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Illinois' Managed Care Programs

 

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Illinois’ Managed Care Programs
 

Welcome to the Managed Care section of the Illinois Department of Healthcare and Family Services (HFS) website.  

In 2018, HealthCare and Family Services expanded their managed care program to cover all counties in Illinois.  This program is a member-focused program called HealthChoice Illinois. 

Special Needs for Children - Latest News

Special Needs Children in HealthChoice Illinois – Enrollment begins effective November 1, 2019
 
Beginning in mid-September, families of Special Needs Children will begin receiving enrollment packets from Illinois Client Enrollment Services to enroll in a HealthChoice Illinois plan.  Special Needs Children include:
 
·         children receiving Supplemental Security Income (SSI),
 
·         children enrolled in the Division of Specialized Care for Children (DSCC) CORE program
 
·         children with a physical disability category
 
These children have historically been excluded from managed care, but they and their families will now be able to receive the care coordination and other benefits provided by the Department’s HealthChoice Illinois managed care plans. 
 
Please make sure you read the enrollment letter and the health plan information that is sent in the enrollment packet carefully.  It is better if you choose a health plan for your child because you know your child’s healthcare needs best. 
 
 
Please note that children in the Medically Fragile/Technology Dependent (MFTD) waiver and children enrolled in the Nursing Personal Care Services program remain excluded from managed care enrollment and should not receive an enrollment packet.
  
Frequently Asked Questions
 
1.       What population of Special Needs Children will participate in Managed Care?
Children under the age of 21
·         with a physical disability category, or
·         enrolled in the Division of Specialized Care for Children (DSCC) CORE program, or
·         receiving Supplemental Security Income (SSI)
 
2.       Will these Special Needs Children be required to participate in Managed Care?
Yes, there is no opt out.
 
3.       Will Medically Fragile Technology Dependent (MFTD) waiver members and Nursing and Personal Care Services Program (NPCS) continue to be excluded from Managed Care?
Yes, children who are enrolled in MFTD and who receive NPCS will continue to be excluded from managed care.
 
4.       How are children on a Developmental Disability (DD) waiver or residing in a DD facility impacted by the Special Needs Children enrollment?
Service Package III is not part of the current changes.  DHS will continue to coordinate waiver services for children enrolled in the DD waiver.
 
5.       How will the enrollment process work for Special Needs Children?
HFS will mail an enrollment packet in mid-September.  The letter will allow members to choose from a list of health plans that are available.  If they do not choose a health plan by the deadline, one will be chosen for them.  Members have an additional 90 days after 11/01/19 to make a one-time switch.  After 90 days have passed, the member will be locked in to their health plan for a year.
 
6.       What services will the Special Needs Children be receiving from the managed care health plans?
Special Needs Children will receive all the Medicaid covered services and medical care coordination from the health plan. 
 
 

What is Managed Care?

Managed care is a kind of health insurance program.   When you enroll in managed care, you become a member of a Health Plan.  You will have at least 4 Health Plans to choose from depending on where you live.  The Health Plan you choose will offer you a full range of services while helping you coordinate your health care.

What is Care Coordination and why is it important?

Serving members through care coordination is an effective way to provide health care services to you.   Included here are some of the ways care coordination through your Health Plan can help you:  

-        Find a primary care provider (PCP) who will get to know you and your health care needs

-        Help you manage your health care conditions like diabetes, high blood pressure or asthma

-        Give you information you need to stay healthy

-        Help you identify your health goals and create a care plan to achieve those goals

 

What can a Care Coordinator help me do?

Some individuals get a care coordinator to help you reach your goals.  A care coordinator can:

-        Answer questions about your care

-        Help you find a doctor or specialist

-        Help you transition out of a hospital or facility

-        Help connect you with community resources

 

This site will include information on the two Medicaid Managed Care programs offered in Illinois, how to enroll, and who to contact if you have questions about your Health Plan.