Medicaid Managed Care 2.0
By next summer, an estimated 2.7 million Medicaid recipients will be enrolled in managed care. This enrollment target will be the culmination of a program refresh that began earlier this year when the state Department of Healthcare and Family Services sought proposals from managed care plans looking to serve Medicaid members.
By the May 15 deadline, nine plans had made the case that they were qualified to support the health and wellness of Illinois' Medicaid recipients. Following a thorough evaluation, six plans were chosen:
- Blue Cross Blue Shield of Illinois
- County Care Health Plan
- Harmony Health Plan
- IlliniCare Health Plan
- Meridian Health
- Molina Healthcare of Illinois
The key difference for this new iteration of managed care is that, for the first time, the entire state of Illinois will be served by managed care. Five of the plans will serve members in every county in Illinois. County Care Health Plan will serve Cook County only. All six plans must be ready to serve members beginning January 1, 2018.
Medicaid recipients will begin to see the effects of implementation when letters from HFS are sent to all eligible participants. These letters will detail the available plan options, how to enroll in a plan, and the deadline to make changes.
Who is impacted
All managed care members currently enrolled in Family Health Plan (FHP), ACA Adult (ACA), Integrated Care Plan (ICP), or Managed LTSS (MLTSS) will be part of this transition. They be given the opportunity to stay with their current plan or choose a new plan. Their effective date will be
January 1st, 2018.
All youth served in the Department of Child and Family Services system (DCFS Youth) will be served by IlliniCare Health Plan. No effective date for the DCFS Youth population has been announced.
Eligible Medicaid recipients who live in counties not currently under managed care will be transitioned to a health plan later in the spring.
Who is not impacted
Members of an MMAI plan will not be affected. They will not have to change plans or choose a new plan. However, dual-eligibles who have an MLTSS plan will be impacted. They will receive a letter and will have the option to choose a new plan for their MLTSS services.
How the transition will roll out
Current managed care members will begin receiving letters from HFS in mid-October. Members of plans continuing to operate in 2018 will receive a letter explaining they have a chance to change plans if they wish. If they do nothing, they will remain with their current plan. Members of plans that will cease operations at the end of 2017 will receive a letter explaining they must change plans. If they do not choose a new plan, a plan will be chosen for them. Both groups will have 30 days from the receipt of their letter to make an affirmative choice. The effective date for these groups will be January
Medicaid members who live in counties new to managed care will receive a letter
January 1 informing them how to choose one of the five statewide plans. They will have 30 days to choose a plan. If they do not choose a plan, one will be assigned to them. The effective dates for these members
is tentatively scheduled for
Every enrollee will have 90 days from their effective date to change plans if they desire to do so.
It is also worth noting that HFS has the right to change these dates and timeframes. The best source of information and updates on the managed care program is HFS'
Medicaid Managed Care RFP page