The Medicare Medicaid Alignment Initiative (MMAI): A New Program for People with Medicare and Medicaid. updated September 2014

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1 The Medicare Medicaid Alignment Initiative (MMAI): A New Program for People with Medicare and Medicaid updated September

2 What is the Medicare Medicaid Alignment Initiative? A new program for people who have Medicare and Medicaid Instead of receiving your healthcare benefits through Medicare and Medicaid, you can receive ALL of your benefits in one health plan (through a private company). 2

3 What is the Medicare Medicaid Alignment Initiative? Medicare Part A Medicare Part D Medicare Part B Medicaid With MMAI, you receive all of your health services through one MMAI health plan, instead of using three different cards when you go to the doctor, hospital, or pharmacy. 3

4 What is the Purpose of MMAI? The state of Illinois has created several new programs to enroll people with Medicaid into health plans through private companies. MMAI is one of these programs. These programs have two main goals: To provide better, more coordinated care to people who have Medicaid. To save money for the Medicaid program. 4

5 What services does MMAI cover? All of your health care benefits, including Doctor visits and lab tests Hospital care Prescription drugs Medical equipment and supplies Home health or rehabilitation services Mental health services In home care that you get through the Community Care Program or the Department of Rehabilitative Services (DRS) Services provided in a nursing home or supportive living facility All MMAI plans must cover everything that Medicare and Medicaid cover. Some MMAI plans cover extra services that Medicaid does not usually cover, like a gym membership, over the counter drugs, or transportation to your doctor. 5

6 What Does MMAI Cost? You will not be charged any more for your services with an MMAI plan than you would be charged with regular Medicare and Medicaid. Some MMAI plans charge less than Medicaid for certain services. (For example, some MMAI plans do not charge a copayment for prescription drugs.) MMAI plans must pay your doctors and other health care providers at least as much as Medicaid does. 6

7 Who Can Enroll in the Program? To enroll in an MMAI plan, you must: Be enrolled in Medicare Part A and Part B OR a Medicare Advantage plan Be enrolled in full Medicaid (be on Medicaid without a spenddown) Be age 21 and over Live in one of these counties: Cook, Lake, Kane, DuPage, Will, Kankakee, Knox, Peoria, Tazewell, McLean, Logan, DeWitt, Sangamon, Macon, Christian, Piatt, Champaign, Vermilion, Ford, Menard, Stark 7

8 Who Can Enroll in the Program? You cannot enroll in the Medicare Medicaid Alignment Initiative if you are: Enrolled in Medicaid Spenddown Spenddown is when you use medical bills or receipts to qualify for Medicaid because your income or resources are higher than Medicaid s limits. Getting care in the Illinois Breast and Cervical Cancer Program Getting private third party insurance (such as employer or retiree coverage) Getting services through an Illinois waiver program for people with Developmental Disabilities (in home services or living in a CILA) 8

9 What are the benefits of enrolling in the program? Care Coordination is provided to help you manage your healthcare services and make sure that you are receiving the care you need, when you need it. Your plan will ask you to complete a health risk assessment so that they can assign you to a care coordinator who can help you with your specific health care needs. A Care Coordinator will help you understand your plan of care, provide follow up, and help you access services that you need. You can contact your care coordinator by calling your MMAI plan and asking to speak with your care coordinator. (You can call them even if they have not called you.) 9

10 What are the benefits of enrolling in the program? Provides all of the same services that Medicare and Medicaid cover, but plans may offer extra benefits. such as gym memberships, over the counter drug coverage, transportation for medical appointments, etc. You will not pay more for services in an MMAI plan than you would pay with regular Medicaid. Each plan has a large list of doctors, specialists and hospitals that you can choose from to get services. This list is called a network. (If you enroll in an MMAI plan, you will need to use providers who are in your plan s network.) 10

11 What if my doctor is not in an MMAI plan s network? You can keep seeing your health care providers for 180 days from the day you join an MMAI plan, even if they are not in the plan s network This rule applies to doctors, hospitals, in-home care, etc. anyone who provides you with health care services that are covered by Medicare or Medicaid. The rule gives time for your provider to join your plan s network or for you to find a different provider in your plan s network. Even if your provider does not join the plan s network, they may sign an agreement with your plan to keep seeing you after the 180 days. If your doctor or another health care provider has questions about the 180 day transition policy, tell them to call your plan s Provider Relations Department for more information. 11

12 How do I get more information about my MMAI plan options? If you are eligible, you will get a letter from Illinois Client Enrollment Services explaining your new plan options. Call Client Enrollment Services at to: Compare benefits of each MMAI health plan Check which providers are in each plan s network Enroll in a MMAI plan and choose a primary care provider Client Enrollment Services also has a website where you can download materials about MMAI and see a summary of each MMAI plan s benefits: If you are eligible for MMAI, you will need to contact Client Enrollment Services to choose a plan and a primary care doctor, or they will choose a plan and primary care doctor for you. 12

13 What if I want to keep my current coverage? If you do not want to enroll in an MMAI plan, you can keep your current coverage through Medicare and Medicaid. You must contact the Client Enrollment Services and tell them that you want to opt out of the MMAI program or they will choose a plan and primary care provider for you. If you opt out of MMAI, you will continue to use regular Medicare and Medicaid when you get health care services. If you do enroll in MMAI, you can choose to opt out or change your plan at any time. If you opt out of MMAI after you have already been enrolled in an MMAI plan, you must re-enroll in a Medicare Part D plan to cover your prescription drugs. 13

14 What if I want to keep my current coverage? If you live in a long term care facility (nursing home) or you receive services in your home through the Community Care Program or the Department of Rehabilitation Services (DORS), you will need to enroll in a plan to cover your nursing home care or your in-home services. If you opt out of MMAI, you will receive another letter later asking you to choose a plan to cover your nursing home or in-home care. This plan will only cover your nursing home or in-home care. Your medical services will be covered by regular Medicare and Medicaid. If you do not choose a plan yourself, Client Enrollment Services will choose a plan for you. Once you are enrolled in a plan, you must stay in that plan for 12 months. 14

15 What information do I need when calling the Client Enrollment Services? Have the following information ready: Your Social Security Number and date of birth Name of your primary care doctor and other health care providers you wish to continue seeing (specialists, hospitals, long term care or in-home care providers, etc.) 15

16 What if I need help in another language? Call Client Enrollment Services at (TTY: ) to request an interpreter. You will need to be able to say your name and the language that you speak in English in order to request an interpreter. If you cannot do that, you can sign an authorized representative form so that someone you trust can speak to Client Enrollment Services for you. You can also call Client Enrollment Services to request materials about MMAI in other languages or formats (such as large print). 16

17 What if I am not happy with my If you have a problem with your plan, start by calling your plan to file a complaint (called a grievance ). The state of Illinois has an Ombudsman program to help people who are having problems with their MMAI plans. You can reach the Ombudsman program by calling: MMAI plan? Remember: You can change your MMAI plan or opt out at any time if you are not happy with your plan and want to go back to using regular Medicare and Medicaid for your health care services. 17

18 Thank you! If you have questions, contact: AgeOptions (800)