Medicaid Managed Care - AgeOptions · • Medicaid Managed Care plan for individuals with full Medicaid, full Medicare, and who receive LTSS services • As of July 1, 2019, it is

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: [email protected], 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

http://avisery.org/contact

mailto:[email protected]

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: [email protected]

• Avisery Website: http://avisery.org/

• Sign up for the Avisery Email List: http://avisery.org/contact


http://avisery.org/


• 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


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.


• 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

https://www.illinois.gov/hfs/SiteCollectionDocuments/StatewideHealthChoiceIllinoisPlansJuly12019.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

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HealthChoice Illinois:

Provider Networks


• 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


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


• 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”


Enrollment Rights


• 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)


Enrollment Rights cont…


• 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


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)


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

34


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


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


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)


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”


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


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


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


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

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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

49

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


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

https://www.illinois.gov/hfs/info/MedicaidManagedCareRFP/Pages/default.aspx

https://www.illinois.gov/hfs/MedicalClients/ManagedCare/Pages/FamilyHealthProgramFAQ.aspx

https://enrollhfs.illinois.gov/

https://enrollhfs.illinois.gov/el-materials

https://www.illinois.gov/hfs/MedicalClients/medrede/Pages/default.aspx

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: [email protected]

Avisery Website: http://avisery.org/Avisery Email List Serve Sign Up: http://avisery.org/contact


http://avisery.org/
