HealthierLife: A new Health and Recovery Plan (HARP) called HealthierLife was implemented for eligible members in New York City on October 1. The focus of HealthierLife is to provide additional assistance and resources to individuals with serious mental illness and/or substance use disorders diagnoses. In November, Fidelis Care received conditional approval for HealthierLife to expand in the rest of the State. On a related topic, Fidelis Care and other managed care plans began managing expanded behavioral health benefits for Medicaid members as of October 1. Also at that time, members whose behavioral health benefit was covered under Fee for Service Medicaid through SSI began to receive those benefits through Fidelis Care as well. Fully Integrated Duals Advantage (FIDA): Fidelis Care was one of 22 health plans selected by the State Department of Health to serve enrollees who have Medicare and Medicaid coverage and are eligible for community-based long term care services. The goal of FIDA, which launched on January 1 in New York City and Nassau County, is to simplify access to care and improve care coordination for members. By the end of the year, Fidelis Care had nearly 300 FIDA members.
Medicare Advantage: As part of our geographic growth, Fidelis Care expanded the Fidelis Medicare Advantage program into 10 new counties, and the Dual Advantage program into 19 new counties.
process for those who had not selected a plan for December 1. Through this process, as well as our own proactive outreach, Fidelis Care implemented a variety of initiatives to enroll Health Republic members before the December 15 deadline for January 1, 2016 coverage.
¾ Membership Growth
In the Buffalo Region, Independent Health (IHA) announced in late fall that it would no longer provide Medicaid Managed Care in Niagara County, leaving 15,000 members to find coverage with a new plan by the end of the year. Through extensive community outreach and working closely on special enrollment sessions with local providers, Fidelis Care enrolled approximately 8,300 of the former IHA members.
During the year, Fidelis Care’s membership grew by close to 200,000, which led to the achievement of a 24.7 percent market share Statewide, and a total enrollment of more than 1.3 million. A variety of factors, including our own strategic initiatives as well as unexpected changes in regional markets, dramatically impacted the opportunities to reach new populations of individuals who were seeking health insurance coverage for either themselves or their families. Perhaps the most notable of these factors was the sudden exit of Health Republic Insurance of New York, the largest nonprofit cooperative, which was shut down by the State Department of Financial Services and the NY State of Health Marketplace effective November 30. To help ensure coverage and continuity of care for the more than 70,000 Health Republic members with individual coverage who were impacted, Fidelis Care worked with the State on an auto enrollment
Overall, for 2015 coverage through the Marketplace, Fidelis Care ranked first among 20 health plans, securing 20 percent of the metal-level product enrollment. This marked an increase of three percent from 2014. During the past year, Fidelis Care also became one of the fastestgrowing Medicare Advantage plans in the State, with a membership growth of more than 20,000 and a total membership of more than 46,000. Community Offices: Throughout the year, Fidelis Care’s communitybased offices continued to be a growing focal point of our initiatives
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