Health News
On February 22, the U.S. Department of Health and Human Services announced a Memorandum of Understanding (MOU) with the state of Illinois for a demonstration project that will enroll approximately 136,000 dual eligibles in northeastern and central Illinois into managed care plans. (?Dual eligibles? are individuals who have coverage through both Medicare and Medicaid.) Illinois is the fourth state to receive an MOU for this demonstration, known nationally as the Medicare Medicaid Financial Alignment Initiative (MMAI).
AgeOptions and other organizations that serve older adults have been following the development of this new project, as it will significantly affect the lives of our clients. Here is what we have learned about this new initiative from our research and communications with the entities involved, including the Illinois Department of Healthcare and Family Services and various managed care organizations:
The MMAI project is part of a national effort to better coordinate care for dual eligible beneficiaries. Dual eligibles tend to be sicker and cost more than other Medicare and Medicaid beneficiaries. To address this, as part of the Affordable Care Act, the Centers for Medicare and Medicaid Services created a Medicare-Medicaid Coordination Office (MMCO) to ?make sure Medicare-Medicaid enrollees have full access to seamless, high quality health care and to make the system as cost-effective as possible.? One of the MMCO?s first projects has been working with states to implement initiatives to coordinate care for dual eligibles.
Currently, dual eligibles must navigate and manage multiple systems of coverage in order to access the health care they need (Medicare, Medicare Part D prescription drug plans, and Medicaid). This can be very complex and taxing for individuals who have multiple complex health needs. Therefore, the goals of the MMAI project are to simplify this process and provide higher quality and more coordinated care for dual eligibles.
In January 2014, dual eligibles in the greater Chicago area and parts of Central Illinois will be enrolled into managed care plans. These plans must provide care managers and other supports to coordinate their members? care, in addition to paying for members? medical services and long term services and supports (LTSS). In exchange, these plans will be paid a capitated rate by the state of Illinois and CMS. (?Capitated rate? means the plans will receive a flat rate for each member that they serve, instead of being paid for each individual service that a member receives.) The inclusion of long term services and supports in this project is significant, as these services may be ?new territory? to some managed care organizations. In addition to providing coverage for LTSS provided in long term care facilities, MMAI plans will be responsible for covering home and community based services, such as the Community Care Program. This may cause confusion for dual eligible beneficiaries who are used to receiving Community Care Program services through the existing system, so agencies working with older adults will have to provide education and assistance to help our clients understand these new changes.
Illinois has selected eight managed care plans to provide MMAI coverage. Those eight plans are:
Counties that will be part of the MMAI project:
For more information about the Illinois MMAI project, please see the following resources:
CMS fact sheet
Illinois Memorandum of Understanding
Illinois Department of Healthcare and Family Services webpage on Illinois Care Coordination Initiatives (see section on MMAI)
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Health News
Dual Eligibles Next to Move into Managed Care in Illinois
On February 22, the U.S. Department of Health and Human Services announced a Memorandum of Understanding (MOU) with the state of Illinois for a demonstration project that will enroll approximately 136,000 dual eligibles in northeastern and central Illinois into managed care plans. (?Dual eligibles? are individuals who have coverage through both Medicare and Medicaid.) Illinois is the fourth state to receive an MOU for this demonstration, known nationally as the Medicare Medicaid Financial Alignment Initiative (MMAI).
AgeOptions and other organizations that serve older adults have been following the development of this new project, as it will significantly affect the lives of our clients. Here is what we have learned about this new initiative from our research and communications with the entities involved, including the Illinois Department of Healthcare and Family Services and various managed care organizations:
The MMAI project is part of a national effort to better coordinate care for dual eligible beneficiaries. Dual eligibles tend to be sicker and cost more than other Medicare and Medicaid beneficiaries. To address this, as part of the Affordable Care Act, the Centers for Medicare and Medicaid Services created a Medicare-Medicaid Coordination Office (MMCO) to ?make sure Medicare-Medicaid enrollees have full access to seamless, high quality health care and to make the system as cost-effective as possible.? One of the MMCO?s first projects has been working with states to implement initiatives to coordinate care for dual eligibles.
Currently, dual eligibles must navigate and manage multiple systems of coverage in order to access the health care they need (Medicare, Medicare Part D prescription drug plans, and Medicaid). This can be very complex and taxing for individuals who have multiple complex health needs. Therefore, the goals of the MMAI project are to simplify this process and provide higher quality and more coordinated care for dual eligibles.
In January 2014, dual eligibles in the greater Chicago area and parts of Central Illinois will be enrolled into managed care plans. These plans must provide care managers and other supports to coordinate their members? care, in addition to paying for members? medical services and long term services and supports (LTSS). In exchange, these plans will be paid a capitated rate by the state of Illinois and CMS. (?Capitated rate? means the plans will receive a flat rate for each member that they serve, instead of being paid for each individual service that a member receives.) The inclusion of long term services and supports in this project is significant, as these services may be ?new territory? to some managed care organizations. In addition to providing coverage for LTSS provided in long term care facilities, MMAI plans will be responsible for covering home and community based services, such as the Community Care Program. This may cause confusion for dual eligible beneficiaries who are used to receiving Community Care Program services through the existing system, so agencies working with older adults will have to provide education and assistance to help our clients understand these new changes.
Illinois has selected eight managed care plans to provide MMAI coverage. Those eight plans are:
- Chicago area: Aetna Better Health, Blue Cross/Blue Shield of Illinois, HealthSpring, Humana, IlliniCare (Centene), and Meridian Health Plan of Illinois
- Central Illinois: Molina Healthcare, Health Alliance
Counties that will be part of the MMAI project:
- Greater Chicago area: Cook, DuPage, Lake, Kane, Kankakee, and Will counties
- Central Illinois: Christian, Champaign, DeWitt, Ford, Knox, Logan, Macon, McLean, Menard, Peoria, Piatt, Sangamon, Stark, Tazewell, and Vermilion counties
For more information about the Illinois MMAI project, please see the following resources:
CMS fact sheet
Illinois Memorandum of Understanding
Illinois Department of Healthcare and Family Services webpage on Illinois Care Coordination Initiatives (see section on MMAI)
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UPDATE, Nov.2: a two-year budget was passed by Congress Oct. 29 and awaits the signature of the president. The agreement will reduce the increase in Medicare premiums for Part B, which pays for physicians services, next year to 15...
- What Really Happens After Enrolling In Medicaid Managed Care?
Health & Disability Advocates (HDA) is monitoring the rollout of the Medicare-Medicaid Alignment Initiative (MMAI) and has heard from frustrated case managers working with consumers who are confused about the enrollment process and their rights. In...
- Moving Forward: Current Waivers For Coordinated Care Projects In Illinois
?Care Coordination,? along with related terms like ?managed care? and ?medical home? have become the buzz words of health care reform. The terms refer to new types of health care delivery models that many states and programs are turning to as the key...
- Cutting Illinois Cares Rx Would Be Penny-wise & Pound Foolish
The Chicago Tribune recent editorial, "Time to move on medicaid spending," correctly points out that Illinois must look at its Medicaid spending and implement innovative ways to cut costs while preserving care to its very poor and sick participants. ...
- Older Adults And People With Disabilities In Illinois Are Already Benefiting From Health Care Reform
Older adults and people with disabilities in Illinois are concerned about what they?ve been hearing about changes to the Medicare program and other healthcare reforms that affect them and their families. It is often hard to sort out the facts, so many...