Mandatory Managed Care Expansion for Family Health Plan (FHP) and ACA Adults-Metro East Area

Helping Families. Supporting Communities. Empowering Individuals.

Healthcare and Family ServicesDepartment of Human Services

07/16/14

Policy Memo

Summary

Starting June 13, 2014, Healthcare and Family Services (HFS) began mailing mandatory Managed Care expansion enrollment packets to Family Health Plan (FHP) and ACA Adult cases in the Metro East Region.

  • FHP and ACA adults cases, including those currently enrolled in Illinois Health Connect or enrolled with a Voluntary Managed Care Organization (VMCO), will join one of the three mandatory Managed Care Organizations (MCOs) offered in the Metro East Region for their medical services and care coordination services: Harmony Health Plan, Meridian Health Plan and Molina Healthcare.
  • The MCO provides all medically necessary medical services, including dental, and medical transportation and all long term support services whether provided in the community or in a facility.
  • In surrounding counties, Illinois Health Connect will continue to be a plan choice for most individuals enrolled in Medicaid. In some counties, voluntary managed care will also be available.
  • Enrollment is mandatory.
  • Once enrolled, the plan that the individual selects or is assigned to will send the member a welcome packet and member ID card.
  • To enroll, individuals must contact Illinois Client Enrollment Services at 1-877-912-8880 (TTY: 1-866-565-8576) or online at www.EnrollHFS.illinois.gov/.

Starting June 13, 2014, Healthcare and Family Services (HFS) began its expansion of its mandatory Managed Care Program (MCO) into the Metro East Region. This region includes three Counties: Clinton, Madison and St. Clair. This region is the first of five regions that will be expanded to include enrollment into a MCO for medical services and care coordination services. The MCO provides all medically necessary medical services, including dental, and medical transportation and all long term support services whether provided in the community or in a facility.

This expansion includes the following Medicaid populations:

  • Family Health Plan (FHP) cases; and
  • ACA Adult cases.

Enrollment of these populations is mandatory. This means that FHP or ACA cases in the Metro East Region, including those individuals currently enrolled in Illinois Health Connect or a Voluntary Managed Care Organization (VMCO), will now join a mandatory Managed Care Plan (MCO) for their health care services. Illinois Health Connect and the VMCOs will no longer be a plan option for individuals in the Metro East Region.  In surrounding counties, Illinois Health Connect will continue to be a plan choice for most individuals enrolled in the HFS Medical program. In some counties, voluntary managed care will also be available.

Illinois Client Enrollment Services (CES) has begun mailing initial enrollment packets (see Initial Enrollment Letter Sample (pdf)) to the FHP and ACA cases that will be required to join a mandatory MCO in this region. Individuals will have a 60 day voluntary enrollment period to pick an MCO and Primary Care Provider (PCP) in the MCO's network for their care coordination services. The three MCOs that an individual may select are:

  • Harmony Health Plan
  • Meridian Health Plan
  • Molina Healthcare

If an individual does not select a MCO and PCP within the first 30 days of their voluntary enrollment period, CES will mail a second enrollment packet (see Second Enrollment Letter Sample (pdf)) to the individual. This packet will identify the MCO and PCP an individual will be assigned to if they do not pick an MCO and PCP by day 60 of their voluntary enrollment period. Once enrolled with an MCO and PCP, the MCO will confirm enrollment by sending their member a welcome packet and member ID card. Members should refer to this packet for more information about their MCO and should call their MCO if they have questions.

Once individuals have selected or have been assigned to an MCO, they may change their MCO once during the initial 90 days of enrollment. After that period, they are locked in, required to remain with the MCO, for one year. At the end of their lock in period, an individual will have the option to change their MCO or stay with their current MCO for the next year.

All enrollments into a MCO must be processed by Illinois Client Enrollment Services. Please refer individuals with questions about their MCO choices, or who are seeking to enroll in an MCO, to the CES Call Center at 1-877-912-8880 (TTY: 1-866-565-8576). An individual may also get more information about their plan choices or enroll on-line at www.EnrollHFS.illinois.gov/.

[Signed]

Michelle R. B. Saddler, Secretary

Illinois Department of Human Services

Julie Hamos, Director

Illinois Department of Healthcare and Family Services

Forms Referenced:

Initial Enrollment Letter

Second Enrollment Letter