ALERT:  Medicare Rights Center is doing a WEBINAR on MAP APPEALS on SEPTEMBER 1, 2020.  Register here. 

As if there’s not enough change,  beginning January 2020, about 10% of Managed Long Term Care members now must deal with a new fair hearing process.   These are people who are in Medicaid Advantage Plus (“MAP”) plans.  These are “Fully Capitated” plans that combine in one plan a Medicare Advantage Plan, an MLTC plan and a Medicaid managed care plan.  See helpful info on ICAN website  —What kinds of MLTC plans are there? 

  • Medicare Rights Center is doing a WEBINAR on MAP APPEALS on SEPTEMBER 1, 2020.  Register here. 

Most people are in “partially capitated” MLTC plans which means they have their Medicare coverage separate – whether through Original Medicare or Medicare Advantage.  But nearly 22,000 are in MAP plans – all but 700 of those are in NYC.  See DOH monthly stats (Tab for Medicaid Advantage Plus shows  number enrolled in each plan in NYC and county).

MLTC Medicaid Plans – New York City

Medicaid Advantage Plus – New York City

Program of All-Inclusive Care for the Elderly – New York City

  • Since Jan. 2020, MAP members who want to appeal an adverse decision denying or reducing Medicaid personal care or CDPAP services (or any other  plan services) must use a NEW hearing procedure that is slightly different than the regular OTDA Fair Hearings used for MLTC.   In both MAP and MLTC, “exhaustion” of the plan appeal is required first before a fair hearing.  See article on MLTC appeals and exhaustion.

  • The new Integrated Appeal process essentially continues the integrated procedure that was used in the FIDA demonstration program, that ended  Dec. 31, 2019.  OTDA calls it “FIDE” appeals – Fully Integrated Dual E??.  

  • The increased enrollment in MAP is mostly due to the closing of the FIDA plans.  All during 2019, the FIDA plans informed their members that they were closing and that the members could switch to their Medicaid Advantage Plus product.  The last few remaining FIDA members were assigned to MAP plans.  Unlike FIDA, which was limited to NYC, Long Island and Westchester,  MAP  is a statewide program -so advocates statewide need to learn about this new appeal process. See Medicare Rights Center Fact Sheet on  Medicaid Advantage Plus (MAP) appeals


Medicare Rights Center has created a toolkit with resources about MAP benefits, consumer rights and appeals.  On that webpage you will find links to fliers:


FIDA (*transitioned 12/31/2019*) and NY Integrated Appeals and Grievances Demonstration

On January 1, 2020, CMS and NYSDOH transitioned remaining FIDA enrollees to MAP plans and aligned D-SNPs. This transition also included extending the FIDA integrated appeals and grievances process to MAP and aligned D-SNP plans. Under the revamped NY Integrated Appeals and Grievances Demonstration, CMS and NYSDOH are testing the integrated appeals and grievances process begun under FIDA with a larger volume of full benefit dual eligible individuals. As of January 2020, approximately 18,000 individuals are enrolled in a MAP and aligned D-SNP plan.

Information from CMS on NY Integrated Appeals and Grievances Demonstration:

Go to Source

Medicaid Advantage Plus “MAP” – New “FIDE” Appeals & Hearing Process in 2020