Date: May 14, 2019
To: All Medical Assistance Program Providers
Re: ALERT: Statewide HealthChoice Illinois Managed Long Term Services and Supports Implementation – Coverage Effective July 1, 2019
Effective July 1, 2019, the Managed Long Term Services and Supports (MLTSS) program will be part of HealthChoice Illinois statewide. This means in every Illinois county, HealthChoice Illinois health plans will begin managing dual eligible beneficiaries who:
· Have full Medicare (both Part A and Part B) and Medicaid benefits (“full dual eligible beneficiaries”);
· 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 Program, Persons with Disabilities, Persons with HIV or AIDS, Persons with Brain Injury, and Persons who are Elderly.
The Department strongly encourages nursing facilities and Home and Community Based Services (HCBS) waiver providers to sign contracts with HealthChoice Illinois health plans as soon as possible in order to participate in the statewide HealthChoice Illinois MLTSS program. Contracting is also important for timely payment and continuity of care.
Contracting with Participating HealthChoice Illinois Plans
Contact information for participating health plans is provided in Attachment A.
The following health plans offer MLTSS benefits through HealthChoice Illinois:
· Blue Cross Blue Shield of Illinois
· CountyCare (available only in Cook County)
· IlliniCare Health Plan
· Meridian Health
· Molina Healthcare of Illinois
· NextLevel Health (available only in Cook County)
Eligibility, Enrollment, and Billing
Medicare will continue to be the primary payer for full dual eligible beneficiaries receiving MLTSS services through HealthChoice Illinois. Providers serving HealthChoice Illinois MLTSS enrollees will bill the HealthChoice Illinois health plan, Medicare, or Medicaid Fee-for-Service depending on the service being provided. Providers should review the May 14, 2019 MEDI/MLTSS Identifying Dual Eligible Beneficiaries provider notice for instructions on how to identify HealthChoice Illinois MLTSS members in MEDI, and what entity to bill depending on the service being provided.
Enrollment packets will be mailed statewide as early as the week of May 13, 2019 with July 1, 2019 coverage effective dates to full dual eligible beneficiaries who are eligible to enroll in HealthChoice Illinois MLTSS, and not currently enrolled in Medicaid managed care. Beneficiaries will have a 30-day enrollment choice period. Their enrollment packet will note the HealthChoice Illinois plan in which they will be auto-assigned if they do not make a choice. Enrollees also will have 90 days after the enrollment effective date to switch HealthChoice Illinois plans, and have an annual open enrollment period.
All HealthChoice Illinois MLTSS enrollees who live in a county with a Medicare-Medicaid Alignment Initiative (MMAI) health plan may choose to enroll in MMAI, switch MMAI health plans if another choice is available, or opt-out of MMAI at any time. The MMAI program brings together Medicare, Medicaid and prescription drug benefits into one health plan.
Questions regarding this notice may be directed to the Department’s Bureau of Managed Care at