Medicaid Managed Care Overview In 2011, the General Assembly passed - PowerPoint PPT Presentation

Medicaid Managed Care Overview

In 2011, the General Assembly passed PA 96-1501 2011 to address increasing budget pressures in the Medicaid program, requiring Illinois to enroll 50% Medicaid of its Medicaid population in “care coordination” Reform Law by January 1, 2015.

• Mandatory Enrollment • Mandated Staff & Provider Trainings • Auto-Assignments • Required Member Materials • IT Structure & Interface • Stringent Marketing & • Encounters Submission Outreach Regulations Medicaid • Capitated Rates based on FFS • Defined Appeals & • 85% MLR Grievances Procedures MCO • Defined Benefit Package • Mandated Reporting Characteristics • Defined Population • Defined BEP Spend • Defined Quality Measures & • Robust Fraud, Waste & P4Ps Abuse Standards • Network Capacity Standards • State & Federal Policy Changes • Defined Staffing Ratios

Medicare-Medicaid Alignment Initiative Integrated Care Program (ICP) (MMAI) • Eligible for Medicaid • Eligible for Medicare & Medicaid • 100% Federal Poverty Level (FPL) • 100% Federal Poverty Level (FPL) • 19-64 years of age (65+ that don’t 19-64 years of age on Social Security qualify for Medicare) • Disability Income (SSDI) Disabled receiving Supplemental • 65+ receiving Social Security Security Income (SSI) • Retirement Income Medicaid Family Health Program (FHP) Medicaid Long Term Supports & Services • Eligible for Medicaid (MLTSS) • All Kids, 0-18 years of age, 300% FPL Programs & • Eligible for Medicare & Medicaid • Family Care, Parents/Guardians with Opt Out of MMAI (Medicaid Coverage Living with Children 0-18 years of age, • Only) 138% FPL Populations 100% Federal Poverty Level (FPL) • • 19-64 years of age on Social Security Affordable Care Act Adults (ACA) Disability Income (SSDI) • Eligible for Medicaid under the ACA • 65+ receiving Social Security • Adults without Children 0-18 years of Retirement Income age • 138% Federal Poverty Level (FPL) • 19-64 years of age

Illinois Association of Medicaid Health Plans IAMHP Medicaid Health Plans Enrollment 1. MeridianHealth 389,000 2. BlueCross BlueShield of Illinois 382,000 3. IlliniCare Health (Centene) 217,000 4. Molina Healthcare 163,000 5. CountyCare 140,000 6. Harmony WellCare 138,000 7. NextLevel 56,000 8. Humana (MMAI Only 1/1/08) 12,000 9. Aetna Better Health (MMAI Only 1/1/18) 238,000 10. FHN/CCAI (Term. 12/31/17) 217,000 11. Cigna-HealthSpring (Term. 12/31/17) 4,000 12. Health Alliance (Term. 12/31/16) 0 September 2017

The Rauner Administration is committed to an ambitious Health and Human Services (HHS) Transformation initiative that is grounded in five themes: Health and • Prevention and population health; • Paying for value, quality, and outcomes; Human • Rebalancing from institutional to community care; Services • Data Integration and Predictive Analytics; and • Education and Self-Sufficiency. Transformation The issuance of a Purchase of Care Request for Proposals aimed at transforming the Medicaid managed care system is key element of the Health and Human Services Transformation initiative.

The RFP indicated significant forthcoming changes February 27, to the Medicaid managed care system, including: 2017 – • Expanding managed care to the entire state • Reducing the number of health plans Medicaid • 3-5 statewide plans • 1-2 plans covering just Cook County Managed Care • Issuing one contract to a statewide plan RFP is Issued to care for children who are or have previously been under the care of the Department of Children and Family Services

Illinois Association of Medicaid Health Plans Nine MCO Members (2018): • CountyCare – HealthChoice Illinois, Cook County Only • NextLevel Health – HealthChoice Illinois, Cook County Only • Harmony WellCare – HealthChoice Illinois • BCBSIL – HealthChoice Illinois, MMAI • Molina Healthcare – HealthChoice Illinois, MMAI • Meridian Health – HealthChoice Illinois, MMAI • IlliniCare – HealthChoice Illinois, DCFS, MMAI • Aetna Better Health – MMAI • Humana – MMAI

Illinois Department of Healthcare and Family Services Medicaid Managed Care Program Map January 1, 2018 All Statewide HealthChoice Illinois Plans serve Cook County. Two Cook County HealthChoice Illinois Plans serve only Cook County. ( ) Statewide HealthChoice Illinois Plans Blue Cross Community Health Plan Harmony Health Plan, Inc. IlliniCare Health Meridian Health Plan Molina Healthcare Cook County HealthChoice Illinois Plans CountyCare Health Plan NextLevel Health Partners Medicare Medicaid Alignment Initiative (MMAI) Aetna Better Health Premier Plan Cook, DuPage, Kane, Kankakee, Will Blue Cross Community Cook, DuPage, Kane, Kankakee, Lake, Will Humana Health Plan, Inc Cook, DuPage, Kane, Kankakee, Lake, Will IlliniCare Health Cook, DuPage, Kane, Kankakee, Lake, Will Meridian Complete Cook, DuPage, Kane, Will Molina Healthcare of Illinois Voluntary Enrollment only: Champaign, DeWitt, Ford, Knox, McLean, Peoria, Stark, Tazewell, Vermilion

Health Choice Illinois • Enrollment Process: Phase I Transition Assignment in Current MCO Regions • Letters mailed October & November 2017 with effective date of January 1, 2018 • Clients assigned to current MCO with 90-day option to change to another MCO • Locked in for 12 months

Health Choice Illinois • Enrollment Process: Phase II Full Enrollment Packet in Expansion Regions • Enrollment Packets mailed beginning January 2018 with effective date beginning April 1, 2018 • Clients given 30-day option to voluntarily enroll with one of five statewide MCOs by calling Client Enrollment Broker (Maximus) • If no choice is made, client will be auto assigned to an MCO based on an algorithm • 90-day option period to change to another MCO • Locked in for 12 months

Health Choice Illinois • Enrollment Process: Phase III Enrollment of Special Needs Children • Enrollment Packets mailed beginning May 2018 with effective date beginning July 1, 2018 (TENTATIVE)

HealthChoice Illinois Transition and Expansion Mail Schedule October 16, 2017 Effective Auto-Assignment Description Mail Start Week Mail End Week Enrollment Date* Date* Counties included in mailing Transition of members currently enrolled October 30, 2017 November 30, 2017 January 1, 2018 N/A Current Mandatory and with a managed care health plan that was Voluntary (VMC) Counties. Only awarded a new contract for January 1, 2018. MCO members will be included in Members will stay enrolled with their the daily transition notice current health plan. Each member will be mailings. mailed a HealthChoice Illinois transition notice. Transition of members currently enrolled November 6, 2017 November 30, 2017 January 1, 2018 N/A Current Mandatory and with a managed care health plan that was Voluntary (VMC) Counties. Only not awarded a new contract for January 1, MCO members will be included in 2018. Members will be transitioned to a new the daily transition notice health plan. Each member will be mailed a mailings. HealthChoice Illinois transition notice. Enrollment of newly eligible potential January 8, 2018 February 16, 2018 Earliest effective Earliest Auto- All counties statewide will be enrollees, previous Illinois Health Connect Choice enrollment Assignment date is included in the daily enrollment members, and no-longer excluded date is April 1, 2018 April 1, 2018 packet mailings. populations (does not include Special Needs Children or DCFS Youth in Care). Each individual will be mailed a HealthChoice Illinois enrollment packet. Each individual will have a 30-day enrollment choice period to select a health plan and Primary Care Provider. Enrollment of Special Needs Children. Each May 7, 2018 May 16, 2018 TENTATIVE TENTATIVE All counties statewide will be individual will be mailed a HealthChoice Earliest effective Earliest Auto- included in the daily enrollment Illinois enrollment packet. Each individual Choice enrollment Assignment date is packet mailings. will have a 30-day enrollment choice period date is July 1, 2018 July 1, 2018 to select a health plan and Primary Care Provider. Enrollment of DCFS Youth in Care into a TENTATIVE All counties statewide will be HealthChoice Illinois plan. Earliest effective included in the assignment enrollment date is process. July 1, 2018 *All individuals will have a 90-day switch period to select a different plan. Sample transition and enrollment packet materials are available on the Illinois Client Enrollment Broker Program web site at www.enrollhfs.illinois.gov/

• #1. What is my relationship with plans that weren’t awarded a contract for the new program? HFS Series: • #2. Five key ways the new managed care will Succeeding in mean less work for providers • #3. Simplified credentialing: Cutting back on the New provider overhead costs Managed Care • #4. How HFS and the health plans will communicate transition details to clients • #5. How you can help your patients understand what they need to know about this transition