Report Recommends Strategies to Coordinate Care for 880,000 People Enrolled in Medicaid and Medicare

New York, NY – April 25, 2019 – The Citizens Budget Commission (CBC) today released “Options to Enhance the Coordination of Care for Dually Eligible Individuals in New York State.” The report details the challenges of providing coordinated care for the 880,000 New Yorkers enrolled in both Medicaid and Medicare, and recommends strategies to improve care while containing costs for the State. The dually eligible population represents just 15 percent of Medicaid enrollment in New York, but comprises 36 percent of the program's cost—approximately $26 billion.

In 2015 New York launched the Fully Integrated Duals Advantage (FIDA) program to align all of a dual enrollee's benefits under a single three-way managed care model. However, FIDA failed to enroll more than 8,800 of the eligible population of more than 100,000. The State will now allow FIDA to expire in December 2019, and will pursue different options to manage these high need individuals.

“This moment presents an important opportunity for New York State to increase effective, integrated care coordination for the high-need, high-cost dually eligible population,” said CBC president Andrew Rein. “The State and stakeholders should consider which of the various options will best improve care coordination and what strategies will increase access to and enrollment in the most cost effective options.”

To improve care and constrain costs, CBC identified five strategies the State may implement independently or in concert with one another including:

• Revitalizing positive aspects of FIDA such as unified enrollment and appeals processes for enrollees;
• Building enrollment in the State's existing Medicaid Advantage and Medicaid Advantage Plus programs;
• Encouraging the partnering of separate Medicare Advantage Dual Special Needs plans and Medicaid Managed Long-term Care plans;
• Enrolling eligible high-needs dually eligible individuals in care management services through Medicaid health homes; and
• Facilitating marketing of Medicaid Advantage Dual Special Needs Plans to aging Medicaid members and low-acuity dually eligible individuals.

This discussion paper is the third report in a series of research covering important aspects of Medicaid redesign in New York State. The research was completed with support from the New York Community Trust. To read "Options to Enhance the Coordination of Care for Dually Eligible Individuals in New York State" visit https://cbcny.org/research/.