Frequently Asked Questions
Who can join SWH Whole Health FIDA Plan?You can join the SWH Whole Health FIDA Plan if you are:
- Age 21 or older
- Entitled to benefits under Medicare Part A and enrolled under Parts B and D, and receiving full Medicaid benefits
- Reside in a SWH Whole Health FIDA Plan Demonstration County: Bronx, Kings, New York or Queens counties
- You must also meet one of the following three criteria:
- Are clinically eligible to reside in a nursing home and are receiving facility-based Long-term services and supports (LTSS);
- Are eligible for the Nursing Home Transition and Diversion Waiver (NHTD); or
- Require community-based Long-term services and supports (LTSS) for more than 120 days
- Residents of a New York State Office of Mental Health (OMH) facility;
- People receiving services from the New York State Office for People with Developmental Disabilities (OPWDD) system;
- Individuals under the age of 21;
- Residents of psychiatric facilities;
- Individuals expected to be Medicaid eligible for less than six months;
- Individuals eligible for Medicaid benefits only with respect to tuberculosis related services;
- Individuals with a "county of fiscal responsibility";
- Code 99 (Individuals eligible only for breast and cervical cancer services);
- Code 97 (Individuals residing in a State Office of Mental Health (OMH) facility);
- Code 98 (Individuals in an Office for People with Developmental Disabilities (OPWDD) facility or treatment center);
- Individuals receiving hospice services (at time of enrollment);
- Individuals eligible for the family planning expansion program;
- Individuals under 65 (screened and require treatment) in the Centers for Disease Control and Prevention breast and/or cervical cancer early detection program and need treatment for breast or cervical cancer, and are not otherwise covered under creditable health coverage;
- Residents of intermediate care facilities for individuals with intellectual/developmental disabilities (ICF/IIDD);
- Individuals who could otherwise reside in an intermediate care facility for individuals with intellectual/developmental disabilities (ICF/IIDD), but choose not to;
- Residents of alcohol/substance abuse long-term residential treatment programs;
- Individuals eligible for Emergency Medicaid;
- Individuals in the Office for People with Developmental Disabilities (OPWDD) Home and Community-Based Services (HCBS) Waiver program;
- Individuals in the Traumatic Brain Injury (TBI) waiver program;
- Residents of Assisted Living Programs; and
- Individuals in the Foster Family Care Demonstration.
Denial of Enrollment: You will be denied enrollment to SWH Whole Health FIDA Plan if:
- You do not meet the eligibility criteria listed above;
- You cannot be maintained safely in your home;
- You are enrolled in another Managed Care Plan capitated by Medicaid and do not want to disenroll.
What is SWH Whole Health FIDA Plan's service area?
Our service area is Bronx, Kings, Queens and New York counties.
Do I still get my Medicare and Medicaid benefits?
Yes, you still receive all your Medicare and Managed Long-term services and supports (LTSS), plus more benefits and services.
What is the open enrollment period?
Eligible individuals may enroll at anytime of the year. There is no open enrollment period.
Last Updated 09/12/2014
H8851_2015_099 Approved 12/18/2014