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Medicaid Managed Care
1
© 2019 AgeOptions. Any reproduction, transmission or distribution of these materials without the express permission of Age Options is strictly prohibited.
Avisery by AgeOptions trains professionals
on how to help consumers navigate the complexities of
Medicare & Medicaid.
Make Medicare Work (MMW) Coalition
• MMW is a coalition led by AgeOptions, Progress Center for Independent Living and Smart Policy Works
• Together since 2006, we promote affordable, accessible healthcare options in Illinois to ensure that older adults and people with disabilities make informed choices about their healthcare
What We Do
Providing TRAINING, TECHNICAL ASSISTANCE and MATERIALS to support professionals in providing trusted healthcare counseling services to consumers
ADVOCATING for consumer focused laws & policies
Providing comprehensive COUNSELING to Medicare & Medicaid consumers
Through the Avisery by AgeOptions program, we support the work of MMW by:
Avisery by AgeOptions Mission: The core mission of Avisery is to ensure that low income, vulnerable older adults and people with disabilities have access to affordable, comprehensive healthcare. Avisery is funded by a combination of foundation grants and fee-for-service activities.
To achieve our mission, Avisery is grant funded to provide community based organizations with affordable, accessible training, technical assistance and materials in order to help guide Medicare & Medicaid consumers to coverage that best suits their individual needs. We also engage in advocacy efforts to alleviate barriers to healthcare services across Illinois.
To ensure the stability and longevity of our program, Avisery also provides Medicare and Medicaid training to a wide array of professionals on a sliding fee scale. Avisery regularly provides training and support to healthcare providers, managed care organizations, financial planners, elder law attorneys, and more!
The Retirement Research
Foundation
Russell & Josephine Kott
Memorial Charitable Trust
Illinois Senior Health
Insurance Program
Other Grants
Fee for Service Revenue
Thank you to our funders
Avisery Training Activities in 2020
Our Spring calendar of training events will be released in February, 2020!
Half-day workshop to introduce the basics of Medicare and where to send people for help. (CEUs are offered)
Daylong interactive trainings for professionals counseling clients on their Medicare & Medicaid coverage options. (CEUs are offered)
In person or webinar based presentations. Our library of presentation topics include: ABCDs of Medicare, Medicare Coverage Options, prescription drug coverage, Employer based Coverage & Medicare, Medicaid Managed Care, and MORE!
How to Access Avisery Services• In Person Trainings & Webinars
– Seasonal Calendar of Events & event registration sent through our Avisery Email List
– To sign up for our email list visit: http://avisery.org/contact
• Program Related Questions, Technical Assistance & Reporting Barriers to Care – Send to our program’s Email Address: Avisery@ageoptions.org, or– Call Avisery at (708)628-3440– Please note: Do not email client sensitive information
• Counseling Tools (Charts, Materials, etc.)– Sent through our Avisery Email List & available on our website here:
http://www.ageoptions.org/services-and-programs_makemedicarework.html
Contact Information
• Avisery by AgeOptions1048 Lake Street, Suite 300Oak Park, IL 60301
• Avisery Phone Number: (708)628-3440
• Avisery Email Address: Avisery@ageoptions.org
• Avisery Website: http://avisery.org/
• Sign up for the Avisery Email List: http://avisery.org/contact
• Define “Managed Care,” its purpose, and how it’s implemented in Illinois
• Purpose of Care Coordination
• How Medicaid Managed Care is different than Fee-for-Service Medicaid
• 3 Managed Care Programs in Illinois– HealthChoice Illinois
– HealthChoice Illinois MLTSS
– The Medicare Medicaid Alignment Initiative (MMAI)
• What all Medicaid Managed Care Plans have in common
What We’ll Cover
Overview of
Managed Care
• Managed Care: A health care delivery system organized to manage health care costs and utilization, while improving quality of services delivered
• State Medicaid agencies contract with Managed Care Organizations (MCOs) to provide health care services
• In order to effectively deliver cost-efficient, high-quality services, MCOs may implement:– Care coordination
– Integrated delivery systems (provider networks)
– Utilization review
– Emphasis on preventive care
– Financial incentives to encourage members to use care efficiently
What is “Managed Care?”
https://www.medicaid.gov/medicaid/managed-care/index.html
• A health insurance program for people with fullMedicaid benefits– Most individuals with full Medicaid benefits will likely
need to choose a Medicaid Managed Care Plan
• Each Medicaid Managed Care Plan will have a network of providers
• Medicaid Managed Care plans must offer care coordination to help members better manage their overall health
• Plan options are based on geographic areas
Medicaid Managed Care
in Illinois
Medicaid Managed Care in
Illinois
Illinois
Department of
Healthcare &
Family Services
(HFS)
Managed Care
Organization (MCO)
Healthcare Provider
Managed Care
Organization (MCO)
Managed Care
Organization (MCO)
Healthcare Provider
Healthcare Provider
Healthcare Provider
Healthcare Provider
Healthcare Provider
Healthcare Provider
Healthcare Provider
Healthcare Provider
HFS contracts with Managed Care Organizations who then contract with Healthcare Providers
Fee for Service Medicaid vs.
Medicaid Managed Care
• About 80% of the Illinois
Medicaid population
• Beneficiaries must use
healthcare providers contracted
with their MCO
• Capitated Payment: Managed
Care Organization gets paid a
rate per member, per month flat
rate (MCO takes on financial
risk) – Rate impacted by client
risk level
• About 20% of the Illinois
Medicaid population
• Beneficiaries must use
healthcare providers
contracted with HFS
• Fee for Service Payment:
Provider paid for each
service individually (state
government takes on the
financial risk)
Fee-for-Service
Medicaid Medicaid Managed Care
• Using a primary point of contact, the Care Coordinator, to establish communication and collaboration among an individual’s health care providers
• A Care Coordinator will:
– Be a main point of contact for the individual’s Health Plan
– Help locate healthcare providers within a plan’s network
– Create an individualized Care Plan to help an individual meet their health goals
– Make sure an individual has access to the healthcare providers they need to better manage their overall health including (but not limited to):
• Primary and Specialty Care Physicians
• Hospital networks
• Prescription drugs and in-network pharmacies
• Long-Term Services and Supports (LTSS)
• Social Services
Care Coordination
Care Coordination
Care Coordinator
Primary Care
Specialty Care
Hospital
Behavioral Health
Prescription Drugs
Long Term Services
and Supports
(LTSS)
Social Services, Housing,
etc.
• 2011: Integrated Care Program (ICP) for seniors and people with
disabilities who are eligible for AABD Medicaid, but not Medicare
• 2014: Family Health Program (FHP) for kids, parents, & ACA
Adults
• 2014: Medicare Medicaid Alignment Initiative (MMAI) for
individuals with full Medicare and Medicaid benefits
• 2016: Managed Long Term Services & Supports (MLTSS) for
individuals with full Medicare and Medicaid benefits who receive
LTSS services
• 2018 & 2019: HealthChoice Illinois expands Medicaid managed
care coverage from select geographic areas to across all 102
counties in Illinois
Timeline of Medicaid Managed
Care Programs in Illinois
All Medicaid Managed Care programs were only available in
certain geographic areas of Illinois before 2018
Medicaid Managed Care Programs
19
HealthChoice
Illinois: Covering
All counties in
Illinois
Integrated Care
Program (ICP)
Family Health
Program (FHP)
Medicare Medicaid
Alignment Initiative
(MMAI)
Managed Long Term
Services & Supports
(MLTSS)
Medicare Medicaid Alignment
Initiative (MMAI)-
Remaining in Chicagoland &
Central Illinois only
2011 - 2017Only available in
specific areas
2018 & 2019Expands
Statewide
2019 Medicaid
Managed Care Map
21
Source:
https://www.illinois.gov/hfs/SiteCollectionDocuments/Stat
ewideHealthChoiceIllinoisPlansJuly12019.pdf
HealthChoice
Illinois
• Align Illinois 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
Source: https://www.illinois.gov/hfs/MedicalProviders/cc/Pages/defaultnew.aspx
Goals of HealthChoice Illinois
For individuals without Medicare:
• Medicaid Managed Care program for people with full
Medicaid (no spenddown)
• Offered across the entire state of Illinois
• Mandatory for individuals who are eligible
• Members select a HealthChoice Illinois plan of their
choice
• Must utilize the plan’s provider network
• Offers all healthcare services and supports covered by
fee-for-service Medicaid
HealthChoice Illinois- Overview
HealthChoice Illinois
Covered ServicesFor individuals without Medicare:
• Offers the same healthcare services covered under the
Medicaid program
– Primary care and hospital services
– Prescriptions: Single “uniform” Medicaid drug List
– medical supplies, lab tests and X - rays
– Dental, vision, hearing, and transportation services
– Behavioral health, therapy, home healthcare, hospice
– Long Term Care Services & Supports received through
nursing home or home and community based waiver
services
• Benefits not covered by fee-for-service Medicaid may be
available depending on the Medicaid Managed Care plans
• Plans can impose utilization management restrictions
25
HealthChoice Illinois:
Provider Networks
For individuals without Medicare:
• Beneficiaries must use their Managed Care plan’s
provider network to receive coverage
• Provider credentialing done through registration in new
IMPACT system instead of through each plan
• Must choose an in-network Primary Care Provider
• Check provider networks before plan choice by:
– Contacting Client Enrollment Services (CES)
– Viewing network on CES website
– Contacting provider directly
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Who is eligible for HealthChoice Illinois?
For individuals without Medicare benefits:
Receive full Medicaid benefits, but not Medicare benefits and
Any Age and
Live in the State of Illinois
Covers all populations previously served through Medicaid
Managed Care (aside from MMAI), and expands these
programs statewide
Plan to add populations of special-needs children, previously
excluded from Medicaid Managed Care coverage: Currently
delayed
Mandatory Enrollment
HealthChoice Illinois:
Excluded Populations• Individuals without Medicare benefits:
– Those with Medicaid Spenddown
– Individuals enrolled in private health insurance coverage (e.g., retiree
or employer coverage)
– Medicaid Presumptive eligibility groups (temporary benefits)
– ALL Kids Premium Level 2 enrollees
– Enrolled in a Medicaid waiver program for individuals with
Developmental Disabilities or receiving developmental disability
institutional services
– Individuals enrolled in partial/limited Medicaid benefits
• Such as the Illinois Breast and Cervical Cancer Program
– Individuals who are American Indian/Alaskan Natives (but can
voluntarily enroll in HealthChoice Illinois)
HealthChoice Illinois: Enrollment
For individuals without Medicare:
• If someone is eligible, enrollment is mandatory
• Individuals required to join a plan, will receive a notice in
the mail instructing them to select a plan (plan choices
vary by geographic area)
• Will have 30 days to choose a plan listed on the notice
• If no choice is made by the end of the 30 days,
beneficiaries will be passively (automatically) enrolled
into a plan listed on the notice
• Enrollment completed in one of two ways:
– Calling Illinois Client Enrollment Services (CES)
– Visiting www.EnrollHFS.Illinois.gov and clicking “Enroll”
HealthChoice Illinois:
Enrollment Rights
For individuals without Medicare:
• Brand new HealthChoice Illinois members will have
a 90 day “Switch Period” from plan’s initial
effective date to switch one time to a different
HealthChoice Illinois plan
• Individuals will then be locked in for 12 months from
their last plan’s effective date, until their annual
Open Enrollment Period (OEP)
HealthChoice Illinois:
Enrollment Rights cont…
For individuals without Medicare:
• Annual OEP= 60 day period when HealthChoice Illinois
members can choose a new plan
• Brand new HealthChoice Illinois members and
members switching between HealthChoice Illinois
plans during their OEP are entitled to a 90 day
“Transition Period” where plan members may be able
to continue utilizing out of network providers for current
ongoing course of treatment
HealthChoice Illinois:
Plan Options
Current HealthChoice IL Plans:
– Blue Cross Blue Shield of Illinois
– Illinicare Health Plan (also serving DCFS population)
– Meridian Health
– Molina Healthcare of Illinois
– NextLevel Health (available in Cook County only)
– CountyCare (available in Cook County only)
HealthChoice Illinois
MLTSSFor individuals receiving Medicare and
Long Term Care Services & Supports
HealthChoice Illinois MLTSS-
Overview • Medicaid Managed Care plan for individuals with full Medicaid, full
Medicare, and who receive LTSS services
• As of July 1, 2019, it is mandatory for Medicare enrollees across
Illinois to receive coverage of their LTSS services through a
Medicaid Managed Care program
– HealthChoice Illinois MLTSS or Medicare Medicaid Alignment Initiative (MMAI)
• LTSS Services include care received through a nursing home or
one of the following five Home and Community Based Waiver
Services (HCBS) programs:
– Persons with disabilities (Home Services Program)
– Persons with Brain Injury (Home Services Program)
– Persons with HIV or AIDS (Home Services Program)
– Persons who are Elderly (Community Care Program), or
– Supportive Living Facilities
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HealthChoice Illinois MLTSS-
Covered Services
• HealthChoice Illinois MLTSS only covers LTSS received
through a nursing home or one of the five Home and
Community Based Waiver Services (HCBS) programs
• Additionally, if a Medicare and Medicaid beneficiary
receives LTSS services and enrolls in a HealthChoice
Illinois MLTSS plan, their transportation services and
some behavioral health services will ALSO be covered
by their MLTSS plan
– This is because these are Medicaid only covered
services
• Members also have a care coordinator 35
HealthChoice Illinois MLTSS-
Services NOT covered
• ALL other healthcare services will NOT be covered
by their MLTSS plan, so individuals must choose
how they would like to receive their healthcare
services:
– Fee-for-Service Medicare and Medicaid, with a stand-alone
prescription drug plan, or
– Medicare Advantage plan
– Note: An individual enrolled in HealthChoice Illinois MLTSS
cannot also be enrolled in an MMAI plan. However, eligible
individuals can choose to receive ALL healthcare services
through an MMAI plan instead of MLTSS.
36
Hospital
Visits Doctors
Lab
tests
Home
health
Durable
medical
equipment
Skilled nursing
facility (short-
term rehab)
Ambulance
servicesPrescription
drugs
Services Covered Under Fee-for-
Service Medicare (or Medicare
Advantage) & Fee-for-Service
Medicaid
Services Covered under
HealthChoice Ilinois MLTSS Plan
HealthChoice Ilinois MLTSS Plan
Mental &
Behavioral
Health Services
Long Term
Services and
Supports (LTSS)
Transportation
Services covered
by Fee for Service
Programs
HealthChoice Illinois MLTSS:
Provider Networks
• Beneficiaries must use LTSS, transportation and
behavioral health providers in the MLTSS plan’s network
• Provider credentialing done through registration in
IMPACT system instead of through each individual plan
• HealthChoice Illinois MLTSS enrollees do NOT need to
choose a PCP
• Check provider networks before plan choice by:
– Contacting Client Enrollment Services (CES)
– Viewing network on CES website
– Contacting provider directly
39
Who is eligible for HealthChoice
Illinois MLTSS?
Mandatory Enrollment
Enrolled in Medicare Parts A & B, and full
Medicaid, and
Age 21 or older, and
Live in the State of Illinois, and
Are receiving LTSS services through nursing home
care or through one of the five HCBS waivers, and
NOT enrolled in MMAI
HealthChoice Illinois MLTSS:
Excluded PopulationsThese groups of people are ineligible to join a
HealthChoice Illinois MLTSS Plan:– MMAI enrollees (unless someone with LTSS disenrolls from MMAI)
– Individuals with Medicare & full Medicaid who do not receive LTSS
services
– Those with Medicaid Spenddown
– Individuals enrolled in private health insurance coverage (e.g., retiree
or employer coverage)
– Medicaid Presumptive eligibility groups (temporary benefits)
– ALL Kids Premium Level 2 enrollees
– Enrolled in a Medicaid waiver program for individuals with
Developmental Disabilities or receiving developmental disability
institutional services
– Individuals enrolled in partial/limited Medicaid benefits
– Individuals who are American Indian/Alaskan Natives (can voluntarily
enroll)
HealthChoice Illinois
MLTSS: Enrollment • Individuals required to join a HealthChoice Illinois
MLTSS plan, will receive a notice in the mail instructing
them to select a plan (plan choices dictated by
geographic area)
• A beneficiary will have 30 days to choose a plan listed
on the notice they receive
– If no choice is made by the end of the 30 days,
beneficiaries will be passively (automatically) enrolled into
a plan listed on the notice
• Enrollment completed in one of two ways:
– Calling Illinois Client Enrollment Services (CES)
– Visiting www.EnrollHFS.Illinois.gov and clicking “Enroll”
HealthChoice Illinois MLTSS:
Enrollment Rights
• Brand new HealthChoice Illinois MLTSS members,
will have a 90 day “Switch Period” from plan’s
initial effective date to switch one time to a different
MLTSS plan
• Individuals will then be locked in for 12 months from
their last plan’s effective date, until their annual
Open Enrollment Period (OEP)
– However, if a beneficiary is living in an MMAI area, they
can enroll into MMAI plan instead of a HealthChoice Illinois
MLTSS plan at any time of the year
HealthChoice Illinois MLTSS:
Enrollment Rights cont…
• Annual OEP= 60 day period when HealthChoice
Illinois MLTSS members can choose a new plan
• Brand new HealthChoice Illinois MLTSS members and
members switching between HealthChoice Illinois
MLTSS plans during their OEP are entitled to a 90 day
“Transition Period” where plan members may be
able to continue utilizing out of network providers for
current ongoing course of treatment
HealthChoice Illinois:
Plan Options
Current HealthChoice Illinois Plans: Same as
HealthChoice Illinois for individuals without Medicare
– Blue Cross Blue Shield of Illinois
– Illinicare Health Plan (also serving DCFS population)
– Meridian Health
– Molina Healthcare of Illinois
– NextLevel Health (available in Cook County only)
– CountyCare (available in Cook County only)
The Medicare
Medicaid Alignment
Initiative (MMAI)
What is MMAI?• A voluntary healthcare program for people with Medicare
and full Medicaid
– Can enroll, disenroll, or change plans at any time
• Receive ALL healthcare services Medicare & Medicaid
cover through one health plan
– Also covers Long Term Services and Supports (LTSS)
– Includes additional benefits not covered by Medicare & Medicaid
• Transportation, extra dental & vision coverage, prescription drugs with no
co-pay, gym memberships
• Offers Care Coordination to assist with navigating your plan,
meeting your health goals
• Must utilize plans’ provider network or services are not
covered
• Separate contract than HealthChoice Illinois program
46
Medicare Medicaid Alignment
Initiative (MMAI) Services Covered
Hospital
VisitsDoctors
Lab
tests
Home
health
Durable
medical
equipment
Skilled nursing
facility (short-
term rehab)
Ambulance
servicesPrescription
drugs
Mental &
Behavioral
Health Services
Long Term
Services and
Supports (LTSS)
Transportation
Other extra services
not covered by
Medicare & Medicaid
48
Who is eligible for MMAI?
Enrolled in Medicare Parts A & B, and
Enrolled full Medicaid (no spenddown) and
Age 21 or older and
Live in Cook, DuPage, Kane, Kankakee, Lake, Will,
Champaign, DeWitt, Ford, Knox, McLean, Peoria, Stark,
Tazewell, Vermilion, Christian, Logan, Macon, Menard, Piatt,
or Sangamon Counties
Eligible for Voluntary
Enrollment
MMAI: Excluded Populations
Enrolled in HealthChoice Illinois MLTSS (If eligible for MMAI,
can choose to enroll in MMAI instead of MLTSS)
Only eligible for Medicaid through Breast & Cervical Cancer
program
Receiving third-party insurance (employer or retiree coverage)
Receiving Temporary Medicaid benefits
Enrolled in the Health Benefits for Workers with Disabilities
program
Receiving support through:
Developmental disability institutional services
Waiver program for individuals with developmental disabilities
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MMAI Geographic Areas
MMAI is not expanding statewide at this time and
passive (automatic) enrollment now occurs in all
MMAI geographic areas
– Chicagoland Counties:
• Cook, DuPage, Kane, Kankakee, Lake,
Will
– Central Illinois Counties:
• Champaign, DeWitt, Ford, Knox, McLean,
Peoria, Stark, Tazewell, Vermilion
• As of July 1, 2019- Christian, Logan, Macon,
Menard, Piatt, and Sangamon
MMAI: Enrollment
• The MMAI program conducts passive enrollment
– Passive enrollment is automatic enrollment into a plan
– Beneficiary will be sent an enrollment packet with a
plan selected
– Will have at least 60 days from receiving the initial
notice to choose their plan or to opt-out of MMAI
completely
– If no active choice is made by the individual, Client
Enrollment Services will proceed with passive
enrollment into the MMAI plan listed in the notice
– If a beneficiary receives LTSS services they must
choose an MMAI plan or an MLTSS plan with Client
Enrollment Services
MMAI: Enrollment Rights• An individual can enroll, disenroll, or switch MMAI plans at
any time of the year, even if the beneficiary is
automatically enrolled
– Reminder: all enrollment/disenrollment is conducted through Client
Enrollment Services
– Disenrollment date will be effective the 1st of the month, following
the month of the disenrollment request
– If receiving LTSS services, must either choose an MMAI plan or an
MLTSS plan
• MMAI provides a 180 day “Transition Period” for brand
new MMAI plan enrollees where the beneficiary can
continue seeing out of network providers if they are
receiving current ongoing treatment
– The Transition Period is 90 days for individuals switching in
between MMAI plans
Medicare Medicaid Alignment
Initiative (MMAI) PlansMMAI Plans in 2019:
• Aetna Better Health serves: Cook, DuPage, Kane, Kankakee,
and Will counties
• Blue Cross Community MMAI serves: Cook, DuPage, Kane,
Kankakee, Lake, and Will counties
• Humana Health Plan serves: Cook, DuPage, Kane,
Kankakee, Lake, and Will Counties
• IlliniCare serves: Cook, DuPage, Kane, Kankakee, Lake, and
Will Counties
• Meridian Complete serves: Cook, DuPage, Kane, and Will
Counties
• Molina Healthcare serves: Champaign, Dewitt, Ford, Knox,
McLean, Peoria, Stark, Tazewell, and Vermilion, Christian,
Logan, Macon, Menard, Piatt, and Sangamon Counties
Check In: MMAI vs.
HealthChoice Illinois MLTSSMedicare Medicaid Alignment Initiative (MMAI):
• For individuals with full Medicare & Medicaid benefits
• Enrollees do not have to be receiving LTSS services
• Covers ALL healthcare services covered by Medicare & Medicaid,
and LTSS, plus some extra benefits not covered such as free gym
memberships or extra dental benefits
• If enrolled, an individual does not have any other form of
coverage through Part D, Medicare Advantage, MLTSS, etc.
• Voluntary program
– Individuals can enroll, change plans, or disenroll any time of the year
– If a Medicare beneficiary receives LTSS services, it is mandatory for
them to enroll in MMAI or MLTSS
• Not a part of the HealthChoice Illinois Program
• Not available statewide; only offered in the Chicagoland and Central
Illinois areas
Check In: MMAI vs.
HealthChoice Illinois MLTSSHealthChoice Illinois MLTSS:
• For people with full Medicaid and Medicare benefits, and receive
LTSS Services (through a Nursing Facility or one of the five
HCBS waivers)
• Only covers LTSS services, transportation and some behavioral health
• Enrollees must choose the way they would like to receive coverage of
their Medicare and Medicaid medical benefits
– Fee-for-service Medicaid and Medicare, Medicare Advantage, or Medicare Part D
• Locked into a plan for 12 months after enrollment until annual Open
Enrollment Period
• If a dual eligible lives in an MMAI program area, they can enroll into
an MMAI plan at any time of the year
• It is mandatory for Medicare and Medicaid beneficiaries who receive
LTSS services to either choose an MMAI plan or MLTSS plan
What Do All Medicaid
Managed Care Plans
Have in Common?
Initial Enrollment
• Individuals eligible for enrollment will receive a notice &
enrollment packet explaining their coverage options and will
have at least 30 days to choose a plan
• Individuals eligible for passive enrollment must choose a plan
by the date on the letter or they will be automatically enrolled
into a plan
• Once beneficiaries are enrolled in a plan, they will receive a
plan welcome packet, including information about the plan &
plan ID card to access services
• All Illinois Medicaid managed care programs provide at least a
90 day “transition period” to continue seeing out of network
providers when enrolled into a new plan
– MMAI provides a 180 day period for new enrollees & 90 days for
individuals switching between plans
Use of Provider Networks• Must use plan provider network to receive coverage
– If you receive a service out of network, that service is not
covered by Medicare or Medicaid
• Must choose an in-network Primary Care Physician
(except for HealthChoice Illinois MLTSS)
• Can check provider networks with Client Enrollment
Services
– By phone or online
– We recommend calling providers directly to ensure they
are within a plan’s network
• All enrollees have access to a Care Coordinator, who
can assist with locating in-network providers, and
helping enrollees manage their overall health
Healthcare Coverage
• People in Medicaid Managed Care are still in
the Medicaid program and have all of the rights
and protections of the Medicaid program
• Plans may not charge more than FFS Medicaid
copayments
• Most plans include extra benefits that FFS
Medicare and Medicaid do not cover
Medicaid Redeterminations
• Individuals’ Medicaid redetermination dates are different
than their Medicaid Managed Care annual OEP
• Annual redetermination notices are sent by Illinois
Department of Healthcare & Family Services
• Must return completed redetermination notice within 10
days of mailing date
• Return to the HFS office that the letter was mailed from
– Can also submit through Manage My Case Portal at
https://abe.illinois.gov/abe/access/
• If missed Redetermination Due Date, may be able to be
reinstated within 90 days from being dropped from
Medicaid
Client Enrollment Services • All enrollment, disenrollment, and plan changes are
conducted through Illinois Client Enrollment Services
– Objective, third party entity
– All calls are free
• Can verify in-network providers, prescription drugs covered
by plans, and inform beneficiaries of extra benefits covered
by each plan
Illinois Client Enrollment Services
(877)912-8880
TTY: (866)565-8576
http://enrollhfs.illinois.gov/
HealthChoice Illinois Questions?Illinois Department on
Aging (IDOA) Senior
Helpline
To be referred to…
• Local Area Agency on Aging
• SHIP Counselor
1-800-252-8966
HealthChoice Illinois Plan For questions about plans’ covered
services, to access benefits, speak
with care coordinator, file
complaints, etc.
Plan’s Member
Services Phone
Number
HFS Client Enrollment
Services (CES)
Enroll, disenroll, switch plans,
check manage care plan
enrollment & eligibility
1-877-912-8880
HFS ABE Benefits hotline Check Medicaid Application Status 1-800-843-6154
Resources
• For more information, see RFP & Materials:– https://www.illinois.gov/hfs/info/MedicaidManagedCareRFP/Pages/default.aspx
• HFS Program FAQs & Map: – https://www.illinois.gov/hfs/MedicalClients/ManagedCare/Pages/FamilyHealthProgram
FAQ.aspx
• Client Enrollment Services Website: – https://enrollhfs.illinois.gov/
• CES HealthChoice Illinois & MMAI Enrollment
Materials:– https://enrollhfs.illinois.gov/el-materials
• Medicaid Redetermination info:– https://www.illinois.gov/hfs/MedicalClients/medrede/Pages/default.aspx
• Starting Strong Webinar- HealthChoice Illinois:– http://www.everthriveil.org/resources/starting-strong-webinars
Contact Information
AgeOptions 1048 Lake Street, Suite 300Oak Park, IL 60301
Avisery Phone Number: (708)628-3440
Avisery Email Address: Avisery@ageoptions.org
Avisery Website: http://avisery.org/Avisery Email List Serve Sign Up: http://avisery.org/contact
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