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Welcome to HealthChoice Illinois: Medicaid managed care
Beginning January 1st, 2018, Illinois transitioned their managed care program into a more streamlined, accountable, and integrated program.  The goal of the member-centric HealthChoice Illinois Program is to provide enhanced quality and improved outcomes, all while managing cost.  Statewide, providers have an opportunity to contract with each of the 4 (6 in Cook County) qualified, experienced, and financially sound managed care plans that have been chosen to provide services.  
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
·       Managed care provides services for clients statewide, reaching approximately 80% of Medicaid enrollees
·        Uniform credentialing process makes it easy for providers to enroll.  There do not need to credential separately through each plan individually.  Providers only need to credential once through IMPACT.    
       For more on these and other benefits, see the “Succeeding with the new Managed Care Program” notices
       Strategies to help clients transition to HealthChoice Illinois are also included.
What are the goals of HFS’s HealthChoice Illinois program?
·        Streamline managed care programs and reduce confusion for enrollees and providers by offering the information needed to make smart health care choices
·        Increase integration of behavioral and physical health
·        Provide a health plan and primary care provider (PCP) for every client
·        Offer Care Coordination to help clients with complex needs navigate the health care system
·        Align State and MCO objectives to enhance quality and improve outcomes     
How and why should a provider participate in HealthChoice Illinois?
       Contracting with health plans allows providers to continue serving existing patients throughout the transition and beyond.    To contract with a health plan, providers should contact the plan directly to speak about qualifications or contractual agreements.  HFS built HealthChoice Illinois after listening to the concerns and suggestions of providers like you. Smarter and more efficient than ever, we think you’ll discover the new program significantly reduces administrative requirements -- so you can focus on client care.
What are additional resources I can use to understand and navigate my way through the many aspects of HealthChoice Illinois?
In addition to the links at the right, more resources can be found on the provider page of the Illinois Association of Medicaid Health Plans (IAMHP) at http://www.iamhp.net/providers.
WellCare Health Plans, the company that owns Harmony Health Plan of Illinois, has purchased Meridian Health Plan of Illinois
Is Harmony Health Plan still an option for Illinois Medicaid members in HealthChoice Illinois?
As of January 1, 2019 Harmony Health Plan merged with Meridian Health Plan of Illinois.  After January 1st, Harmony will no longer provide services to members.
 
What will happen to members who were enrolled in Harmony Health Plan? 
Unless members change to a different health plan, Meridian will provide services beginning January 1, 2019.  To stay in Meridian, members do not have to do anything at all.
 
Will members be able to keep their primary care provider (PCP)?
Meridian will make every effort to keep members with the same Primary Care Provider (PCP). If a member wants to change their PCP, they may do so at any time by calling Meridian Member Services at 1-866-606-3700 (TTY: 711) after December 31, 2018
 
What plan will providers call for billing inquiries?
Billing inquiries for dates of service before January 1, 2019, provider should contact Harmony Health Plan 1-800-608-8158
Billing inquiries for dates of service after January 1, 2018, providers should contact Meridian, a WellCare Company 1-866-606-3700
 
 

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