Skip to Main Content

Breadcrumb

  1. HFS
  2. Managed Care

Managed Care 

Pursuant to state law (PA 96-1501), the Illinois Department of Healthcare and Family Services (HFS) is in the process of enrolling Illinois Medicaid and All Kids clients into care coordination in five mandatory managed care regions: Rockford, Central Illinois, Metro East, Quad Cities, and the Greater Chicago Region, which is made up of the Cook and Collar Counties. It is expected that 60% or more of our 3 million clients will have enrolled or be in the process of being enrolled in Health Plans by early 2015. The goal is to provide a health plan and primary care provider (PCP) for every client; to maintain continuity of care with that PCP; to create comprehensive networks of care around our clients including primary care, specialists, hospitals and behavioral care; and to offer care coordination to help clients with complex needs navigate the healthcare system.

Seniors and Persons with Disabilities

Integrated Care Program (ICP) - The Integrated Care Program is a mandatory managed care program for participants in the mandatory regions. Several Managed Care Organizations (MCOs) and Managed Care Community Networks (MCCN) are contracted to provide the full spectrum of Medicaid covered services to seniors and persons with disabilities ages 19 and older who are eligible for Medicaid but are not eligible for Medicare. For additional information please see the HFS Integrated Care Program webpage.

Care Coordination Entities (CCE) - Care Coordination Entities are also an option in certain counties for Seniors and Persons with Disabilities (SPDs). The CCE were developed through the Care Coordination Innovations Project to form alternative models of delivering care to Medicaid clients through provider-organized networks, initially organized around the needs of our most complex clients. For additional information please see the HFS Innovations Project, Seniors and Persons with Disabilities webpage.

Medicare Medicaid Alignment Initiative (MMAI) - The Medicare Medicaid Alignment Initiative (MMAI) demonstration is a managed care program available in two regions of the state, the Greater Chicago region, and the Central Illinois region, for SPDs that are dually eligible for both Medicare and Medicaid and are ages 21 and older. Several MCOs are contracted to provide not only all Medicaid covered services, but all Medicare covered services as well including Parts A, B, and D. For additional information please see the HFS Medicare-Medicaid Alignment Initiative webpage.

Family Health Plans (FHP) and Affordable Care Act (ACA) Clients

Managed Care For Adults and Families - The Managed Care for Adults and Families Program is a mandatory managed care program serving children and their parents, and adults newly eligible under the Affordable Care Act. This program operates in all five mandatory managed care regions and uses Managed Care Organizations (MCOs) and Managed Care Community Networks (MCCN) to provide the full spectrum of Medicaid covered services.

Accountable Care Entities (ACEs) - An Accountable Care Entity (ACE) is a new model of an integrated delivery system created under Public Act 98-104 (pdf). ACEs are organized by providers and will coordinate and ensure access to Medicaid services for their enrollees. During the first 18 months as an ACE, services will continue to be reimbursed through the Department’s fee-for-service program. Beginning in month 19 the ACEs will begin directly reimbursing providers for services to their enrollees. ACEs are also an option in certain counties for individuals who choose an entity to provide care coordination only on their behalf. For additional information please see the HFS Accountable Care Entity (ACEs) webpage.

Children with Special Needs Care Coordination Entities (CSN CCE) - The CSN CCEs provide an alternative model of delivering Medicaid services to children through provider-organized networks organized around the needs of the most children with the most complex needs. This program will offer a redesigned healthcare delivery system that is more patient-centered, with focus on improved health outcomes, enhanced patient access, and patient safety. For additional information please see the HFS Innovations Project, Children with Complex Health Needs webpage.

Non- Mandatory Regions

Clients enrolled in Medicaid in the non-mandatory regions of the state will continue to receive their care through the Illinois Health Connect program. Illinois Health Connect is a Health Plan that creates medical homes to encourage delivery of healthcare services in the most appropriate setting and ensure access to preventive healthcare services. Clients residing in non-mandatory managed care regions must enroll in Illinois Health Connect, and in some counties may have additional choice(s) of MCOs, ACEs or CCEs. For additional information please see the Illinois Health Connect webpage.

Client Enrollment Information

When it is time for a client to select their Health Plan and PCP, they will receive enrollment information from Illinois Client Enrollment Services. This enrollment information will provide the client with their Health Plan choices and information on the two ways to enroll:

Each client will have a 60 day voluntary choice period to select their Health Plan and PCP. If the client does not make a Health Plan and PCP choice during this 60 day period, they will be auto-enrolled in a Health Plan and PCP. Once enrolled in a Health Plan, clients will then have 90 days from their effective date of enrollment to change their Health Plan, or they will be locked into their Health Plan choice for a year. Clients can change their PCPs by contacting their Health Plan. For information more information about enrollment, please visit the Illinois Client Enrollment Services website.