Illinois State Medicaid Transition to Managed-Care Health Plans

April 2018 ~

Illinois Medicaid has transferred the healthcare coverage of approximately 550,000 residents to managed care plans. These residents are now covered under the HealthChoice Illinois program and will see their health care handled by managed care organizations.

In an effort to reduce healthcare costs, the Illinois Department of HealthCare and Family Services (HFS) announced a schedule update for the HealthChoice Illinois managed care program expansion. HealthChoice Illinois program for dual-eligible individuals receiving long term care and who are not enrolled in the Medicare-Medicaid Alignment Initiative (MMAI) or individuals receiving waiver services in the expansion counties has been postponed.

HFS notes that this change effects only individuals receiving services in one of the following programs and who recently selected or were assigned to a health plan in the HealthChoice Illinois program in the expansion counties for an April 1, or later effective date.

  • Community Care Program (Elderly Waiver)
  • Home Services Program (Division of Rehabilitation Services Waivers)
  • Supportive Living Program (SLP Waiver)
  • Nursing home or long term care facility (non-MMAI dual eligible)

As of April 1, individuals under this managed care enrollment postponement will continue to receive services in the HFS Fee-For-Service (FFS) program and will continue to access their long term care and waiver services with their HFS medical card. HFS MEDI System will reflect that the individual is in the HFS FFS program and no health plan assignment in HealthChoice Illinois will be present as of April 1.

According to the announcement, the expansion schedule change does not change individual access to healthcare services or benefits in any way. Providers will continue to bill the appropriate State Agency for services rendered.

Florida HFS states it will issue a new provider notice when managed care enrollment for these individuals receiving long term care or waiver services begins in the expansion counties.

 

 

Source(s): HealthChoice Illinois; The State Journal-Register; WJPF; HFS Provider NoticeProvider Notice Issued 03/29/2018;

 

 

AdvantEdge