Medicare Rights Center, Inc.

Dual eligibles, individuals who qualify for both Medicare and Medicaid, are among New York State’s—and the nation’s—costliest and most complex Medicaid beneficiaries.

Dual eligibles are expensive in large part because they have greater care needs and are more vulnerable than the average Medicaid enrollee, requiring a complex array of services from multiple providers. However, the care they receive through Medicare and Medicaid fee-for-service programs is fragmented and uncoordinated because of conflicting program rules and perverse incentives between the two programs. The State proposed implementing a Federal model, the Fully Integrated Duals Advantage Program (FIDA). With support from NYHealth, Medicare Rights Center, Inc. (MRC) led a coalition of seven consumer-oriented organizations to analyze FIDA’s potential impact.

MRC’s coalition consisted of organizations that represent the interests of seniors, people with disabilities, and people with low incomes: the Center for Disability Rights, the Center for Independence of the Disabled, Community Services Society, Empire Justice Center, Legal Aid Society, New York Association on Independent Living, and Selfhelp. MRC and its coalition partners helped answer questions about FIDA’s financing mechanisms; how plan and provider capacity will be developed and assessed; how beneficiaries will be educated about and enrolled in the program; and what consumer protections will be in place. Specifically, MRC informed the design and development of New York’s duals integration plan, as well as monitored and provided real-time feedback on implementation issues to make program improvements.