Mandatory Managed Care Expansion for Family Health Plan (FHP) and ACA Adults-Central Illinois and Quad Cities Area

09/18/14

Policy Memo

Summary

• Healthcare and Family Services is mailing mandatory Managed Care enrollment packets to Family Health Plan (FHP) and ACA Adult cases in the Central Illinois and the Quad Cities Regions.
• FHP and ACA adults cases, including those currently enrolled in Illinois Health Connect or enrolled with a Voluntary Managed Care Organization (VMCO), must enroll in a Managed Care Organization (MCO) or an Accountable Care Entity (ACE) offered in the Central Illinois or Quad Cities Regions for their care coordination.
• Choices of health plans depends on the county where the individuals live.  See available options below. 
• Rural counties will continue to include Illinois Health Connect as a plan choice for most individuals enrolled in Medicaid. In some counties, voluntary managed care and the ACE Illinois Partnership for Health will also be available.
• Enrollment in a health plan is mandatory in the mandatory regions.
• Individuals who select an MCO will receive all of their health services from the MCO and have a Primary Care Provider (PCP) in the MCO's network.
• Individuals who select an ACE will continue receiving health services in the fee-for-service system as they do now, but they will also receive care coordination services from the ACE.
• Individuals who select an ACE receive coordinated health care services from a team of doctors, hospitals, health clinics and community providers.
• Once enrolled, the plan that the individual selects or is assigned to, will send their member a welcome packet.
• 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/.
• The mail out schedule for this program is available at http://www2.illinois.gov/hfs/SiteCollectionDocuments/CC__mailsched.pdf

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Managed care enrollment has expanded to the Central Illinois and the Quad Cities Regions for persons who receive medical benefits under Family Health Plans (FHP) and ACA Adult.  Enrollment of these populations is mandatory. Individuals currently enrolled in Illinois Health Connect or in a Voluntary Managed Care Organization (VMCO) must choose a mandatory health plan for their health care services. Illinois Health Connect and the VMCOs will no longer be a plan option for individuals who live in Central Illinois and Quad Cities Regions.  In rural counties, Illinois Health Connect will continue to be a plan choice for most individuals enrolled in the HFS Medical program. 

Illinois Client Enrollment Services (CES) are mailing initial enrollment packets (see Initial Enrollment Letter Sample (pdf)) to the FHP and ACA cases that are required to join a mandatory health plan. Individuals have a 60-day voluntary enrollment period to choose a health plan.

If an individual does not select a health plan 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 health plan an individual will be assigned to if they do not pick by day 60 of their voluntary enrollment period. Once enrolled with a health plan, the health plan will confirm enrollment by sending their member a welcome packet.  Members should refer to this information for more information about their health plan and should call their health plan if they have questions.

Central Illinois Region (15 counties)

Quad Cities Region (3 counties):

Plan Choices

Central Illinois Region customers may choose one of the following health plans: 

• Health Alliance
• Molina Healthcare
• Meridian Health Plan (Meridian is an option in these five Central Illinois counties: Knox, Stark, Peoria, Tazewell, McLean)
• Illinois Partnership for Health (ACE)
• Advocate Accountable (ACE) is an option in McLean County
• SmartPlan Choice (ACE) is an option in Ford, Champaign, and Vermilion Counties

Quad City Region customers may choose one of the following plans:

• Meridian Health Plan
• IlliniCare Health Plan
• Illinois Partnership for Health (ACE)

Individuals who select an MCO will receive all of their health services from the MCO and have a Primary Care Provider (PCP) in the MCO's network.  Individuals who select an ACE will continue receiving health services in the fee-for-service system as they do now, but they will also receive care coordination services from the ACE.  Individuals who select an ACE receive coordinated health care services from a team of doctors, hospitals, health clinics and community providers.

Rural counties will continue to include Illinois Health Connect as a plan choice for most individuals enrolled in Medicaid. In some counties, voluntary managed care and the ACE Illinois Partnership for Health will also be available.

How to Enroll

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

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

[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