Illinois MMAI and MLTSS Updates for 2018
The Department of Health and Family Services (“HFS”) has reduced the provider burden of credentialing with health plans. Providers must enroll and be accepted into IMPACT, the HFS provider enrollment system. Then no additional credentialing should be required.
MMAI will continue to operate in select counties only in Illinois:
- Greater Chicago Region: Cook, DuPage, Kane, Kankakee, Lake, and Will Counties.
- Central Illinois Region: Champaign, DeWitt, Ford, Knox, McLean, Peoria, Stark, Tazewell, and Vermilion Counties.
In 2018, the following health plans will participate in MMAI:
- Greater Chicago Region:
- Aetna Better Health.
- Blue Cross Blue Shield of Illinois.
- Humana Health Plan.
- IlliniCare Health Plan.
- Meridian Health.
- Central Illinois Region:
- Molina Healthcare of Illinois.
Cigna-HealthSpring will leave the MMAI program as of December 31, 2017.
MLTSS is becoming part of HealthChoice Illinois in 2018. It will be active in all Illinois counties, managing the care for dual-eligible beneficiaries. The following criteria must be met for an individual to qualify:
- Have full Medicare and Medicaid benefits;
- Are not enrolled in the Medicare-Medicaid Alignment Initiative (MMAI) program; and
- Reside in a nursing facility or are in the following Home and Community-based Services (HCBS) waivers: Supportive Living Facilities, Persons with Disabilities, Persons with HIV or AIDS, Persons with Brain Injury, and Persons who are Elderly.
Medicare will be the primary payer for dual eligible beneficiaries. Medicaid will be the payer in situations where Medicare does not pay or benefits are exhausted.
The following health plans will offer MLTSS benefits through HealthChoice Illinois in 2018:
- Blue Cross Blue Shield of Illinois.
- CountyCare (available only in Cook County).
- Harmony Health Plan.
- IlliniCare Health Plan.
- Meridian Health.
- Molina Healthcare of Illinois.
- NextLevel Health (available only in Cook County).
Aetna Better Health will be discontinuing MLTSS services beginning January 1, 2018.
The State will be working with the health plans to transition beneficiaries into new plans (as appropriate and/or needed). General information on the programs as well as specific information about the transition plan can be found in several provider notices issued by HFS.
Additional information about all the health plans is available from the Illinois Association of Medicaid Health Plans at http://iamhp.net/.
If you have any questions, please contact your Marcum advisor at 847-282-6300.
