What is FIDA?
FIDA is a joint Medicare and Medicaid demonstration designed to integrate care for New Yorkers who have both Medicare and Medicaid and who reside in the targeted geographic area. Beneficiaries who choose to participate will receive both Medicare and Medicaid coverage, including Part D prescription drugs, from a single, integrated FIDA managed care plan. FIDA builds off the existing Managed Long-Term Care (MLTC) program. FIDA will be jointly administered by the federal Centers for Medicare & Medicaid Services (CMS) and the New York State Department of Health (NYSDOH).
Can you go to the same doctors you see now?
Often that is the case. If your providers (including doctors, therapists, and pharmacies) work with MetroPlus FIDA Plan and have a contract with us, you can keep going to them. Providers with an agreement with us are “in-network.” You must use the providers in MetroPlus FIDA Plan’s network. If you need urgent or emergency care or out-of-area dialysis services, you can use providers outside of MetroPlus FIDA Plan's plan.
To find out if your doctors are in the plan’s network, call Participant Services or read MetroPlus FIDA Plan’s Provider and Pharmacy Directory.
If MetroPlus FIDA Plan is new for you, you can continue seeing the doctors you go to now for 90 days or until your Person-Centered Service Plan is complete, whichever is later. If you currently receive behavioral health services, your Interdisciplinary Team (IDT) will review your current episode of care to decide if you can continue the services with the same provider you see now. If they decide you can see the same provider you see now, you will be able to see that provider for 24 months following your enrollment in MetroPlus FIDA Plan.
Can you remain in the same nursing facility you live in now?
Yes. If you live in a nursing facility when you enroll in MetroPlus FIDA Plan, you can remain in that nursing facility for the entire time that you are in a FIDA Plan like MetroPlus FIDA Plan.
What happens if you need a service but no one in MetroPlus FIDA Plan’s network can provide it?
Most services will be provided by our network providers. If you need a service that cannot be provided within our network, MetroPlus FIDA Plan will pay for the cost of an out-of-network provider.
Do you pay a monthly amount (also called a premium) under MetroPlus FIDA Plan?
You will not pay any monthly premiums to MetroPlus FIDA Plan for your coverage. You also will not have any co-payments or other costs when you get care from network providers.
What is a MetroPlus FIDA Plan Care Manager and Interdisciplinary Team (IDT)?
A MetroPlus FIDA Plan Care Manager is one main person that you may contact. This person helps manage all your providers and services and makes sure you get what you need. This person is part of your Interdisciplinary Team (IDT), which also includes:
- You and your designee(s);
- Your Primary Care Provider (PCP) or a designee from your PCP’s office (or practice) who has clinical experience and knowledge of your needs; Your Behavioral Health (BH) Professional, if you have one, or a designee from your BH Professional’s office (or practice) who has clinical experience and knowledge of your needs;
- Your home care aide(s), or a designee with clinical experience from the home care agency who has knowledge of your needs, if you are receiving home care and approve the home care aide/designee’s participation on the IDT;
- A clinical representative from your nursing facility, if receiving nursing facility care; and
- Additional individuals including:
- Other providers either as requested by you or your designee, or as recommended by the IDT members as necessary for adequate care planning and approved by you or your designee; or
- The registered nurse (RN) who completed your assessment, if approved by you or your designee.