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Disenrollment Policy:
Ending your Participation in our FIDA-IDD Plan

This information tells about ways you can end your participation in our FIDA-IDD Plan and access your Medicare and Medicaid coverage options after you leave PHP Care Complete FIDA-IDD Plan. If you leave our plan, you will still be in the Medicare and Medicaid programs as long as you are eligible.

When can you end your participation in our FIDA-IDD Plan?

Your participation will end on the last day of the month that we get your request to leave PHP Care Complete FIDA-IDD Plan. For example, if we get your request on June 25, your coverage with our plan will end on June 31. Your Medicaid and Medicare coverage will begin the first day of the next month (July 1, in this example). If you leave our plan, you can get information below about your:

  • Medicare options 
  • Medicaid services 

You can get more information about when you can end your participation by calling:

  • New York Medicaid Choice at 1-844-343-2433, Monday through Friday from 8:30 a.m. to 8 p.m. and Saturday from 10 a.m. to 6 p.m. TTY users should call 1-888-329-1541.
  • Health Insurance Information, Counseling and Assistance Program (HIICAP at 1-800-701-0501).
  • Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

The Independent Consumer Advocacy Network (ICAN) can also give you free information and assistance with any issues you may have with your FIDA-IDD Plan. To contact ICAN, call 1-844-614-8800 (TTY users call 711, then follow the prompts to dial 844-614-8800).

NOTE: If you are in a drug management program, you may not be able to change plans. Refer to Chapter 5 Section G for information about drug management programs.

How to end your participation in our FIDA-IDD Plan?

If you decide to end your participation in PHP Care Complete FIDA-IDD Plan, call New York Medicaid Choice or Medicare and tell them you want to leave PHP Care Complete FIDA-IDD Plan:

  • Call New York Medicaid Choice at 1-844-343-2433, Monday through Friday from 8:30 a.m. to 8:00 p.m. and Saturday from 10:00 a.m. to 6:00 p.m. TTY users should call 1-888-329-1541; OR
  • Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. When you call 1-800-MEDICARE, you can also enroll in another Medicare health or drug plan. More information on getting your Medicare services when you leave PHP Care Complete FIDA-IDD Plan is below.
How to get Medicare and Medicaid services separately if you leave our plan?

You will return to getting your Medicaid and Medicare services separately as described below.

How to get your Medicaid services:

If you leave the FIDA-IDD Plan, you will still be able to get your Medicaid services.

  • You will get your long-term services and supports and your Medicaid physical and behavioral health services through Medicaid Fee-for-Service.
  • You can use any provider that accepts Medicaid.
Ways to get your Medicare services:

You will have a choice about how you get your Medicare benefits.

You have three options for getting your Medicare services. By enrolling in one of these options, you will automatically end your participation in PHP Care Complete FIDA-IDD Plan.

1. You can change to:

A Medicare health plan, such as a Medicare Advantage plan or a Program of All-inclusive Care for the Elderly (PACE)

Here is what to do:

Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

If you need help or more information:

  • Call the Health Insurance Information, Counseling and Assistance Program (HIICAP) at 1-800-701-0501. You will automatically be disenrolled from PHP Care Complete FIDA-IDD Plan when your new plan’s coverage begins.

2. You can change to:

Original Medicare with a separate Medicare prescription drug plan

Here is what to do:

Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

If you need help or more information:

  • Call the Health Insurance Information, Counseling and Assistance Program (HIICAP) at 1-800-701-0501.

You will automatically be disenrolled from PHP Care Complete FIDA-IDD Plan when your Original Medicare coverage begins.

3. You can change to:

Original Medicare without a separate Medicare prescription drug plan

NOTE: If you switch to Original Medicare and do not enroll in a separate Medicare prescription drug plan, Medicare may enroll you in a drug plan, unless you tell Medicare you don’t want to join.

You should only drop prescription drug coverage if you have drug coverage from another source, such as an employer or union. If you have questions about whether you need drug coverage, call the Health Insurance Information, Counseling and Assistance Program (HIICAP) at 1-800-701-0501.

Here is what to do:

Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

If you need help or more information:

  • Call the Health Insurance Information, Counseling and Assistance Program (HIICAP) at 1-800-701-0501.

You will automatically be disenrolled from  PHP Care Complete FIDA-IDD Plan when your Original Medicare coverage begins.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you were getting services through the OPWDD Comprehensive Waiver before enrolling in the FIDA-IDD Plan?

If you were getting services through the OPWDD Comprehensive Waiver before enrolling in the FIDA-IDD Plan, you will continue to get OPWDD waiver services upon your disenrollment from our plan.

Until your participation ends, you will keep getting your medical, behavioral health, OPWDD waivered services (if you are enrolled in the OPWDD Comprehensive Waiver) and drugs through our FIDA-IDD Plan.

As described above, if you choose to leave PHP Care Complete FIDA-IDD Plan, it may take time before your participation ends and your new Medicare and Medicaid coverage begins. During this time, keep getting your prescription drugs, services, and items through our plan.

  • Use our network providers to receive medical care.
  • If you are hospitalized on the day that your participation in PHP Care Complete FIDA-IDD Plan ends, our plan will cover your hospital stay until you are discharged. This will happen even if your new coverage begins before you are discharged.
Keep getting your medical items, services and drugs through our plan until your membership ends?

These are the cases when the FIDA-IDD Program rules require that your participation must end:

  • If there is a break in your Medicare Part A and Part B coverage.
  • If you no longer qualify for Medicaid.
  • If you permanently move out of our service area.
  • If you are away from our service area for more than six consecutive months. If you move or take a long trip, you need to call Participant Services to find out if the place you are moving or traveling to is in PHP Care Complete FIDA-IDD Plan’s service area.
  • If you go to jail or prison for a criminal offense.
  • If you lie about or withhold information about other insurance you have for health care or prescription drugs.
  • If you are not a United States citizen or are not lawfully present in the United States.
  • You must be a United States citizen or lawfully present in the United States to be a Participant in our plan.
  • The Centers for Medicare & Medicaid Services will notify us if you aren’t eligible to remain a Participant on this basis.
  • We must disenroll you if you don’t meet this requirement.

In any of the above situations, New York Medicaid Choice will send you a disenrollment notice and will be available to explain your other coverage options.

In addition, we can ask that the FIDA-IDD Program remove you from PHP Care Complete FIDA-IDD Plan for the following reasons:

  • If you intentionally give us incorrect information when you are enrolling in PHP Care Complete FIDA-IDD Plan and that information affects your eligibility for our plan.
  • If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical and other care for you and other Participants of PHP Care Complete FIDA-IDD Plan even after we make and document our efforts to resolve any problems you may have.
  • If you knowingly fail to complete and submit any necessary consent or release form allowing PHP Care Complete FIDA-IDD Plan and providers to access health care and service information that is necessary for us to deliver care to you.
  • If you let someone else use your Participant ID Card to get medical and other care.
  • If we end your participation because of this reason, Medicare may have your case investigated by the Inspector General.

In any of the above situations, we will notify you of our concern before we ask the FIDA-IDD Program approval to have you disenrolled from PHP Care Complete FIDA-IDD Plan. We will do this so that you have the opportunity to resolve the problems first. If the problems aren’t resolved, we will notify you again once we have submitted the request. If the FIDA-IDD Program approves our request, you will get a disenrollment notice. New York Medicaid Choice will be available to explain your other coverage options.

Rules against asking you to disenroll from our FIDA-IDD Plan for any health-related reason?

If you feel that we are asking that you be disenrolled from PHP Care Complete FIDA-IDD Plan for a health-related reason, you should call Medicare at 1‑800‑MEDICARE (1‑800‑633‑4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. You should also call Medicaid at 1-800-541-2831.

Your right to ask for a fair hearing if the FIDA-IDD Program ends your participation in our FIDA-IDD Plan?

If the FIDA-IDD Program ends your participation in PHP Care Complete FIDA-IDD Plan, the FIDA-IDD Program must tell you its reasons in writing. It must also explain how you can ask for a fair hearing about the decision to end your participation.

Your right to file a grievance with PHP Care Complete FIDA-IDD Plan if we ask the FIDA-IDD Program to end your participation in our FIDA-IDD Plan?

If we ask the FIDA-IDD Program to end your participation in our plan, we must tell you our reasons in writing. We must also explain how you can file a grievance or make a complaint about our request to end your participation. CLICK HERE for information about how to file a grievance.

  • Note: You can use the grievance process to express your dissatisfaction with our request to end your participation. However, if you want to ask that the decision be changed, you must file a fair hearing as described above.
How to get more information about ending your participation in our FIDA-IDD Plan?

If you have questions or would like more information on when we can end your participation, you can call Participant Services at 1-855-747-5483 and 711 for TTY users, 8AM to 8PM, seven days a week.

ICAN can also give you free information and assistance with any issues you may have with your FIDA-IDD Plan. To contact ICAN, call 1-844-614-8800 (TTY users call 711, then follow the prompts to dial 844-614-8800).