While the Fully Integrated Duals Advantage (FIDA) Program is not yet in its mandatory phase for seniors receiving both New York Medicaid and Medicare, it is very important to be aware of upcoming gaps in insurance coverage. Presented as the one-stop insurance plan that covers everything seniors will need for their health care, the new private managed care insurance scheme will not provide health insurance coverage in four areas historically covered by New York Medicaid and/or Medicare. FIDA will provide patients with access to doctors, hospitals, prescriptions, rehabilitation therapy, home care services, nursing home services, and much more. However, out of network family planning services, methadone maintenance treatment programs, directly observed therapy for tuberculosis disease, and hospice care will now be non-covered services.
These non-covered services may be accessed through fee-for-service Medicare or New York Medicaid. The Interdisciplinary Teams and FIDA plans are required to coordinate, arrange, and ensure receipt of these services by the patient from their Medicare and Medicaid programs when called for in the patient’s service plan.