Background
Illinois operates under a Medicaid Managed Care (MMC) system, where the state partners with health insurance companies and Medicaid Managed Care Organizations (MCOs) to deliver health care coverage to Medicaid enrollees. MMC Procurement is a process where the state evaluates which MCOs will be contracted to operate in their state. The Centers for Medicare and Medicaid Services (CMS) reviews these contracts to ensure they comply with federal requirements. Still, once approved, the state has full authority over how it manages its contracts with MCOs.
The Illinois Department of Healthcare and Family Services (HFS) has extended its contracts with MCOs in the HealthChoice Illinois (HCI) program for an additional year, allowing new leadership to transition. Elizabeth Whitehorn, who became HFS Director in January, informed Medicaid Advisory Committee members that delaying the procurement process by a year would provide the "necessary time to ensure the process is structured to support health care transformation."
Timeline
The design work for the Request For Proposal (RFP) is set to begin around November 15, 2024, with the RFP slated for release in Summer 2025. The new HealthChoice Illinois (HCI) contract will take effect on January 1, 2027.
The process has historically involved the state preparing to release a proposal, MCOs submitting applications, the state selecting contract awardees, and allowing time for MCOs to prepare for implementing coverage. This entire cycle averages 18-24 months to complete. Once the state contract expires, the procurement process starts again, and MCOs that want to continue providing services must submit new applications.
HFS Listening Sessions
HFS will host a series of listening sessions before the managed care procurement process. The agency shared that they will prioritize input from advocates, providers, and associations regarding the current state of HealthChoice Illinois and will seek their advice on ways to enhance services moving forward. HFS plans to guide the feedback discussions with questions such as:
“What works well for you?”
“Where do you see opportunities to improve?”
“How else can we meet your needs?”
Five listening sessions are scheduled, including in-person events on September 12 in Chicago and September 17 in Springfield. The others will be virtual discussions held during the Medicaid Advisory Committee meetings.
2024 Timeline | Meeting Modality | Audience | Registration Details |
August 21 | Virtual10:00 - 12:00Closed Captioning Available | Discussion: Pub Ed Subcommittee of the MAC | |
September 12 | In-Person1:00 - 4:00ADA Accessible | Town HallChicago Location: College of Pharmacy833 S Wood St Room B32Chicago, IL 60612 | |
September 17 | In-Person1:00-4:00ADA Accessible | Town HallSpringfield Location:Illinois Department of Agriculture801 E Sangamon AveJohn Block BuildingIllinois State FairgroundsGate 11 | |
September 24 | Virtual10:00 - 12:00Closed Captioning Available | Discussion: Health Equity and Quality Care Subcommittee of the MAC | |
October 3 | Virtual6:00 - 8:00 pmClosed Captioning Available | Discussion: MAC Special Meeting | |
November 1 | Virtual10:00 - 12:00Closed Captioning Available | MAC |
MMAI to D-SNP
Also, it is essential to note that the CMS notified the state that it will not extend the Medicare-Medicaid Alignment Initiative (MMAI) demonstration program past 2025. Illinois is set to shift from the MMAI to a Dual Eligible Special Needs Plan (D-SNP) in 2026. This will affect Illinois residents enrolled in Medicare and Medicaid, including those with long-term services and support. This group of Medicare-Medicaid enrollees are known as dual-eligible individuals. Roughly half of the dual-eligible population are people of color, and 40% are under the age of 65. A shared trait of this population is their limited financial resources, and more complex health care needs compared to the average Medicaid enrollee.
MMAI: Combines a member’s health care and prescription benefits under a single set of benefits to provide a more streamlined health care experience. The program combines medical care with community-based services into a single comprehensive plan. Services under the program include, but are not limited to, hospital care, prescription coverage, behavioral health, and personal care assistance.
D-SNP: Continues to separate Medicaid and Medicare benefits while providing care coordination to help merge and organize benefits for enrollees between the two plans. There are multiple levels of D-SNP, including Highly Integrated Dual Eligible (HIDE-SNP) and Fully Integrated Dual Eligible (FIDE-SNP), which increase the level of integration between Medicare and Medicaid benefits.
Sources
Last updated 9.16.2024
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