www2.illinois.gov/hfs 11 Illinois Department of Healthcare and Family Services Medicaid Managed Long Term Services and Supports (MLTSS) Implementation April 11, 2016 Robert Mendonsa, Deputy Administrator of Care Coordination

www2.illinois.gov/hfs 2 Medicaid Programs for Dual Eligibles Beginning July 1, 2016, Illinois will have two care coordination programs for individuals with full Medicaid and Medicare benefits: Medicare Medicaid Alignment Initiative (MMAI) ‒ Health plan provides care coordination and covers all Medicaid and Medicare benefits Medicaid Managed Long Term Services and Supports (MLTSS) – New Program ‒ Health plan provides care coordination and covers LTSS, behavioral health, and non-emergency transportation Medicaid benefits

www2.illinois.gov/hfs 3 About MMAI The Medicare Medicaid Alignment Initiative (MMAI) program began in March 2014 in the Greater Chicago and Central Illinois Regions MMAI covers Medicare, Medicaid, and prescription drug benefits under one health plan Most MMAI plans also offer extra benefits like more dental care and lower prescription co-pays

www2.illinois.gov/hfs 4 About MMAI (cont.) MMAI members have a care coordinator and care plan with member-driven goals Care coordinators help MMAI members manage all of their health care, including primary care, mental health care, hospital care, specialty care, long term services and supports, and care from other providers HFS and federal CMS have seen great MMAI successes through care coordination

www2.illinois.gov/hfs 5 MMAI Success Stories When a 57 year old female joined MMAI, she was visiting the ER on a weekly basis, typically following a fall in her home The care coordinator learned that her current apartment was infested with bed bugs and that her husband was abusive The care coordinator and PCP worked with the member to move her to a short-term SLF for rehab for her falls and to keep her safe while exploring living options –A referral also was made to Adult Protective Services –Through her relationship with her care coordinator the member agreed to engage in counseling services The care coordinator also worked with the landlord to take care of the bed bug infestation The member is returning home alone with homemaker services and said she feels optimistic for the first time in a long time

www2.illinois.gov/hfs 6 MMAI Success Stories Prior to engaging in case management through MMAI, Hank was visiting the ER about twice a month Deanna, Hank’s care coordinator, worked with him to utilize his PCP and the plan’s behavioral health crisis line and nurse line Hank reported living with intense pain, so Deanna connected him to a pain specialist and ensured he received the medication he needed When Hank expressed ambivalence about his CMHC providers, Deanna assisted Hank in evaluating this ambivalence and empowering him to change treatment teams if he so chooses Hank has not been in the ER since last June

www2.illinois.gov/hfs 7 About MLTSS Medicaid Managed Long Term Services and Supports (MLTSS) is a “sister program” to MMAI The MLTSS Program is for dual eligible individuals receiving full Medicaid and Medicare benefits who opt-out of MMAI and live in a nursing facility or receive wavier services MLTSS plans will cover long term care, waiver services, some behavioral health services, and transportation to medical appointments MLTSS members will have care coordinators to help manage their health care, including services covered through MLTSS and Medicare

www2.illinois.gov/hfs 8 MLTSS Enrollment Dual eligibiles who opt-out of MMAI and live in a nursing home or receive waiver services will need to choose a MLTSS plan ‒ MLTSS members will receive Medicare benefits from Medicare Advantage, Medicare Part D, and/or Medicare fee-for-service In June 2016, HFS will begin mailing MLTSS enrollment letters in the Greater Chicago Region with an auto-assignment algorithm that considers: ‒ The client’s current Medicare Advantage plan, ‒ The long term care facility the client is currently admitted to, ‒ The client’s most recent prior MLTSS enrollment, ‒ The client’s most recent prior ICP enrollment, and ‒ A random plan selection when an assignment cannot be made based on any of the previous criteria.

www2.illinois.gov/hfs 9 MLTSS Enrollment (cont.) The enrollment letters will include a 60 day choice period and provide the Client Enrollment Services (CES) phone number for help picking a health plan ‒ The letter will include plan comparison charts to help clients compare the extra benefits being offered by each MLTSS plan and information about the client’s option to enroll in MMAI instead After enrollment, MLTSS enrollees will have a 90- day switch period and then will be “locked in” for one year ‒ MLTSS enrollees can opt-in to MMAI at any time ‒ For continuity of care, new enrollees will receive a 180-day transition period and enrollees switching from another health plan will receive a 90-day transition period

www2.illinois.gov/hfs 10 Enrollment Projections Total Greater Chicago MMAI LTSS Opt-Outs as of 4/1/16 (will receive MLTSS enrollment letters beginning June 2016) RegionCounty Nursing Facility Aging Waiver TBI Waiver HIV/ AIDS Waiver Phys. Disabled Waiver SLF Waiver Total (NF + Waivers) Greater ChicagoCook 8,11411, ,0851,175 23,291 Greater ChicagoDuPage ,321 Greater ChicagoKane Greater ChicagoKankakee Greater ChicagoLake ,101 Greater ChicagoWill Total Greater Chicago MMAI LTSS Opt-Outs 10,17112, ,4451,49027,545 Total Greater Chicago MMAI LTSS Enrollees as of 4/1/16 (will not receive MLTSS enrollment letters) RegionCounty Nursing Facility Aging Waiver TBI Waiver HIV/ AIDS Waiver Phys. Disabled Waiver SLF Waiver Total (NF + Waivers) Greater ChicagoCook7,3877, ,0141,63517,397 Greater ChicagoDuPage ,206 Greater ChicagoKane Greater ChicagoKankakee Greater ChicagoLake Greater ChicagoWill Total Greater Chicago MMAI LTSS Enrollees 9,7528, ,3152,04421,664

www2.illinois.gov/hfs 11 Next Steps A provider notice about MLTSS will be released in April Letters to clients will be mailed in June and July ‒ Depending on call volume to CES, the roll out may be slowed with letters mailed in August and September too Please help us spread the word about MLTSS, MMAI, and the benefits of care coordination You also can provide feedback at MAC meetings or via Note: MLTSS will not be implemented in Central Illinois until there are at least two plans participating in MMAI in the Central Illinois Region