PM 20-24-02: Leaving a MCO

WAG 20-24-02.

  • New Text.Customers may not opt out of or disenroll from the HealthChoice Illinois or YouthCare plan to return to regular Medicaid (fee-for-service). Currently, all but one HealthChoice Illinois plan (CountyCare) provides services across the entire state of Illinois. CountyCare serves only Cook County. A CountyCare member who moves out of Cook County should contact the Family Community Resource Center (FCRC) to change their address and county of residence, so they are disenrolled from CountyCare and given the opportunity to choose another HealthChoice Illinois plan. If there is a gap between managed care enrollments, the customer is in regular Medicaid and can see any Medicaid provider accepting fee-for-service patients. Customers may also change their addresses in ABE Manage My Case or on the HFS Website.
  • HealthChoice Illinois enrollees are given an opportunity one time per year during their Open Enrollment period to switch to a different HealthChoice Illinois plan. Open Enrollment periods vary depending upon the effective date of a customer's plan. Approximately 75 days prior to the customer's effective plan enrollment date, the customer will receive an Open Enrollment letter from Illinois Client Enrollment Services (ICES) detailing their health plan choices and the date by which any health plan change must be made. Any plan change will become effective on the customer's plan enrollment date. The Open Enrollment letter is mailed to the customer's address, if the customer wants to remain in the same MCO, they do not have to take any action.
  • Dual eligible customers enrolled in the Medicare-Medicaid Alignment Initiative (MMAI) program may opt out of or switch MMAI plans at any time. Dual eligible customers who opt out of the MMAI program and are receiving waiver services or long-term care services must enroll with an HealthChoice Illinois Managed Long Term Services and Supports (MLTSS) health plan for their MLTSS services only. Once opted out, MMAI eligible customers may also choose to re-enroll in the MMAI program at any time by contacting (CES) 1-877-912-8880 (TTY: 866-565-8576). ICES is open Monday through Friday from 8:00 am to 6:00 pm. New Text.