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
In 2011, the General Assembly passed PA 96-1501 to address increasing budget pressures in the Medicaid program, requiring Illinois to enroll 50%
by January 1, 2015.
P4Ps
Trainings
Outreach Regulations
Grievances Procedures
Abuse Standards
Changes
Medicare-Medicaid Alignment Initiative (MMAI)
Disability Income (SSDI)
Retirement Income Medicaid Long Term Supports & Services (MLTSS)
Only)
Disability Income (SSDI)
Retirement Income Integrated Care Program (ICP)
qualify for Medicare)
Security Income (SSI) Family Health Program (FHP)
Living with Children 0-18 years of age, 138% FPL Affordable Care Act Adults (ACA)
age
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) September 2017
The Rauner Administration is committed to an ambitious Health and Human Services (HHS) Transformation initiative that is grounded in five themes:
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 to the Medicaid managed care system, including:
to care for children who are or have previously been under the care of the Department of Children and Family Services
Nine MCO Members (2018):
Illinois Department of Healthcare and Family Services Medicaid Managed Care Program Map
January 1, 2018
Blue Cross Community Health Plan Harmony Health Plan, Inc. IlliniCare Health Meridian Health Plan Molina Healthcare Statewide HealthChoice Illinois Plans CountyCare Health Plan NextLevel Health Partners Cook County HealthChoice Illinois Plans All Statewide HealthChoice Illinois Plans serve Cook County. Two Cook County HealthChoice Illinois Plans serve only Cook County. ( ) 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 Transition Assignment in Current MCO Regions
2017 with effective date of January 1, 2018
90-day option to change to another MCO
Full Enrollment Packet in Expansion Regions
January 2018 with effective date beginning April 1, 2018
voluntarily enroll with one of five statewide MCOs by calling Client Enrollment Broker (Maximus)
assigned to an MCO based on an algorithm
another MCO
Enrollment of Special Needs Children
May 2018 with effective date beginning July 1, 2018 (TENTATIVE)
HealthChoice Illinois Transition and Expansion Mail Schedule October 16, 2017
Description Mail Start Week Mail End Week Effective Enrollment Date* Auto-Assignment Date* Counties included in mailing
Transition of members currently enrolled with a managed care health plan that was awarded a new contract for January 1, 2018. Members will stay enrolled with their current health plan. Each member will be mailed a HealthChoice Illinois transition notice. October 30, 2017 November 30, 2017 January 1, 2018 N/A Current Mandatory and Voluntary (VMC) Counties. Only MCO members will be included in the daily transition notice mailings. Transition of members currently enrolled with a managed care health plan that was not awarded a new contract for January 1,
health plan. Each member will be mailed a HealthChoice Illinois transition notice. November 6, 2017 November 30, 2017 January 1, 2018 N/A Current Mandatory and Voluntary (VMC) Counties. Only MCO members will be included in the daily transition notice mailings. Enrollment of newly eligible potential enrollees, previous Illinois Health Connect members, and no-longer excluded 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. January 8, 2018 February 16, 2018 Earliest effective Choice enrollment date is April 1, 2018 Earliest Auto- Assignment date is April 1, 2018 All counties statewide will be included in the daily enrollment packet mailings. Enrollment of Special Needs Children. 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. May 7, 2018 May 16, 2018 TENTATIVE Earliest effective Choice enrollment date is July 1, 2018 TENTATIVE Earliest Auto- Assignment date is July 1, 2018 All counties statewide will be included in the daily enrollment packet mailings. Enrollment of DCFS Youth in Care into a HealthChoice Illinois plan. TENTATIVE Earliest effective enrollment date is July 1, 2018 All counties statewide will be included in the assignment process. *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/
weren’t awarded a contract for the new program?
mean less work for providers
provider overhead costs
communicate transition details to clients
what they need to know about this transition
From HFS:
the only requirement to begin developing relationships with every Medicaid managed care health plan…Medicaid providers will need to only register with HFS IMPACT website…
Medicare or other products. Second, although providers will be credentialed through IMPACT, they should continue to provide specific information requested by MCOs that is not included in the credentialing process but is needed for MCO Operations, such as provider office hours.
and plans must still enter into contractual relationships and satisfy all necessary operational requirements.
Guides, the Info for Providers section also includes links to Provider Manuals and Prior Authorization links
needed to reflect any URL changes, document updates, etc.
don’t hesitate to share what additional information we can collect from the health plans and post to our site.
Samantha Olds Frey, Executive Director samantha@iamhpteam.org 314-599-0698 Cyrus Winnett, Associate Director cyrus@iamhpteam.org 217-341-4452