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ILLINOIS CARE COORDINATION: MMAI ENROLLMENT STRATEGIES August 2014 Illinois Department of Healthcare and Family Services.

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Presentation on theme: "ILLINOIS CARE COORDINATION: MMAI ENROLLMENT STRATEGIES August 2014 Illinois Department of Healthcare and Family Services."— Presentation transcript:

1 ILLINOIS CARE COORDINATION: MMAI ENROLLMENT STRATEGIES August 2014 Illinois Department of Healthcare and Family Services

2 MMAI  MMAI is a 3 year demonstration program that is currently enrolling clients in two regions of IL:  Greater Chicago – Cook, DuPage, Kane, Kankakee, Lake and Will Counties  Central Illinois – Champaign, Christian, DeWitt, Ford, Knox, Logan, Macon, McLean, Menard, Peoria, Piatt, Sangamon, Stark, Tazewell and Vermilion Counties  There are no plans to expand to any other regions during this demonstration period.  The number of potential enrollees is approximately 148,000 with the highest potential enrollment Greater Chicago- 128,000.

3 MMAI – Who is eligible to enroll?  Medicare Medicaid Alignment Initiative (MMAI) eligibles include:  Medicare Part A  Medicare Part B  Open Medicaid eligibility through the AABD (Aid to the Aged, Blind and Disabled) program.  Exclusions include:  Individuals on Spenddown (met or unmet)  Those with high level TPL or in partial benefit programs  Individuals receiving institutional developmental disability services or Adults with Developmental Disabilities HCBS waiver services

4 MMAI- Enrollment Materials  Clients receive an announcement letter providing basic information about the program.  Clients next receive an initial enrollment packet, which provides the client with a list of health plans to choose from and the name of the plan and PCP to whom the client will be passively enrolled if no voluntary choice is made.  Clients will receive a reminder notice approximately 14 days after receipt of the initial enrollment packet.  Finally, clients will receive a secondary enrollment packet approximately 30 days after receipt of the initial enrollment packet. The secondary enrollment packet provides the same information as the initial enrollment packet.

5 MMAI- Enrollment  How does a client enroll?  Who can answer questions about choices available such as which plan has the clients PCP in network?

6 MMAI- IL Client Enrollment Services (ICES)  ICES (i.e., MAXIMUS, the enrollment broker) is responsible for providing unbiased education to clients about their health plan choices and conducting all enrollments into the MMAI program.  The enrollment broker can assist clients in searching available health plans to determine which plan or plans their PCP participates in.  Web enrollments are not permitted for the MMAI program. Clients and their families or individuals assisting them should call to enroll: o (TTY: )

7 Voluntary vs. Passive Enrollment  MMAI is a voluntary program with passive enrollment.  The client can voluntarily select a health plan. Enrollment is prospective and will begin on a future date.  The client can choose to keep all benefits the same by opting – out of MMAI.  If a client does not make an active choice by either selecting a plan or opting out of the program, a choice is made for them.  The choice or assignment made is based on all sorts of data including current PCP, claims history, and geography.

8 MMAI- Disenrollment  Disenrollments are effective the first day of the month following request  Individuals can disenroll thru ICES or through Medicare  Those receiving LTSS and who disenroll from MMAI will be required to enroll in the MLTSS program.

9 MMAI- Community Members  Mailings and enrollments for clients living in the community began earlier this year.  Can enroll at any time. If a voluntary choice is not made within the timeframe provided in the initial enrollment packet, the client will be passively enrolled with the “best fit” health plan and PCP.  Can change MMAI plans at any time. Enrollment in new plan will be effective on a future date.  Can opt out at any time. Client will be disenrolled from the MMAI plan on the first day of the following month.  Clients who are already enrolled in a Medicare Advantage or DSNP plan should not be passively enrolled out of their current plan. However, if a client is enrolled in an MA plan operated by a parent company that also offers an MMAI plan, the client will be moved to the coordinating MMAI plan unless a different, voluntary choice is made.

10 MMAI- LTSS Members  Mailings to LTSS clients are scheduled to begin later this month  If a voluntary choice is not made within the timeframe provided in the initial enrollment packet, the client will be passively enrolled with the “best fit” MMAI plan and PCP.  Clients may opt out of the demonstration portion of the MMAI program at any time but LTSS clients are required to be enrolled in an MLTSS plan.  Client will have 90 days from the effective date of the enrollment to switch to a different MLTSS plan.  After 90 days, client will be locked in to their MLTSS plan for 12 months.  Clients may switch to a new MLTSS plan during their annual open enrollment period.

11 MMAI- Roles in the Enrollment Process  The Client Enrollment Broker (CEB), Maximus, mails enrollment materials to potential enrollees, provides unbiased information, as well as enrollment and disenrollment of clients.  HFS IL Health Benefits Hotline helps people enrolled in Medicaid with service or billing problems. They can help members with enrollment issues, and with health plan complaints.  Medicare helps clients resolve enrollment issues, and can disenroll clients from MMAI.  SHIP counselors can help clients understand your plan choices, answer questions about changing to a new plan  Advocates such as the Ombudsman, can help clients each step of the way.

12 MMAI- Resources  The member handbook is a valuable resource including these chapters in particular:  Chapter 2 – important contact numbers for members  Chapter 4 – covered services  Chapter 9 – grievances and appeals  HFS IL Health Benefits Hotline : (TTY )  Medicare: MEDICARE ( ), (TTY )  SHIP: (TTY )


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