Managed Care Organization Illinois HealthChoice Program Overview

The Illinois HealthChoice Program is a managed care organization that provides healthcare services to eligible individuals.

The program is administered by the Illinois Department of Healthcare and Family Services.

Eligible individuals include those who are low-income, elderly, or have disabilities.

The program aims to provide comprehensive and coordinated healthcare services to its beneficiaries.

Illinois Medicaid Reform began with the implementation of a new Medicaid Managed Care Organization Dispute Resolution Process on February 28. This process aims to resolve disputes between Medicaid managed care organizations and the Department of Healthcare and Family Services.

Governor Pritzker signed Senate Bill 1321/PA101-0209, comprehensive Medicaid managed care reform legislation, on August 5. This legislation was strongly backed by the Illinois Health and Hospital Association (IHA).

Illinois has a managed care program called HealthChoice Illinois (HCI), which serves a population of families and children, adults eligible for Medicaid under the Affordable Care Act, seniors and adults with disabilities, and dual Medicare-Medicaid eligible adults. HCI also covers special needs children.

The HCI program has five managed care plans, including CountyCare Health Plan, which serves Cook County only. CountyCare Health Plan can be reached at www.countycare.com or 1-855-444-1661.

Here are the five managed care plans operating in the HCI program:

IHA conducts a quarterly MCO Administrative Performance Survey to demonstrate the burden of MCO claim denials on member hospitals and health systems.

The survey results show the significant impact of MCO claim denials on hospitals and health systems, highlighting the need for reform.

IHA continues to hold this survey as part of ongoing efforts to address the issue, with results available for 2Q 2019 and 3Q-4Q 2020.

HFS Guidance on Potentially Preventable Readmissions Policies is a significant development in the managed care landscape. Pursuant to 89 Ill. Adm. Code 152.300, HFS is requiring MCOs to update their current hospital readmission policies.

HFS is taking a proactive approach to address potentially preventable readmissions. This move aims to improve patient outcomes and reduce healthcare costs.

MCOs must update their current hospital readmission policies to comply with the new guidelines. This will likely involve revising their clinical and reimbursement policies.

The update is a response to the need for more effective management of hospital readmissions. By requiring MCOs to update their policies, HFS hopes to reduce the number of preventable readmissions.

This development highlights the importance of collaboration between HFS and MCOs in improving healthcare outcomes. By working together, they can create more effective policies that benefit patients and the healthcare system as a whole.

HFS's guidance on potentially preventable readmissions policies will likely have a significant impact on MCOs. They must now review and revise their current policies to ensure compliance with the new guidelines.

The update is a step in the right direction towards improving patient care and reducing healthcare costs. By requiring MCOs to update their policies, HFS is taking a proactive approach to addressing a critical issue in the healthcare system.

IHA conducted a quarterly MCO Administrative Performance Survey for 3Q-4Q 2020.

The survey aimed to demonstrate the significant burden of MCO claim denials on member hospitals, health systems. This effort highlights the importance of understanding the impact of MCO claim denials on healthcare providers.

The survey results showed that ongoing efforts were made to address the issue, with a focus on member hospitals and health systems.

IHA continues to hold a quarterly MCO Administrative Performance Survey as part of ongoing efforts to demonstrate the significant burden of MCO claim denials on member hospitals and health systems.

The survey results for 2Q 2019 showed the ongoing struggle of hospitals and health systems with MCO claim denials.

In 2Q 2019, MCO claim denials continued to be a significant burden on member hospitals and health systems.

This burden is a key issue that IHA aims to address through their ongoing survey efforts.

The ongoing efforts to demonstrate the significant burden of MCO claim denials on member hospitals and health systems have been a major concern for medical-equipment vendors.

IHA continues to hold a quarterly MCO Administrative Performance Survey, which aims to highlight the impact of MCO claim denials.

Medical-equipment vendors are worried that the Medicaid reboot will lead to increased claim denials and administrative burdens.

The Medicaid Managed Care and Prior Authorization Reform Bills aim to reform clinical and reimbursement policies implemented by commercial health insurance issuers and Medicaid MCOs.

This could potentially lead to more streamlined processes for medical-equipment vendors, reducing administrative burdens and increasing reimbursement rates.

However, the extent to which these reforms will benefit medical-equipment vendors remains to be seen.

Disputes can arise between managed care organizations and healthcare providers in Illinois, but there are steps to resolve them.

The Illinois Department of Healthcare and Family Services (HFS) is responsible for resolving disputes between managed care organizations and healthcare providers.

Healthcare providers in Illinois can contact the HFS to report disputes or concerns, and the department will work to resolve the issue.

The Medicaid MCO Dispute Resolution Process is kicking off on February 28. This new process is being implemented by the Dept. of Healthcare and Family Services.

IHA has been conducting a quarterly MCO Administrative Performance Survey to demonstrate the significant burden of MCO claim denials on member hospitals and health systems. The survey results for 3Q-4Q 2020 are available, showing the ongoing efforts to address this issue.

The MCO Administrative Performance Survey has been a quarterly effort by IHA since at least 2Q 2019. This demonstrates the long-standing commitment to addressing the impact of MCO claim denials on healthcare providers.

If you're looking for contact information for HealthChoice Illinois, you have several options.

Aetna Better Health of Illinois can be reached at 1-866-329-4701 or through their website at www.aetnabetterhealth.com/illinois-medicaid.

Blue Cross Community Health Plan has a phone number of 1-877-860-2837 and a website at www.bcbsil.com/bcchp.

Meridian Health Plan, which serves Youth in Care only, can be contacted at 1-866-606-3700 or through their website at corp.mhplan.com/en/member/illinois.

Here are the contact details for HealthChoice Illinois plans:

Illinois has a managed care program called HealthChoice Illinois (HCI) that serves several populations, including families and children, adults eligible for Medicaid under the Affordable Care Act, and seniors and adults with disabilities.

The HCI program has a comprehensive set of benefits for all enrolled customers, except for the MLTSS population, which receives long term services and supports, mental health and transportation services, and some Medicare and Medicaid fee-for-service coverage.

There are five managed care plans operating in the HCI program, including CountyCare Health Plan, which serves Cook County only.

Here are the populations served by the HCI program:

Youth in Care, which includes youth living with foster parents, in group homes, or in residential settings, receive additional benefits through the YouthCare program, including trauma-informed care coordination for behavioral health needs.

The Medicare/Medicaid Alignment Initiative (MMAI) is a three-way partnership between HFS, the federal Centers for Medicare and Medicaid Services (CMS), and health plans.

This statewide program was launched on July 1, 2021, and aims to provide coordinated care to customers who are eligible for both Medicare and Medicaid services.

Five (5) Managed Care Organizations (MCOs) contracted to provide services under MMAI in FY2022.

These MCOs are responsible for covering all Medicare and Medicaid services, including Long Term Services and Supports.

Customers can opt out of MMAI at any time, but those receiving services in a nursing facility or under a Home and Community Based Services (HCBS) Waiver may be required to participate in the HCI program under MLTSS.

To choose a health plan in Illinois, you'll receive an enrollment packet in the mail with a deadline to select a plan. If you don't choose a plan by that date, a plan and Primary Care Provider (PCP) will be chosen for you.

You can decide which health plan and PCP are right for you by considering factors such as whether you already like a doctor, what health plans your doctor works with, and whether you need a doctor who speaks a certain language.

You can research plans and decide which is right for you by visiting EnrollHFS.Illinois.Gov or calling the plan's member services line. For more help, you can call Illinois Client Enrollment Services at (877) 912-8880 or go online to EnrollHFS.Illinois.Gov.

Here are some questions to consider when choosing a health plan:

HealthChoice Illinois (HCI) is a statewide managed care program that serves a diverse population, including families and children, adults eligible for Medicaid under the Affordable Care Act, seniors, and adults with disabilities who are not eligible for Medicare. It's one of three distinct care coordination programs operated by the Illinois Department of Healthcare and Family Services.

In FY 2022, HCI had contracts with five managed care plans, including CountyCare Health Plan, which serves Cook County only. These plans provide a comprehensive set of benefits to enrolled customers, except for the MLTSS population, who receive some long-term services and supports, along with mental health and transportation services.

The HCI program covers a wide range of services, including medical, dental, and behavioral health services, as well as pharmacy services. However, MLTSS customers receive some services through Medicare and Medicaid fee-for-service.

Here's a breakdown of the population served by HCI:

For more information about the MCOs operating in the HCI program, you can check the Managed Care map provided by the Illinois Department of Healthcare and Family Services.

You'll receive an enrollment packet in the mail from Illinois Client Enrollment Services, which will include a letter specifying the deadline to choose a health plan. If you don't make a selection by that date, a health plan and Primary Care Provider (PCP) will be chosen for you.

The enrollment packet will also include information about the health plans and PCPs available to you. You can use this to research and decide which plan is right for you.

To make an informed decision, consider the following questions:

To get more information about each plan, visit EnrollHFS.Illinois.Gov or call the plan's member services line. You can also call Illinois Client Enrollment Services at (877) 912-8880 for more help choosing a plan and finding a doctor.