Overview:
Illinois' Managed Care Program is a streamlined, accountable, and integrated program that strives to improve outcomes for its customers consistent with the Department's program goals. It aligns with the Department's mission of healthcare equity, addresses social determinants of health, and advances quality pillars, such as Adult Behavioral Health, Child Behavioral Health, Maternal and Child Health and Community-Based Services and Supports.
Managed Care Programs:
The Department operates three distinct care coordination programs within the broader Illinois Medicaid Managed Care program: HealthChoice Illinois (HCI), YouthCare, and the Medicare Medicaid Alignment Initiative (MMAI).
HealthChoice Illinois (HCI)
The statewide HealthChoice Illinois Managed Care Program offers most Medicaid customers enhanced health care coordination and quality services at sustainable costs, including the following populations:
- Families and children;
- Adults eligible for Medicaid under the Affordable Care Act;
- Seniors and adults with disabilities who are not eligible for Medicare;
- Dual Medicare-Medicaid eligible adults receiving certain Long Term Services and Supports, referred to as the MLTSS population;
- Special needs children, which includes Former Youth in Care and Youth in Care.
The Managed Care map provides more information about the MCOs that are operating in the HCI program. HCI covers a comprehensive set of benefits for all enrolled customers except the MLTSS population. MLTSS customers receive some long term services and supports, along with some mental health and transportation services, from their HCI health plan. All other services for MLTSS customers are covered by Medicare and Medicaid fee for service.
HealthChoice Illinois - YouthCare
The statewide, specialized HCI health plan, provides services to DCFS Youth in Care as well as DCFS Former Youth in Care. YouthCare works to improve access to care through active coordination and through a more robust provider network. With YouthCare, DCFS youth receive additional benefits, such as trauma-informed care coordination for behavioral health needs. YouthCare provides specialized programming for adoptive families, including an adoption-competent network of therapists to support the different phases of adoption and child development. The Department continues to work closely with the DCFS and YouthCare and various stakeholders to support program initiatives and workgroups to enhance the quality of care for DCFS youth.
To learn more about YouthCare and available resources, please visit www.ILYouthCare.com and the DCFS managed care page at https://dcfshealthplan.illinois.gov .
Medicare/Medicaid Alignment Initiative (MMAI)
The Medicare/Medicaid Alignment Initiative is an on-going three-way partnership between HFS, the federal Centers for Medicare and Medicaid Services (CMS), and health plans. MMAI reformed the way care is delivered to customers who are eligible for both Medicare and Medicaid services (dually eligible) by providing coordinated care and became a statewide program on July 1, 2021. The Managed Care map provides more information about the MCOs that are operating in the MMAI program by county.
MCOs providing services under MMAI are responsible for covering all Medicare and Medicaid services, including Long Term Services and Supports. Customers can opt out of MMAI at any time, as well as re-enroll at any time; however, customers that receive services in a nursing facility or under one of the Home and Community Based Services (HCBS) Waivers and request to opt out of MMAI are required to participate in the HCI program under MLTSS. More information can be found on the MMAI section of the HFS website.
Provider Participation:
The Managed Care Program provides quality care for beneficiaries, with reduced administrative requirements and other enhancements to allow providers to better focus on client care. In order to participate in the statewide managed care programs, and provide services to patients enrolled in a plan, Providers are encouraged to contract with each of the qualified, experienced, and financially sound Managed Care plans. Before contracting with any plans, providers must also make sure they are enrolled in the Department's IMPACT system. Once providers are enrolled in IMPACT and contracted with plans, they may provide services to customers enrolled in that plan.
It is important that providers check a customer's eligibility on the date of service to confirm the customers' plan enrollment, even if the enrollment had previously been verified. The Recipient Eligibility Verification (REV) System, the Automated Voice Response System (AVRS), and the Medical Electronic Data Interchange (MEDI) system will identify the plan in which the customer is enrolled.
