This article is based on a brochure about New York’s Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD). You can read it online or download this printable version.

How to use this brochure

You can read this brochure from the beginning if you don’t know anything about FIDA-IDD.

You can also use the Table of Contents to skip straight to your question.

If there’s anything you don’t understand or want more information about, you can always call ICAN at (844) 614-8800.

What is FIDA-IDD?
Why FIDA-IDD?
How is FIDA-IDD different than what I have now?
What does FIDA-IDD cover?
Your care team in FIDA-IDD
Who can join FIDA-IDD?
Is FIDA-IDD right for me?
How do I join FIDA-IDD?
What will happen after I join?
ICAN can help you.

What is FIDA-IDD?

FIDA-IDD covers medical primary care, plus long term services & supports, OPWDD services, behavioral health services, and pharmacy benefits all in one plan.

FIDA-IDD stands for Fully Integrated Duals Advantage for individuals with Intellectual and Developmental Disabilities.

The FIDA-IDD is a health plan that integrates Medicare and Medicaid benefits and provides care coordination all in one health plan.

FIDA-IDD is only for people with both Medicare and Medicaid.

FIDA-IDD is a way to get all of your medical care and long term supports and services through one health insurance plan.

FIDA-IDD covers all of the same services you get now.

Why FIDA-IDD?

People with Medicare and Medicaid have many different types of insurance covering different things.

Because of this, people with Medicare and Medicaid sometimes have trouble getting good quality healthcare. Some of the reasons are:

It can be hard to juggle different insurance plans.
Sometimes, doctors and other providers don’t talk to each other. This can lead to unnecessary tests or procedures.
If you have problems with your health insurance, it can be hard to know who to call.
Even with Medicare and Medicaid, you sometimes have to pay for services.

FIDA-IDD is designed to be much better than that.

With FIDA-IDD, you would have one plan that replaces all of those different types of insurance plans. If you enroll in FIDA-IDD, you will have access to all of the same types of services you do now.

Replace many plans and program with one FIDA-IDD plan.

For example, you might have:

Original Medicare (your red, white and blue card) for doctors and hospitals.
You also have a Medicare Part D plan for prescription drugs.
Some people have a Medicare Advantage plan that covers doctors, hospitals, and drugs.
You may also receive developmental disability services through the Office for People With Developmental Disabilities
(OPWDD).
And then there’s Medicaid to cover whatever is left.

That’s a lot of different kinds of programs and health care coverages!

How is FIDA-IDD different than what I have now?

Just one insurance card.

You no longer need to use your Medicare and Medicaid card.

The FIDA-IDD plan has a network of developmental disability and healthcare providers you would have access to.

All of your Medicare, Medicaid, developmental disability services, and long term services & supports are under one plan, including Part D drug coverage.

FIDA-IDD covers all your OPWDD services including waiver services.

FIDA-IDD may also cover certain services you may not have been able to get before, like home modifications, non-medical transportation, house calls by medical personnel, and a 24/7 nursing hotline.

No cost. With the FIDA-IDD, all covered care and services are free.

FIDA-IDD makes you the center of your own care team. Your care team is called the Interdisciplinary Team (IDT) and is made up of you, your care manager from the FIDA-IDD plan, and your DD service providers.

But it can also include anyone else you want, including your family or friends, therapist, or others you choose. Your team will meet at least once a year to talk about your needs and goals.

The FIDA-IDD plan must cover whatever services your team decides you need.

If you change your mind about the FIDA-IDD, you can disenroll at any time.

It is your choice whether to join the FIDA-IDD.

What does FIDA-IDD cover?

FIDA-IDD covers all of the same services you can get through Medicare and Medicaid. This includes developmental disability services, doctors, hospitals, prescription drugs, home care, and more.

Complete health care coverage
A care team to support your needs and goals
Care management
Primary care, specialist and hospital care
Long-term supports and services
Behavioral health
Developmental disability services
Prescription and non-prescription drugs

If you are enrolled in the OPWDD waiver program, you can get waiver services.

Here are just some examples of the OPWDD services covered by FIDA-IDD:

Assistive Technology
Community Habilitation
Day Habilitation
Intensive Behavioral Services
Pathways to Employment
Pre-Vocational Services
Residential Habilitation
Respite
Self Direction
Fiscal Intermediary
Support Brokerage
Live-in-Caregiver
Individual Goods and Services
Community Transition Services
Supported Employment

Your care team in FIDA-IDD

You will have a two-person care coordination team to help you manage all your care needs and reach your personal goals.

Your care manager will be a licensed professional. The care manager will lead your team, help figure out your needs, help you with your medications and doctor visits, and answer your health care questions.
Your care coordinator will assist you with community activities such as making appointments and arranging transportation.

Your care team will work closely with you and your family to understand what you need, what you want, and your goals, even if it is difficult for you to communicate.

You and your care team (IDT) will also work with you to develop a care plan known as your Life Plan.

Who can join FIDA-IDD?

Do you have Medicare?
Do you have Medicaid?
Are you eligible to receive services through Office for People With Developmental Disabilities?
Do you live in NYC or Nassau, Rockland, Suffolk or Westchester?
Are you age 21 or older?
Are you not living in a skilled nursing facility, development center, or psychiatric facility?

In general, if you have answered yes to all of the above questions, you may be eligible to join the FIDA-IDD.

Is FIDA-IDD right for me?

FIDA-IDD is not right for everyone.

Changing your health insurance is a big decision. There are some things you should think about before you make that decision:

Are your providers part of the FIDA-IDD plan network?
Are your current medications covered by the FIDA-IDD plan?
Do you have any other health insurance besides Medicare and Medicaid? If you join FIDA-IDD, it may impact any other insurance you may have (for example, a Medigap supplement, or coverage from a family member).
The FIDA-IDD replaces almost all of your existing health insurance.
While you will still have Medicare and Medicaid, you will get those benefits through the FIDA-IDD plan.

How do I join FIDA-IDD?

There is only one FIDA-IDD plan. The FIDA-IDD plan is called Partners Health Plan Care Complete FIDA-IDD or PHP. PHP is a non-profit organization with a history of providing services to people with developmental disabilities.

You will only be enrolled in FIDA-IDD if you choose to. To enroll in the FIDA-IDD call New York Medicaid Choice at (844) 343-2433.

A counselor will help educate you on the benefits of the FIDA-IDD so you can decide if the FIDA-IDD is right for you.

You can also call ICAN at (844) 614-8800 to assist you.

Soon after enrollment, the FIDA-IDD plan will contact you to schedule an assessment of your needs.

What will happen after I join?

Once you join, the FIDA-IDD plan will continue to cover currently covered services for at least 90 days. This is called a transition period. During the transition period, you and your care team will be working to develop your Life Plan.

If you live in an OPWDD-certified residence, you can continue to live there for as long as you need this service.

Because the FIDA-IDD provides care management and care coordination, you will no longer receive Medicaid Service Coordination (MSC).

If you change your mind about FIDA-IDD after joining, you can disenroll at any time. Call ICAN if you have questions about this.