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SWH Whole Health FIDA Plan

The SWH Whole Health FIDA Plan is a coordinated plan of care and services for frail, and/or chronically ill individuals who can be maintained at home or who may reside in a nursing home, hospital or other long term-care facility.

SWH Whole Health FIDA Plan offers comprehensive care, including preventive services, physician services, hospital care, pharmacy, and Long-term services and supports (LTSS).

Some benefits and services include:

Benefits & Services

  • Interdisciplinary Team (IDT) to coordinate all your specific needs
  • Doctor visits
  • Long-term services & supports (LTSS)
  • $0 Co-pays for Pharmacy
  • $0 Doctor appointments
  • $0 Dental care
  • $0 Vision services
  • Eyeglasses
  • Healthy You Card — You will receive an OTC (over-the-counter) card for additional health-related items not already included on the SWH Whole Health FIDA Plan drug list or already covered using your SWH Whole Health FIDA Plan Participant ID Card. Up to $100 a month (up to $1,200 a year)
  • Home assessment to evaluate your individual needs
  • Access to a SWH Whole Health FIDA Plan team member or interpreter who speaks your language
  • Medicare prescription drug coverage
  • Transportation
  • Medication Therapy Management program
  • Private duty nursing services
  • Home health services
  • Home delivered meals
  • Adult day healthcare
  • Personal care services
  • Personal Emergency Response Services (PERS)
  • 24/7 phone access to a SWH Whole Health FIDA Plan Care Manager

Who Can Join?

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 FIDA 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.

The following individuals are not eligible for the SWH Whole Health FIDA Plan:
  • 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; 
  • 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.

Last Updated 01/01/2019

H8851_2017_099 Pending CMS Review