Illinois Health Care Coverage Options Conference AgeOptions All rights reserved.
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1 Illinois Health Care Coverage Options Conference AgeOptions All rights reserved.
2 MMW work is supported by grants from local and regional foundations: Retirement Research Foundation Michael Reese Health Trust Chicago Community Trust
3 What We Do Gather and create practical, accessible information and materials Educate Medicare consumers, service providers and policymakers Problem solving individual and systemic Provide training and technical support for professionals and volunteers Advocate for consumer focused laws and policies Target underserved groups
4 Medicaid Managed Care Expansion Illinois is expanding Medicaid managed care to every county in 2018 Currently, about 65% of the state is enrolled Will expand to cover 80% of Medicaid enrollees Family Health Plans, ACA Adult, Integrated Care Program, and MLTSS program will cover entire state MMAI will not be expanded at this time and continue serving current program geographic areas
5 Family Health Plans/Affordable Care Act Adult Plans (FHP/ACA) Expanding state-wide in 2018 Individuals who are enrolled in ALLKIDS, FamilyCare, or ACA Adult Medicaid Some specific populations are currently excluded (e.g., certain children with special needs) Current only active in select counties Mandatory Program automatically enrolled into a plan if they do not choose one 5
6 Integrated Care Program (ICP) Expanding state-wide in 2018 Individuals on AABD Medicaid or HBWD Medicaid who are: Age 19 or older On FULL Medicaid (no spenddown) NOT on Medicare NOT on other private insurance (that covers hospital & doctor visits) NOT in the Illinois Breast and Cervical Cancer program Currently only active in select counties Mandatory Program automatically enrolled into a plan if they do not choose one *American Indians/Alaskan Natives will not be automatically enrolled into ICP but can voluntarily enroll if they wish 6
7 Medicare Medicaid Alignment Initiative (MMAI) NOT expanding statewide and remaining in current geographic area (Chicago land area & Central Illinois) Individuals with full Medicare and full AABD Medicaid benefits who are: Receiving both Medicare Parts A and B NOT enrolled in Medicaid with a spenddown Age 21 or over NOT enrolled in private insurance that provides health coverage (e.g., retiree or employer coverage) NOT enrolled in a Medicaid waiver program for individuals with Developmental Disabilities Living in one of the program s impacted counties 7
8 Medicare Medicaid Alignment Initiative (MMAI) Individuals who do NOT receive long term services & supports (LTSS) through a nursing home or community based waiver programs: NOT a mandatory program People eligible for MMAI can enroll, change plans, or opt out of the program at any time Individuals receiving LTSS If an individual receiving LTSS opts out of MMAI, they Must join the Managed Long Term Services & Supports (MLTSS) program for their LTSS services, transportation, and some behavior health services All other medical services will remain fee for service Medicare and Medicaid 8
9 Managed Long Term Services & Supports (MLTSS) Program Expanding state-wide in 2018 Currently only active in areas with MMAI Individuals with full Medicare & full AABD Medicaid benefits who are: Receiving LTSS through a nursing home or waiver services Receiving both Medicare Parts A and B NOT enrolled in Medicaid with a spenddown Age 21 or over NOT enrolled in private insurance that provides health coverage (e.g., retiree or employer coverage) MLTSS will cover LTSS services, transportation & some behavior health services All other medical services will remain fee for service Medicare & Medicaid 9
10 Current Managed Care Regions
11 Medicaid RFP- Goals Align State and MCO objectives to enhance quality and improve outcomes Increase integration of behavioral and physical health Streamline current managed care programs and reduce complexity for members and providers Achieve greater managed care coverage across Illinois Bring fiscal sustainability to Illinois Medicaid program by managing costs, without compromising quality or access
12 Medicaid RFP-Health Plans 5 health plans selected to cover the entire state of Illinois, including Chicago 1 additional plan selected to serve Cook County ONLY 1 of the 5 statewide plans selected to serve the DCFS youth population New contracts begin January 1, 2018 Contract length of 4 years
13 Medicaid RFP- Winning Proposals IlliniCare Health Plan Will serve all populations, including DCFS youth Blue Cross Blue Shield of Illinois Harmony Health Plan Meridian Health Molina Healthcare of Illinois County Care Health Plan Serving populations in Cook County only O_RFP.pdf
14 Medicaid RFP- Populations Served Medicaid Managed Care will expand to cover all 102 counties in Illinois Each health plan must serve all Medicaid categories currently enrolled in managed care Including Family Health Plans, ACA Adult Program, Integrated Care Program (ICP), and Managed Long Term Services & Supports (MLTSS) program Excluding the Medicare Medicaid Alignment Initiative (MMAI)
15 Medicaid RFP- Populations Served Addition of new populations: Special-Needs Children previously excludedchildren eligible for Supplemental Security Income (SSI) Will be served by all managed care plans DCFS Youth population IlliniCare will cover the DCFS youth population across the entire state
16 Medicaid RFP- Services All Medicaid covered medical & behavioral health services Long Term Care Services & Supports Nursing Care Facilities Home & Community Based Waiver services NEW: DD population waiver services- All plans must be ready to serve this population, but will not be implemented right away Additional services as outline by the pending 1115 waiver and state plan amendment Services will be delivered through an Integrated Health Home (IHH) Model
17 Medicaid RFP- Implementation Current Medicaid managed care members will be affected first (mailings in mid-oct. to early Nov.) Those with plans who won contracts Minimum of 30 days to change plans if they choose If the member does nothing, will remain with their current plan Those with plans who lost (Aetna, Next Level Health) Minimum of 30 days to choose a new plan. They cannot stay with their current plan. If the member does nothing, will be auto-assigned to a different plan Both groups will have 90 days following Jan. 1 to change plans
18 Medicaid RFP- Implementation Medicaid enrollees residing in counties not currently offering Managed Care will have their mailings sent after January 1, 2018 Estimated go-live for new counties is April 1 Will have a minimum of 30 days to pick a plan If no choice is made, they will be auto-assigned New enrollees will also have 90 days from their effective date to change plans For more information, see RFP & Materials:
19 Client Enrollment Services Letters will be coming from IL Client Enrollment Services Ensure address is up to date with Department of Human Services (DHS) office All enrollment & disenrollment done through: Illinois Client Enrollment Services (877) TTY: (866) Objective, third party entity no relationship to any of the managed care plans
20 Questions??
21 Alicia Donegan, Health Care Choices Coordinator AgeOptions 1048 Lake Street, Suite 300 Oak Park, Illinois phone (708) fax (708) For more information and resources, visit our MMW webpage at:
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