December 12, 2016

Temporary Suspension of the Integrated Care Program in Central Illinois

Temporary Suspension of the Integrated Care Program in Central Illinois

In May of 2011, the State of Illinois launched its first mandatory Medicaid only care coordination initiative for seniors and persons with disabilities known as the Integrated Care Program (ICP). This program currently operates in selected regions of the state and is composed of several risk-based health maintenance organizations known as Medicaid managed care organizations (MCOs). These organizations are required to be licensed through the state to provide medically necessary services for their Medicaid enrollees.

Coordination Expansion Map
For a list of regions and health plans, you may view the care coordination expansion map.

On October 27, 2016, the Illinois Department of Healthcare and Family Services (HFS) announced that Health Alliance Connect will no longer be operating as a MCO in Illinois. Individuals with Health Alliance benefits have received letters from the Illinois enrollment broker (Maximus) explaining the change in their benefits and options for re-enrolling with another MCO for all participating regions except for central Illinois which includes; Champaign, Christian, DeWitt, Ford, Logan, Macon, McLean, Menard, Piatt, Sangamon and Vermilion. Individuals residing in these counties will transition back to fee-for-service since there is only one other participating MCO in this region. As part of ICP requirements, enrollees must be able to choose from at least two health plans in their participating region. Until further notice of another participating health plan, ICP will be on a temporary suspension in central Illinois. Any newly qualified individuals in this region will be straight fee-for-service Medicaid.

We encourage providers in the Rockford and Quad Cities region to diligently re-verify benefits for previous Health Alliance members to ensure that you are billing the appropriate health plan.

For residents who transferred to another health plan that is not in your network, the facility will still be able to treat that individual for up to 90 days for continuity of care purposes. If the facility wishes to treat that resident beyond the continuity of care timeframe, then the facility should request a single case agreement with that health plan in order to continue treating the individual on an out of network basis.

HFS Provider Notices

View HFS Provider Notice PRN161207A.

View HFS Provider Notice PRN161027A.

If you need assistance or have questions regarding the Illinois Medicaid managed care programs, please contact your Marcum LLP advisor at 847-282-6300.


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