Managed LTSS Programs
In 2011, the Illinois General Assembly adopted a Medicaid reform law (P.A. 96-1501) mandating the state to move 50% of Illinois Medicaid recipients from fee-for-service to risk-based care coordination by January 2015. Currently, the state has two Medicaid managed LTSS programs. (Source: State Website on Integrated Care Program)
In May 2011, the state implemented its first integrated health care program, a mandatory managed care program for the non-dual ABD population known as the Integrated Care Program (ICP), in 5 pilot counties. (Source: State Integrated Care Program website) In February 2013, health plans began covering LTSS benefits for ICP enrollees. In mid- 2013, the state began its ICP enrollment expansion. In March 2014, the state began ICP enrollment expansion in the City of Chicago, the state’s final region for ICP expansion. (Source: HMA Weekly Roundup, 4/2/2014)
In early 2013, the state implemented its second managed care program, known as the Care Coordination Innovations Project. Eligible populations include older adults, adults with physical disabilities, and children with complex needs. The managed care entities include Care Coordination Entities (CCEs) and Managed Care Community Networks (MCCNs). CCEs are provider-organized networks providing care coordination for risk- and performance-based fees; medical and other services are paid on a fee-for-service basis. Some CCEs have already begun serving beneficiaries, while others will go live later in 2014. MCCNs are provider-sponsored organizations that contract Medicaid covered services through a risk-based capitated fee model. Participation in a CCE or MCCN is voluntary. (Source: State Presentation on Innovations Project, 10/31/2011; HMA Weekly Roundup, 4/23/2014)
Care Coordination Information and Fact Sheet
State Website on Care Coordination initiative
In early June 2014, the state postponed the July 1, 2014 launch date for its Medicaid managed care programs, in order to finalize contracts and mail out patient information packages. On June 17, 2014, the state updated its care coordination rollout map. (Source: Chicago Tribune, 6/10/2014; HMA Weekly Roundup, 6/11/2014; HMA Weekly Roundup, 6/18/2014).
Care Coordination Expansion Map (6/25/2014)
Care Coordination Webcast Presentation (6/30/2014)
On June 4, 2014, Illinois submitted to CMS a §1115 Waiver for its Path to Transformation demonstration. The waiver proposes comprehensive reforms to the state’s Medicaid program that will impact all Medicaid eligible populations, including seniors and people with disabilities. The waiver proposes significant changes to Medicaid LTSS, including consolidating the nine existing waivers into a single §1115 waiver; reducing waiting lists; moving individuals from sheltered workshops into integrated employment; and expanding availability of behavioral health services. The waiver also proposes to create a fund to reimburse institutions that close or reduce capacity, and to establish an assessment of HCBS providers. Lastly, the waiver suggests that Illinois may examine institutional eligibility criteria to ensure that policies prioritize services in other settings. (Source: Illinois.gov website; Draft Waiver Concept Paper, 11/7/13)
§1115 Waiver Proposal (6/4/2014)
As of the January 6, 2015 meeting of the Medicaid Advisory Committee (MAC) Care Coordination Subcommittee, the state had enrolled more than 1.4 million Medicaid beneficiaries in care coordination plans, which include Managed Care Organizations (MCOs), Accountable Care Entities (ACEs), and Care Coordination Entities (CCEs). State Healthcare and Family Services (HFS) officials estimate that an additional 700,000 Medicaid beneficiaries will be enrolled in care coordination plans by May 2015. (Source: HMA Weekly Roundup, 1/14/2015)
As of April 2015, roughly 2 million individuals are enrolled in managed care programs, up from 75,000 in April 2014. The Family Health Program serves 1.8 million individuals; 120,000 non-dual eligible seniors or disabled are enrolled in the state’s Integrated Care Program (ICP); and 58,000 dual eligibles are enrolled in the state’s Medicare-Medicaid Alignment Initiative (MMAI). (Source: HMA Weekly Roundup, 5/13/2015)
On February 27, 2017, the Illinois Department of Healthcare and Family Services (HFS) posted a request for proposals (RFP) for MCOs that are interested in providing services for the state’s Medicaid managed care program, which includes MLTSS. HFS is seeking between four and seven MCOs to operate contracts statewide. MCOs will be responsible for providing the full spectrum of Medicaid services under this contract.
This procurement aims to enhance population health, the experience of the Medicaid consumer, and lower costs. In that vein, the RFP has the following themes:
o Preventative care and population health;
o Paying for value rather than volume;
o Rebalancing away from institutions and towards the community;
o Improving data integration and predictive capabilities; and
o Bettering education and outreach efforts to improve self-sufficiency.
Beginning in 2014, Illinois transitioned two million of its 3.1 million Medicaid enrollees into managed care, or approximately 65 percent, surpassing the states’ initial goal of 50 percent. Under the RFP, HFS now aims to enroll 80 percent of Medicaid members into managed care. In order to reduce administrative burden,
HFS will combine the states’ current three managed care programs: Integrated Care Program (ICP), Family Health Plans/ACA Adults (FHP/ACA), and Managed Long Term Services and Supports. The state’s dual eligible financial alignment demonstration does not fall under this RFP, but the state reserves the right to include it at a later date.
The RFP includes two major changes to the current program. For the following populations, enrollment in managed care will now be mandatory and also be statewide (increasing the footprint from the current 30 counties to all 101 in Illinois):
o Families and children eligible for Medicaid through Title XIX or Title XXI;
o Affordable Care Act (ACA) expansion adults;
o Medicaid-eligible adults with disabilities who are not eligible for Medicare;
o Medicaid-eligible older adults who are not eligible for Medicare;
o Dual eligible adults receiving institutional or HCBS LTSS aside from those receiving partial benefits, or those enrolled in the Illinois Medicare-Medicaid Alignment Initiative; and
o Special needs children.
There are three service packages that pertain to the RFP. Service Package I includes all Medicaid-eligible services unless excluded in the Model Contract or included in Service Packages II or III. Service Package II includes nursing facility services and services provided under the state’s HCBS waivers, except for waivers designated for individuals with developmental disabilities. Service Package III includes developmental disability waiver services and intermediate care facility providers for developmental disabilities (ICF/DD). Illinois does not intend to include Service Package III under the current RFP, but MCOs should be prepared to implement such services within 180 days if HFS chooses to do so.
The new Medicaid managed care program will encompass five geographic regions.
Region 1 Northwestern counties
Region 2 Central counties
Region 3 Southern counties
Region 4 Cook county
Region 5 Collar counties
Proposals are due by May 15, 2017. HFS hopes to make award announcements on June 30, 2017, with an effective date for the new contracts of January 1, 2018. (Source: RFP 2/27/2017)
HFS has posted an attendee list from the mandatory offeror conference for statewide Medicaid managed care that took place on March 10, 2017. The list of potential bidders included:
|Addus HomeCare||Aetna Better Health of Illinois||Agilon Health||AltaStaff, LLC.|
|Annthem, Inc.||Beacon Health Options||BlueCross BlueShield of Illinois||Canary Telehealth|
|Cigna HealthSpring||Community Care Alliance of Illinois||CountyCare/CCHHS||Engaging Solutions, LLC|
|Family Health Network||Fineline Printing Group||FoCoS Innovations||Harmony/WellCare|
|Humana||Illinicare Health||MCNA insurance Co.||Molina Healthcare|
|Meridian Health PLan||NextLevel Health Partners Inc.||Trusted Health Plan||Unitef Healthcare Community & State|
|United Health Care Community/State Optum||Valence Health/Evolent Health|
(Source: Attendee List 3/21/2017)
State Demonstration to Integreate Care for Dual Eligible Individuals
In April 2012, the state submitted a Medicare-Medicaid Alignment Initiative (MAAI) proposal for a demonstration to provide coordinated care under a capitated model in limited geographic areas to full benefit dual eligibles age 21 and over who are aged, blind, or disabled. Persons with I/DD are carved out, and enrollment is voluntary with an opt out option. (Source: Demonstration Proposal; Illinois Care Coordination website; Illinois Medicare-Medicaid Alignment Initiative website)
Illinois Medicare-Medicaid Alignment Initiative Proposal
In February 2013, the state and CMS signed a Memorandum of Understanding to provide coordinated care to more than 135,000 dual eligibles in the Chicago area and throughout central Illinois under the MMAI demonstration, beginning on October 1, 2013. (Source: Centers for Medicare and Medicaid Services) Opt in enrollment began on April 1, 2014. Passive enrollment began on June 1, 2014. (Source: Illinois HFS website; HMA Weekly Roundup, 5/7/2014)
Memorandum of Understanding
Three-Way Contract for Demonstration
State Duals Demonstration website
Balancing Incentive Program
In June 2012, CMS awarded the state an estimated $90 million in enhanced Medicaid funds (a 2% enhanced FMAP rate) from July 1, 2013 through September 30, 2015. (Source: CMS Balancing Incentive Program website)
BIP Application (3/27/2013)
Structural Change Work Plan (12/18/2013)
In 2013, the state submitted a draft Health Home State Plan Amendment to CMS. However, as of April 2014, the state has not submitted a State Plan Amendment to CMS. (Source: CMS Health Home Proposal Status website, 4/2013) As of June 2014, the state has not officially submitted a Proposed Health Home State Plan Amendment to CMS, but the state plans to participate in the Health Home State Plan Option in FY 2014. (Source: CMS Health Home Proposal Status website, 6/2014; Kaiser Health Home website, 6/2014)
As of February 2015, Illinois Medicaid has submitted to CMS a proposed Health Home State Plan Amendment to implement Health Homes for individuals with two chronic conditions or one chronic condition and at risk for developing another chronic condition. HFS officials expect the Health Homes to be developed and operating by October 2015. (Source: Illinois HFS website)
Illinois Health Home State Plan Amendment Concept Paper (1/9/2015)
Disclaimer: This project was supported, in part by grant number 90BC0018, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.