All Kids, Moms & Babies and FamilyCare clients living in certain counties can enroll in Illinois Health Connect or a Managed Care Organization (MCO). An MCO is an HMO or HMO-like health plan that has its own network of doctors and hospitals. Clients that enroll in an MCO get all of their services from the doctors and hospitals that are in the MCO network unless they get approval from the MCO.

The MCOs are required to have an ongoing quality assessment and performance improvement program that consists of monthly and quarterly face-to-face meetings, adoption and monitoring of MCOs' results using industry standards such as HEDIS measures and benchmarks, contract compliance, and performance improvement projects. Additionally, HFS contracts with an external quality review organization (EQRO) to provide the following services: oversight and monitoring of quality assurance components of the MCO contract; identifying areas needing improvement with the MCOs; technical assistance to HFS and the MCOs; identifying best practice findings; and improving healthcare outcomes of MCO enrollees. The EQRO also provides the Illinois External Quality Review Technical Report, which focuses on contract compliance, and validation of performance measures and performance improvement projects. To review this report please see the External Quality Review Technical Report. For a comparison of MCOs' HEDIS rates please see the Illinois HEDIS Medicaid Rates Chart.

Clients can get their healthcare, and may get extra benefits, by enrolling in a Managed Care Organization. The MCOs that participate are:

 

 

  • Harmony Health Plan - Harmony Health Plan is a Managed Care Organization that is an HMO and has been in Illinois for over 14 years. Harmony now has over 145,000 members, a network of 55 hospitals, more than 895 primary care doctors, and over 4,300 specialists. It is the largest Medicaid HMO plan in the state and serves Cook, Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington and Williamson counties.
  • Family Health Network – Family Health Network is the only not-for-profit Managed Care Organization (like an HMO) in Illinois sponsored by community hospitals. Family Health Network has served Illinois for over 14 years. Family Health Network has network of 37 hospitals, more than 800 primary care doctors, over 2,150 specialists, and more than 300 behavioral health professionals. Family Health Network serves Cook County.
  • Meridian Health Plan – Meridian Health Plan is a Managed Care Organization that is an HMO and has over 15 years of experience working with families. Meridian Health Plan has a network of 47 hospitals, more than 800 primary care doctors, and over 2,500 specialists. Meridian Health Plan serves Adams, Brown, Cook, DeKalb, Henderson, Henry, Knox, Lee, Livingston, McHenry, McLean, Mercer, Peoria, Pike, Rock Island, Scott, Tazewell, Warren, Winnebago and Woodford counties.

 

The counties with a Managed Care Organization as an option include Adams, Brown, Cook, DeKalb, Henderson, Henry, Jackson, Kane, Knox, Lee, Livingston, Madison, McHenry, McLean, Mercer, Peoria, Perry, Pike, Randolph, Rock Island, St. Clair, Scott, Tazewell, Warren, Washington, Williamson, Winnebago and Woodford. Not all MCOs are available in all of these counties.

In the counties that offer both delivery systems (MCO and PCCM), Illinois Client Enrollment Service (ICES), contracted by HFS, conducts all client enrollment and education activities, including mailing choice education and enrollment materials and assisting with the selection of a health plan and Primary Care Physician (PCP) in an unbiased manner.

For more information on these health plan options, visit the Illinois Client Enrollment Services Web site at or call the Illinois Client Enrollment Broker Helpline at:

Illinois Client Enrollment Broker
1-877-912-8880
TTY: 1-866-565-8576
The call is free.

 

Managed Care Organizations for Cook County

Family Health Network
322 South Green Street, Suite 400
Chicago, Illinois 60607
Telephone: 312-491-1956
Fax: 312-491-1175
Member Services: 1-888-346-4968

Harmony Health Plan
200 West Adams Street
Chicago, Illinois 60606
Telephone: 312-630-2025
Fax: 312-368-1784
Member Services: 1-800-608-8158

Meridian Health Plan
222 North LaSalle, Suite 930
Chicago, IL 60601
Fax: 312-705-2900
Member Services: 1-866-606-3700

Managed Care Organization for Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington and Williamson Counties

Harmony Health Plan
23 Public Square, Suite 340
Belleville, Illinois 62220
Telephone: 618-236-8050
Fax: 618-233-3621
Member Services: 1-800-608-8158

 

Managed Care Organization for Adams, Brown, Dekalb, Henderson, Henry, Knox, Lee, Livingston, McHenry, McLean, Mercer, Peoria, Pike, Rock Island, Scott, Tazewell, Warren, Winnebago and Woodford counties.

Meridian Health Plan
222 North LaSalle, Suite 930
Chicago, IL 60601
Telephone: 312-705-2900
Fax: 312-980-0404
Member Services: 1-866-606-3700