Medicaid programs and strong Medicare plans, which worked against the demonstration efforts. While a post mortem on the program will be valuable, it’s unlikely New York will venture into the dual-eligible realm in the future.

Valerie E. Pillo is a Market Analyst for DRG and specializes in the physician realm, among other topics. Her work appears regularity in Health Plan Analysis and Market Overviews. Follow her on Twitter @ValeriePilloDRG


Contributor: Valerie E. Pillo -Market Analyst
Published on: 24 January, 2019