PM 20-24-00: Managed Care Organization (MCO)

WAG 20-24-00

New InformationSee policy memo, Changes in Prescription Drug Coverage for Persons Enrolled in Voluntary Medicaid Managed Care Plans, dated 05/31/2013.

New InformationSee policy memo, Integrated Care Program (ICP), dated 05/06/11 for person enrolled in AABD.

A Managed Care Organization (MCO) is a healthcare provider that provides services for a set monthly fee. An MCO is either a Health Maintenance Organization (HMO) or a Managed Care Community Network (MCCN). HMOs are risk-bearing entities licensed by the Illinois Department of Insurance. MCCNs are risk-bearing provider-sponsored organizations within Illinois, which have been certified by HFS.

Enrollment in an MCO is limited to persons who live in a county where an MCO is available and who receive TANF or FamilyCare Assist revised text

Persons who are American Indian or Alaska Native are not selected to participate in an MCO.  Persons who are multiracial including American Indian or Alaska Native are not selected to participate in an MCO.  Accept the person's statement regarding their race.