As the state Department of Health brainstorms on ways to make New York’s dual-eligibles program more palatable to doctors and consumers, another health plan has called it quits.
Empire BCBS HealthPlus is exiting the Fully Integrated Duals Advantage program, making it the fifth insurer to abandon FIDA in its first year. In a letter dated Oct. 2, the insurer informed members that coverage would end Dec. 31. Consumers will be able to sign up for another FIDA plan, or switch back to their old managed long-term care plan and enroll in Medicare. Empire had 275 FIDA members. There are 17 plans remaining.
The goal of FIDA is to better coordinate care for people enrolled in both the Medicare and Medicaid programs. Coordination is accomplished in part through the use of interdisciplinary care teams, which include doctors, patients or their advocates, care managers and appropriate specialists. But the benefits of FIDA were not clearly outlined early on for potential enrollees. Far more New Yorkers opted out of FIDA than enrolled.
A spokesman for Empire BCBS HealthPlus declined to comment.
The other plans that have left the program are ArchCare, EmblemHealth, Montefiore HMO and Integra. The latter missed a critical reporting deadline and won’t be allowed to participate in 2016, according to the state Department of Health.
There were 7,540 people enrolled in FIDA as of Nov. 2, according to a presentation given by DOH officials last week. The number of opt-outs was not disclosed. As of Sept. 1, 57,000 people had elected not to join a FIDA plan.
In a statement to Crain’s, DOH said its goal is to enroll 80,000 to 100,000 people in FIDA in the downstate area. It has held meetings in recent months to discuss the benefits of the program with providers, consumers and their families.
“DOH always anticipated it would most likely take years to build such an enrollment,” the statement said. “Also, DOH expected consolidation in the market. That is why we started with over 20 plans so there is plenty of choice for members in FIDA.”