March 14, 2017

Illinois' Medicaid Managed Care Program is Moving Statewide

Contributor Melissa Korey, Supervisor, Advisory Services

Illinois' Medicaid Managed Care Program is Moving Statewide

Recently, the Illinois Department of Healthcare and Family Services (HFS) announced that the State will be transitioning to a statewide mandatory Medicaid managed care program beginning January 1, 2018.

As part of the transition process the State is accepting request for proposals (RFPs) from Medicaid Managed Care Organizations (MCOs) to bid on servicing all 102 counties in Illinois under the Family Health Plans/ACA Adults (FHPs/ACA), the Integrated Care Program (ICP), and the Managed Long Term Service and Supports (MLTSS) program. The State’s goal is to have approximately four MCOs operate in all counties with an additional one or two MCOs assisting in Cook County. MCOs’ Proposals are due to HFS by May 15, 2017, with award announcements to be released by the end of June. Please note, this rebid process will not affect the dual eligible demonstration (MMAI) which is slated to operate through December 31, 2019.

As with the current Medicaid managed care program, providers will be required to contract with the newly awarded MCOs. Providers should be aware that MCOs may not offer traditional Fee-For-Service (FFS) rates. As part of the technical requirements, MCOs’ proposals must include alternative and value-based reimbursement models. We highly encourage providers to begin assessing your quality outcomes and create benchmarking reports to support your facility’s operations. Do not wait until contracts are available to begin assessing your organizations financial needs. If you need assistance with reviewing your facilities outcomes or analyzing your data to determine how your facility would perform under an alternative or value-based purchasing model, contact your Marcum advisor for assistance.

While standardization is the goal for this initiative, little has been released regarding continuity of care and authorization provisions which will be vital once the program becomes effective. In the interim, the State did announce their plans to implement a phase-in enrollment during the first half of 2018. The first 90 days will be spent on transitioning individuals who are already enrolled in a Medicaid managed care program. Immediately following that group, Illinois Client Enrollment Services (ICES) will begin to enroll newly eligible individuals into the program. Letters will be sent to individuals prior to their effective date under the new program to allow them time to choose a new health plan and a primary care physician. Marcum will posted further details on the enrollment transition, including transitioning your residents’ benefits to a new MCO in consideration with continuity of care provisions and applicable authorization requirements as they become available.

If you have questions or need assistance with implementing best practices or reimbursement models under the Illinois Medicaid managed care program, please contact your Marcum LLP advisor at 847-282-6300.

Related Industry