A Managed Care Organization (MCO) is a health care provider that delivers integrated and quality managed care (covered services) to enrollees and receives a set monthly fee (capitation payment) per enrollee per month. A 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 a MCO is mandatory for most persons who receive Medicaid assistance, such as TANF or FamilyCare Assist.
Persons who are an American Indian or Alaska Native are not required to participate in a MCO, but may voluntarily enroll with a MCO. Persons who are multiracial including American Indian or Alaska Native are not selected to participate in a MCO, but may voluntarily enroll with a MCO. Accept the person's statement regarding their race.
A customer is not allowed to enroll in a MCO if they meet one or more of the following criteria:
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