Regions, Health Plans, and Services Provided
The Illinois Department of Healthcare and Family Services (HFS) implemented the Integrated Care Program (ICP) on May 1, 2011, for seniors and persons with disabilities who are eligible for Medicaid but not eligible for Medicare. ICP is mandatory managed care that began as a pilot program in the greater Chicago region including suburban Cook, DuPage, Kane, Kankakee, Lake and Will counties. It now operates in 29 counties in five regions of Illinois. Those regions include the Rockford region (July 2013), the Central Illinois region (Sept 2013), the Metro East region (Sept 2013) and the Quad Cities region (November 2013). You can view the Health Plans by region.
Service Package I – Implemented May 1, 2011. All standard Medicaid medical services, such as physician and specialist care, emergency care, laboratory and X-rays, pharmacy, mental health and substance abuse services
Service Package II – Implemented February 1, 2013. This package includes Nursing Facility services and the care provided through some of the Home and Community-Based Service (HCBS) waivers operating in Illinois (excluding Developmentally Disabled/DD waiver services).
Nursing Facility Services are long term care services covered by the Department for Medicaid-eligible residents and include Skilled Nursing Facilities and Intermediate Care Facilities (SNF and ICF).
Home and Community-Based Service (HCBS) waivers allow participants to receive non-traditional services in the community or in their own homes, rather than being placed in an institutional setting. Illinois currently operates nine HCBS waivers, five of which will be included during Service Package 2. The remaining three Developmentally Disabled (DD) waiver services will be included during Service Package III. The MFTD waiver services will be discussed at a later date.
Service Package III – DD Waiver services; will begin approximately one year after Service Package II implementation.
Eligible and Excluded Populations
Eligible Populations (Aged, Blind, Disabled) = approximately 36,000
- Age 19 and older
- Non-Medicare eligible older adults and adults with disabilities receiving Medicaid (case numbers beginning with 01, 91, 02, 92, 03, 93) including all Home and Community Based Waiver enrollees
- Children under 19 years of age
- Participants eligible for Medicare Part A or enrolled in Medicare Part B
- American Indians and/or Natives of Alaska (may voluntarily enroll)
- Participants with Spenddown
- All Presumptive Eligibility (temporary benefits) Categories
- Participants in the Illinois Breast and Cervical Cancer Program
- Participants with high-level private health insurance (also known as Third Party Liability or TPL)
Illinois Client Enrollment Broker
HFS contracts with MAXIMUS, Inc. to operate Illinois’ Client Enrollment Services. Illinois’ Client Enrollment Services will:
- Ensure impartial choice education
- Conduct all client enrollment activities, including mailing choice education and enrollment materials and providing information on each health plan to assist enrollees with the selection of a health plan and Primary Care Provider (PCP) in an unbiased manner
- Process requests to change health plans
Client enrollments are handled by Illinois’ Client Enrollment Services. There are two ways clients can enroll:
An initial client enrollment packet is mailed to households with potential enrollees. The packet includes:
- An enrollment letter
- An Integrated Care Plan Information Guide
- Enrollment Tips for picking a health plan and PCP
A comparison chart listing the extra benefits, network hospitals, and other information for each of the two health plans
- A reminder notice is mailed to clients two weeks after the initial enrollment packet is mailed
A second client enrollment packet is mailed to clients who have not responded to the initial client enrollment packet within 30 days. The packet includes a cover letter with the name of the health plan and PCP to whom the client will be assigned if they don’t make a choice within the next 30 days.
- Enrollees will receive a welcome packet from their chosen or assigned health plan to confirm their enrollment
- Enrollees may change their PCP by calling their health plan
- Once each year, during their open enrollment period, enrollees will have a 60-day period to change their health plan. This will be the only time each year they are allowed to switch health plans. A letter will be sent notifying them of their open enrollment period
- Providers should always check a member’s eligibility and health plan through the HFS Medical Electronic Data Interchange (MEDI) System or through the use of a Recipient Electronic Verification (REV) vendor prior to providing services
- Members should bring both their HFS medical card and their ICP health plan card to appointments.
Integrated Care Contracts
Integrated Care Rates
To get more information about Illinois’ Integrated Care Program, please contact: