Presentation on theme: "Illinois care coordination: MMAI Enrollment Strategies"— Presentation transcript:
1Illinois care coordination: MMAI Enrollment Strategies Illinois Department of Healthcare and Family ServicesAugust 2014
2MMAIMMAI 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 CountiesCentral Illinois – Champaign, Christian, DeWitt, Ford, Knox, Logan, Macon, McLean, Menard, Peoria, Piatt, Sangamon, Stark, Tazewell and Vermilion CountiesThere 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.
3MMAI – Who is eligible to enroll? Medicare Medicaid Alignment Initiative (MMAI) eligibles include:Medicare Part AMedicare Part BOpen 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 programsIndividuals receiving institutional developmental disability services or Adults with Developmental Disabilities HCBS waiver services
4MMAI- 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.
5MMAI- Enrollment How does a client enroll? Who can answer questions about choices available such as which plan has the clients PCP in network?
6MMAI- 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:(TTY: )
7Voluntary 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.
8MMAI- DisenrollmentDisenrollments are effective the first day of the month following requestIndividuals can disenroll thru ICES or through1-800-MedicareThose receiving LTSS and who disenroll from MMAI will be required to enroll in the MLTSS program.
9MMAI- 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.
10MMAI- LTSS MembersMailings to LTSS clients are scheduled to begin later this monthIf 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.
11MMAI- 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 planAdvocates such as the Ombudsman, can help clients each step of the way.
12MMAI- ResourcesThe member handbook is a valuable resource including these chapters in particular:Chapter 2 – important contact numbers for membersChapter 4 – covered servicesChapter 9 – grievances and appealsHFS IL Health Benefits Hotline : (TTY )Medicare: MEDICARE ( ), (TTY )SHIP: (TTY )