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Information about the new Medicaid Managed Care 

10/30/2017 The new Medicaid Managed Care Program is named “HealthChoice Illinois,” reflecting the goal of helping beneficiaries make smart healthcare decisions.  Please see the most recent provider notice with more information.  The notice also includes information on the Medicare-Medicaid Alignment Initiative. 

HFS has published the first in a series of articles designed to help providers prepare for these changes.  

Succeeding in the New Managed Care Program Series (#1): What is my relationship with health plans that weren't awarded a contract for the new program?  Exiting health plans will need to pay all verified claims, including any bills that remain outstanding after December 31, 2017. To facilitate resolution of any contractual liabilities throughout the transition, the Department has retained an independent auditing firm to work with the plans and providers. More details about this and other program aspects will be coming soon.

 

The new contracts will both reduce the number of plans and expand managed care statewide.  We recommend that you frequently check the IL Dept. of Healthcare and Family Services updated page.

Starting January 1, 2018, the new MCOs will be:
Blue Cross Blue Shield of Illinois
Harmony Health Plan
IlliniCare Health Plan
Meridian Health
Molina Healthcare of Illinois
CountyCare Health Plan (Cook County only)
NextLevel Health (Cook County only)
DCFS Youth: IlliniCare Health Plan

Although HFS has not yet issued official provider notices, they have made statements at various public meetings regarding the roll out timeline. Please note this information was gleaned through public meetings with HFS and is not meant to inform you of official HFS policy. HFS will be issuing provider notices in the coming weeks. For inquiries and official policy, please visit the Illinois Dept. of Healthcare and Family Services website

Current Managed Care Areas: Starting January 1, 2018, all children and adults currently living in Medicaid Managed Care Regions will be enrolled in one of these health plans. If they are currently enrolled in one of the plans listed above, they will continue to be enrolled in that plan. If they are NOT currently enrolled in the plan, they must either choose a new plan or be auto-enrolled into one of the plans listed above. HFS has stated that all clients will be auto-assigned based on their PCP relationship. As with the previous roll out, they will receive letters from HFS before January 1 with instructions on how to choose a plan and what plan they will be enrolled in if they do not choose a plan. After January 1, 2018, all clients will have 90 days to change plans.

Please consider taking action if you are in a current managed care area:
• If you are not already contracted with at least one of the plans listed above, you should contact them to begin the contracting process. This is the only way your patients will be able to be auto-enrolled in the correct plan.
• You may tell your patients which plans you contract with, but you must tell them ALL the plans where you have contracts.
• Reach out to your Medicaid families to let them know this change is occurring. You can tell them which plans you have contracted with as long as you list ALL the plans with which you have signed contracts.
• HFS will be sending out provider notices to inform physicians on these changes. Sign up to make sure you are receiving the most up to date information.

New Managed Care Areas: (i.e. the rest of Illinois)

Starting on or around April 1, 2018, all children and adults outside of the current managed care areas will be auto-assigned to plans. HFS will send letters to families in February alerting them they need to choose an MCO and will also list the MCO they will be auto-assigned to on April 1 if a plan is not selected. HFS has stated they will base auto-assignment on existing PCP relationship. All clients will have 90 days to change plans once they are enrolled with a plan.

Please consider taking these action if you are in a NEW managed care area:
• If you are not already contracted with at least one of the plans listed above, you should contact them to begin the process. This is the only way your patients will be able to be auto-enrolled in the correct plan.
• You may tell your patients which plans you contract with, but you must tell them ALL the plans with which you have contracts.
• Reach out to your Medicaid families to let them know this change is occurring. You can tell them which plans you have contracted with as long as you list ALL the plans you have signed contracts.
• HFS will be sending out provider notices to inform physicians on these changes. Sign up to make sure you are receiving the most up to date information.

Other Valuable Information

Payment on current contracts: HFS has stated that the current MCOs are liable for all services preformed through December 31, 2017 and is the process of hiring an audit firm to close out these contracts. Currently, the state is in the process of catching up on payments to MCOs which were paused during the budget impasse. The timeline for payments from HFS to MCOs is dependent on available funds to issue payments. The state is under court order to prioritize payments to Medicaid providers and MCOs.

Credentialing: HFS has stated that they will start uniform credentialing in the near future. This means that you will not have to credential with each individual plan. The process will be based on the information included in the IMPACT system. Although HFS has not yet committed to a firm timeline for this process, they expect to do a soft launch in the fall and then begin on January 1.

Included in the RFP process is a mandate for plans to follow a single drug formulary. Plans will still have the ability to require pre-authorization, step plans, etc., but they must cover the drugs listed on the HFS formulary.

Mental Health/1115 Waiver: Please note that also included in the model contracts are waivers from the Centers for Medicaid Services (CMS) to further integrate behavior health services for Medicaid clients through Integrated Health Homes. CMS has not yet granted the waiver (known as the 1115 waiver) or the state plan amendment (needed for the integrated health homes). We will share information as it becomes available.

DCFS and DSCC: We do not yet have information to share on the transition plan for DCFS youth or those whose care is coordinated by Division of Care for Specialized Children (DSCC). If you are a provider that sees DCFS youth, you will need to contract with IlliniCare in the future.

We will continue to update this page with information as it becomes available