HFS LogoDHS Logo

11/03/06

Summary:

  • Illinois is implementing a Primary Care Case Management (PCCM) model of health care to address access and quality issues.
  • The PCCM model assures responsive health care delivery that focuses on prevention, health promotion, primary care and coordinated and appropriate health care.
  • Illinois' PCCM program is called Illinois Health Connect.
  • Automated Health Systems (AHS) will administer Illinois Health Connect for Healthcare and Family Services.
  • Illinois Health Connect will be implemented in two phases:  Voluntary Participation and Mandatory Participation.
  • The Voluntary Manged Care program will continue to be operational in Cook, Madison, Perry, Randolph, St. Clair and Washington counties.
  • Your Healthcare Plus is a separate program designed to help customers manage chronic or complex health conditions.

  1. Implementation of Illinois Health Connect
    1. Voluntary Participation
    2. Mandatory Participation
    3. Implementation
      1. Implementation Schedule
  2. Your Healthcare Plus
  3. Contact Information for Customers
    1. Voluntary Participation Questions
    2. Mandatory Participation Questions
    3. Illinois Nurse Helpline
    4. Your Healthcare Plus

This policy memorandum was prepared by Healthcare and Family Services (HFS). HFS administers the Medicaid and All Kids programs. These programs provide medical benefits to families with children and to other persons. This information is to be used by staff of the Central All Kids and HBWD Units and the Illinois Department of Human Services when determining eligibility and authorizing medical benefits.

In July 2006, the State of Illinois implemented a new program called Illinois Health Connect.  This is a statewide Primary Care Case Management (PCCM) Program for most persons covered by an HFS Medical Program. Illinois Health Connect is a model of health care that combines managed care and fee-for-service and addresses cost and quality issues.  Illinois Health Connect incorporates the concept of providing each participant in the program with a "medical home" through a Primary Care Provider (PCP). 

The goals of Illinois Health Connect are to:

  • Improve the quality of health care;
  • Reduce the usage of the emergency room for routine medical care;
  • Improve access to care through the availability of a provider network and expansion of providers; and
  • Provide the most appropriate and cost-effective level of care to reduce inappropriate spending.

In a medical home, the PCPs will provide medically necessary care in a timely manner with a focus on the provision of quality primary and preventive health care services that support continuity of care initiatives and avoid unnecessary emergency room visits and hospitalizations.  This will include coordinating primary and preventive health care services, age appropriate immunizations, health screenings, making referrals to specialists for additional care or tests as needed and promoting better health behaviors.

All customers who have active regular eligibility as shown on MMIS are required to participate in the PCCM program.  Most children in All Kids, parents in FamilyCare, adults with disabilities and elderly participants will be required to participate in Illinois Health Connect.  The following populations are currently excluded from Illinois Health Connect:

  • People who have Medicare;
  • Children under age 21 who get Supplemental Security Income (SSI);
  • Children in foster care and children who get Subsidized Guardianship or Adoption Assistance from the Department of Children and Family Services (DCFS);
  • Children under age 21 who are blind or who have a disability;
  • People who live in nursing facilities;
  • American Indians and Alaska Natives;
  • Individuals with Spenddown;
  • Refugees;
  • People who get Home and Community-Based services like the Community Care Program, the Home Services Program, or community services for persons with developmental disabilities;
  • Individuals enrolled in the following programs with limited benefits:
    • Illinois Healthy Women
    • All Kids Rebate, FamilyCare Rebate
    • Illinois Cares Rx (formerly SeniorCare/Circuit Breaker)
    • Transitional Assistance, age 19 and older
    • Emergency Medical Only
    • Hospice
    • Sexual Assault, Renal and Hemophilia Programs
  • Populations Already Managed:
    • High Level Third Party Liability (TPL)/Private Insurance
    • Program for All-Inclusive Care for the Elderly (PACE) participants
    • Children under age 21 whose care is managed by the Division of Specialized Care for Children (DSCC) of the University of Illinois at Chicago
  • Individuals residing in Community Integrated Living Arrangements (CILAs); and
  • Individuals in Presumptive Eligibility programs.

Implementation of Illinois Health Connect

Illinois Health Connect is being implemented in two phases: Voluntary Participation and Mandatory Participation.

Voluntary Participation

Voluntary enrollment began in July 2006.  During this voluntary phase, customers may voluntarily enroll in Illinois Health Connect through an approved Federally Qualified Health Center (FQHC), Rural Health Center (RHC), or the Cook County Bureau of Health Services (CCBHS) clinics.  Enrollment forms for the voluntary phase are only available through approved sites and are submitted HFS to be processed.  In the voluntary phase of Illinois Health Connect, a customer may disenroll at any time.

When customers voluntarily enroll in Illinois Health Connect, HFS will send the customer a Welcome Letter, CN 06.25 (pdf)/CN 06.25S (pdf)

CN 06.25 notifies customers of their choice of PCP for each family member and provides helpful information about Illinois Health Connect.  This Welcome Letter is only for the voluntary phase in each region (see PCCM Roll-Out by Region Table (pdf)). A separate Welcome Letter will be prepared for the mandatory phase.

Customers who have questions about voluntary participation in Illinois Health Connect should be referred to the HFS Health Benefits Hotline at 1-866-468-7543 (TTY: 1-877-204-1012).  The call is free.

Mandatory Participation

During mandatory enrollment, all customers required to join Illinois Health Connect will be given a choice of a PCP.  Customers enrolled during the voluntary phase will also go through the mandatory enrollment process.  In counties with the Voluntary Managed Care program (Cook, Madison, Perry, Randolph, St. Clair and Washington), customers can choose between Illinois Health Connect or a managed care health plan (Family Health Network or Harmony Health Plan) for their delivery system.  They also get to choose a PCP.

In mandatory enrollment, customers who do not make a choice after 60 days will be assigned to a PCP.  A customer may change their PCP without cause once a month.

In Illinois Health Connect, if a customer cannot reach their PCP after hours or on the weekends, they can call the Illinois Nurse Helpline for help.  A nurse will answer the customers' medical questions and will help the customer decide if they need to go to the Emergency Room.  The Illinois Nurse Helpline phone number is 1-800-571-8094 (TTY: 1-800-571-8419).  The call is free.

Effective December 1, 2006, customers who have questions about mandatory participation in Illinois Health Connect, should be referred to AHS at 1-877-912-1999 (TTY: 1-866-565-8577), or they can go online at www.illinoishealthconnect.com for more information.  The call is free.

Implementation

AHS will contact providers and participants prior to implementation of Illinois Health Connect in the Regions identified below to provide education and information about Illinois Health Connect, to recruit providers as PCPs, and to assist customers in making a selection of a PCP.

AHS will send notices, enrollment packets and program information to customers who must participate in Illinois Health Connect and must select a PCP.  All materials will explain the customers' choices and timeframes for making a choice, and include an enrollment form and information on how to enroll.

Implementation Schedule

The mandatory participation will be implemented by region.

Rollout Date DHS Regions
12/1/06 Cook and Collar Regions
1/1/07 Northwestern Region
3/1/07 Central and Southern Regions

Refer to the PCCM Roll-Out by Region Table(pdf) for the list of counties in each region identified above.  Central offices 180/220, 189, 196, 238, and 250 will be rolled out based on the code entered in Item 53, True County of Residence.

Your Healthcare Plus

Your Healthcare Plus is Illinois' Disease Management Program, administered by McKesson Health Solutions, LLC.  It is a care support program designed to improve the quality of care and life for disabled adults with chronic or complex health issues, children and adults with asthma, and high frequency emergency room (ER) users.  Your Healthcare Plus supports Illinois Health Connect through its emphasis on the importance of selecting and maintaining a medical home.  Illinois Health Connect customers with one or more chronic or complex illness may be eligible to join Your Healthcare Plus.

Your Healthcare Plus is a voluntary program.  If a customer agrees to join, Your Healthcare Plus will work with the customer and their PCP to develop an individual care plan depending on their needs.  To learn more about Your Healthcare Plus, a customer can call the Your Healthcare Plus Helpline at 1-800-973-6792 (TTY: 1-888-317-2697).  The call is free.

Contact Information for Customers

Voluntary Participation Questions

Customers who have questions about voluntary participation in Illinois Health Connect should be referred to the HFS Health Benefits Hotline at 1-866-468-7543 (TTY: 1-877-204-1012).  The call is free.

Mandatory Participation Questions

Effective December 1, 2006, customers who have questions about mandatory participation in Illinois Health Connect should be referred to AHS at 1-877-912-1999 (TTY: 1-866-565-8577).  The call is free.

Illinois Nurse Helpline

If a customer cannot reach their PCP after hours or on the weekends, they can call the Illinois Nurse Helpline for help at 1-800-571-8094 (TTY: 1-800-571-8419).  The call is free.

Your Healthcare Plus

Customers can call Your Healthcare Plus for more information on chronic or complex illnesses or to join Your Healthcare Plus at 1-800-973-6792 (TTY: 1-888-317-2697).  The call is free.

[signed copy on file]

CAROL L. ADAMS, Ph.D.

Secretary, Illinois Department of Human Services

BARRY S. MARAM

Director, Healthcare and Family Services

Forms referenced:

CN 06.25 (pdf)

CN 06.25S (pdf)