Illinois Medicaid Integrated Care Program August 2013
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1 Illinois Medicaid Integrated Care Program August 2013
2 What We Will Cover Today Background of Illinois Managed Care Transitions Integrated Care Program (ICP) Service Packages 1, 2, and 3 Enrollment Implementation Dates and Geographic Areas Assisting Clients New to ICP 2
3 Background 3 3
4 Background - Illinois Managed Care State Initiatives Transitions Public Act , January 2011: Illinois must move 50% of all Medicaid recipients into riskbased care coordination by 2015 Save Medicaid Access and Resources Together Act (SMART Act), May 2012: Save $16.1 million by integrating care for most complex Medicaid beneficiaries (acute, primary, behavioral, and longterm services and supports) 4
5 Illinois Managed Care Initiatives Integrated Care Program (ICP) Seniors and Persons with Disabilities with Medicaid ONLY (no Medicare) Phase 1 began in suburban Cook and Collar Counties in May 2011, Phase 2 in February Now expanding to Rockford, Central Illinois, Quad Cities, and Metro East areas. Medicare/Medicaid Financial Alignment Initiative (MMAI) Target start date: voluntary enrollment in January ,000 dual eligibles in Chicago region and Central Illinois Innovations Project Demonstration projects provider-based networks testing innovative models of care coordination Expected to begin summer/fall 2013 (4 in Chicago area, 2 downstate), but projects have not yet begun 5
6 Integrated Care Program 6 6
7 Integrated Care Program (ICP) Managed care program for seniors and adults with disabilities who have Medicaid only (no Medicare) Currently operating in select areas of Illinois ICP enrollment is Mandatory - member can choose a plan OR be automatically enrolled into one if no choice is made Managed Care Organizations (MCO s) are responsible for covering members medical and hospital care, prescriptions, mental health/behavioral health and long term care services. MCO s also provides care coordination for members. The state pays the MCO a capitated amount, and the MCO pays the members health care providers for services. 7
8 ICP Service Packages ICP is being implemented in three Service Packages: Service Package I - Medicaid medical services Service Package 2 long term service and supports (LTSS) and waiver services added (excluding Developmentally Disabled (DD) waiver) Service Package 3 - Developmentally Disabled Waiver services 8
9 Eligibility Determinations Illinois Department of Human Services (DHS) will continue to determine eligibility for Medicaid LTSS and home and community based (HCBS) waiver program screenings (such as the Determination of Need or DON assessments for the Community Care Program) will continue to be done by current screeners 9
10 Integrated Care Program Service Package 1 MCO s are responsible for covering members medical and hospital care, prescriptions, and mental health / behavioral health services Must choose a Primary Care Provider (PCP) who will oversee care and provide referrals Plans provider networks that members must use to obtain services (hospitals, doctors, specialists, etc.) 90 day transition period to keep seeing current providers if necessary 10
11 Integrated Care Program Service Package 2 MCO s are responsible for long-term services and supports for ICP members Long-term care facilities In-home services through 5 Home and Community Based Waiver projects (Aging, Disability, AIDS, Traumatic Brain Injury, Supportive Living Facility) Suburban Cook/Collar Counties: addition of Service Package 2 in February 2013 did not create new ICP members just a shift in who pays for LTSS services for existing ICP members 11
12 Integrated Care Program Service Package 2 Determinations of eligibility for waiver services (initial screening and annual redeterminations) will continue to be conducted by same entities as before (e.g., Care Coordination Units for CCP Program) Care planning and care coordination will be provided by ICP plan 12
13 Integrated Care Program Service Package 2 People currently receiving waiver services: Received letter sent by Department of Healthcare and Family Services (HFS) informing them of change Plans must keep current service plans (and providers) in effect for at least 180 days, unless individual consents to change Will be assigned a care coordinator at ICP plan 13
14 Integrated Care Program Service Package 2 People new to waiver services: Eligibility will be determined by same entity as before (e.g., Care Coordination Unit for CCP services) Eligibility information will be shared with ICP plan, who will then initiate a care plan with the member Will be assigned a care coordinator at ICP plan 14
15 Integrated Care Program Service Package 2 Providers of waiver services (home care providers, etc.): ICP plans will pay existing waiver providers for at least 180 days; after that, will need to have a contract with ICP plan(s) to receive payment for waiver services to ICP plan members Plans must pay providers at least state rate Providers must continue to be certified by state before providing waiver services to anyone 15
16 Developmentally Disabled Waiver Services Service Package 3 Not implemented yet. Date to be determined ICP MCO s will also become responsible for services to individuals with developmental disabilities. (For a definition of developmental disabilities, see the HFS website here: rency/pages/transparencyglossary.aspx 16
17 ICP Enrollment Enrollment is mandatory Individuals have 60 days to choose a plan or they will be enrolled into a plan Allowed to switch plans in the first 90 days If an individual does switch plans, he or she has an additional 90 days to switch back to the original plan After 90 days, the individual is locked in to the plan for 12 months 17
18 ICP Enrollment (cont.) Once a year, ICP members will have a 60 day Open Enrollment Period (OEP) to change plans Each individual will receive a letter that notifies them when their OEP will take place To enroll in an ICP MCO, individuals should contact the ICP Enrollment Broker by calling (877) or visiting Can compare plans on the HFS website here: 18
19 Integrated Care Program: Implementation Dates and Geographic Areas 19 19
20 Suburban Cook County, DuPage, Kane, Kankakee, Lake and Will counties Does not include zip codes beginning with 606 (currently excludes city of Chicago) Service Package 1 began May 2011 Service Package 2 began February 2013 Service Package 3 TBD MCO s: Aetna Better Health: IlliniCare Health Plan: 20
21 Rockford Region Winnebago, Boone, and McHenry counties Service Packages 1 and 2 began July 1, 2013 Service Package 3 - TBD MCO s: Aetna Better Health IlliniCare Community Care Alliance of IL (MCCN) 21
22 Central Illinois Region Service Packages 1 and 2 will begin August 2013 Service Package 3 - TBD Knox, Peoria, Stark, and Tazewell counties MCO s: Molina Meridian Health Alliance McLean, Logan, DeWitt, Sangamon, Macon, Christian, Piatt, Champaign, Vermilion, Ford and Menard counties MCO s: Molina Health Alliance My Health Care Coordination (CCE) 22
23 Metro East Region Madison, Clinton and St. Clair counties Service Packages 1 and 2 will begin September 1, 2013 Service Package 3 TBD MCO s: Meridian Molina 23
24 Quad Cities Region Rock Island, Mercer and Henry counties Service Package 1 and 2 will begin October 2013 Service Package 3 TBD MCO s: HealthSpring IlliniCare Health Plan Precedence CCE (CCE) 24
25 Chicago Service Packages 1 and 2 scheduled to begin April 2014 Service package 3 - TBD 25
26 Assisting Clients New to ICP Are the client s provider s in the plan(s) network(s)? Check Enrollment Broker website: or call Enrollment Broker at (877) Verify by contacting plan directly. If a provider is not in any ICP plan networks, client can ask/encourage provider to consider joining plan networks. Clients will have 90 day transition period from the beginning of the ICP program (can continue seeing current providers during that period even if they are not in network). For waiver services, will have 180 day transition period. 26
27 Assisting Clients New to ICP Turning 65 and becoming eligible for Medicare Individual should enroll in Medicare and will begin receiving services from Medicare and fee-for-service Medicaid as a dual eligible. Dual eligibles will be enrolled into Managed Care Organizations in 2014, but for now, these individuals will be put back into regular fee-for-service Medicaid to supplement their Medicare coverage. Department of Healthcare and Family Services (HFS) must disenroll the person from ICP if person gets stuck, need to call HFS ( ). ICP plans cannot fix this. 27
28 Resources Client Enrollment Broker: (877) HFS website Care Coordination: ges/default.aspx 28
29 MMW Resources MMW Materials: makemedicarework.html To be added to the MMW list, contact Alicia Donegan at AgeOptions: 29
30 AgeOptions Social Media Facebook: Health & Disability Advocates Facebook: Illinois Health Matters ( Facebook: 30
31 Thank you! If you have questions, contact: AgeOptions (800) TTY: (708) This presentation was supported in part by grants from the Chicago Community Trust, the Retirement Research Foundation, the Michael Reese Health Trust, and the Circle of Service Foundation. 31
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