1. The Medicare Medicaid Alignment Initiative (MMAI):
A Healthcare Option for People with Medicare and Medicaid in Illinois
[Introduce yourself and say:]
Thank you for attending our presentation today about the Medicare-Medicaid Alignment Initiative, or MMAI. Let’s look at what we will cover today.
Updated June 2018

2. What We Will Discuss Today
What is the Medicare Medicaid Alignment Initiative (MMAI) and what does it cover?
Can I join an MMAI plan and how?
What should I consider before choosing an MMAI plan?
What are my rights in an MMAI plan?
Today, we are talking about the Medicare Medicaid Allignment Initiative or MMAI. MMAI is a healthcare program for people with Medicare and Medicaid in certain parts of Illinois. During our discussion today, we will explain what MMAI is, what services MMAI covers, who is allowed to join an MMAI plan, how you can join an MMAI plan, and what plans you can choose from. We will then walk through some things that you should consider before joining an MMAI plan. Finally, we will share some information about what to do if you want to use a healthcare provider that is not in your MMAI plan’s network or if you have a complaint about your MMAI plan.

3. What is the Medicare Medicaid Alignment Initiative (MMAI)?
Let’s start with “What is MMAI?”

4. What is the Medicare Medicaid Alignment Initiative (MMAI)?
Original Medicare + Medicaid
MMAI
home health
doctor visits
lab tests
skilled nursing
medical equipment
hospital
dental care
prescription
drugs
transportation
Long term care
The Medicare Medicaid Alignment Initiative, or MMAI, is a healthcare program for people with both Medicare and Medicaid. MMAI provides an opportunity to simplify the way that you access your healthcare benefits. Through MMAI, you can get all of your benefits through one health plan, instead of accessing different types of benefits separately through Medicare Part A, Medicare Part B, Medicare Part D, and Medicaid. With MMAI, you can use just one health plan card when you go to the doctor, hospital, or pharmacy, instead of having to use separate cards depending on which ‘piece’ of your coverage you are using.
In MMAI, you can receive all health benefits through one plan and just use one card when you go to the doctor, hospital, or pharmacy.

5. What Services Does MMAI Cover?
MMAI health plans must cover all of the services that Medicare and Medicaid cover, including:
Doctor visits
Mental/behavioral health and substance use services
Hospital stays
Home health
Transportation
Medical equipment
Long term services and supports (LTSS) - services provided in a nursing home, supportive living facility (SLF) or in your home through the Community Care Program or Department of Rehabilitative Services
Lab tests
Ambulance
Skilled nursing care
Prescription drugs
Hearing and vision services
MMAI health plans cover all of the medical care services that Medicare and Medicaid cover, including doctor visits, hospital care, prescription drugs, mental health services and medical
equipment. They also cover nursing facility services and certain services to help people stay in their homes. For example, if you get care through the Community Care Program or the Department of Rehabilitative Services (DRS) and enroll in MMAI, these services will be covered by your MMAI plan.

6. Additional Services MMAI Covers
All MMAI plans offer Care Coordination services to help with:
Navigating the healthcare system and scheduling appointments
Managing chronic health conditions
Finding resources
Requesting coverage for services/prescription drugs that are not typically covered by the plan
In addition to covering all of the services that Medicare and Medicaid cover, all MMAI plans must also offer care coordination services to MMAI plan members. A care coordinator is a staff member trained to help you navigate the healthcare system and meet your health goals. Care coordinators can help with scheduling appointments, finding resources to help you meet your needs, and requesting coverage for a service or prescription drug if the service/drug is not typically covered by the plan.
Care coordination is one of the most important benefits of the MMAI program. Regular Medicare and Medicaid coverage do not offer care coordination services. Because care coordination has been shown to help people manage their health and access the resources they need, it is a free service offered by the MMAI program, to help make your Medicare and Medicaid coverage work together better and make both systems easier to navigate.

7. Additional Services MMAI Covers
Additional Benefits that MMAI plans may cover:
Extra dental, vision, or transportation services
$0 copay for prescription drugs
Over-the-counter (OTC) medications and supplies
Gym memberships or fitness classes
Gift cards for receiving certain preventive healthcare services
In addition to covering medical services, long term services and supports, and care coordination, all of the MMAI plans in Illinois also cover some additional services that Medicare and Medicaid do not typically cover. For example, some plans cover extra dental, vision and transportation services that are not typically covered by Medicaid. Some cover prescription drugs with no copay. Some plans offer coverage for a certain amount of over the counter medications each month. Some plans provide coverage for gym memberships or fitness classes, and some offer gift cards for receiving certain preventive healthcare services.
This is just a sample of the additional benefits an MMAI plan may choose to offer its members, and plans may offer other benefits not listed. Call your plan or call Illinois Client Enrollment Services to see what your plan covers.

8. What Does MMAI Cost?
MMAI plans are not allowed to charge you more than what you would be charged under Medicare or Medicaid
Some MMAI plans offer $0 copays for prescription drugs or other services that would have a copay under traditional Medicare and Medicaid coverage
You may have to follow certain rules in your plan, such as going to in-network doctors and providers
Typically, MMAI plans actually cost less than regular Medicare and Medicaid. This is because MMAI plans may not charge more than Medicare and Medicaid, and most MMAI plans also charge no copays for prescription drugs or other services that would normally have a copay if you have regular Medicare and Medicaid coverage.
However, there are rules that need to be followed, like seeing your plan’s in-network doctors and providers. If you go out of network, you may not be covered by your plan.

9. Can I join an MMAI plan and how?
Now that we know what MMAI is and what it covers, how can people join an MMAI plan?

10. Who Can Join an MMAI Plan?
To enroll in an MMAI health plan, you must:
Have Medicare Part A and Medicare Part B
AND
Have full Medicaid benefits (no spenddown)
Be age 21 or older
Live in one of these counties:
Chicago area: Cook, DuPage, Kane, Kankakee, Lake, Will
Central Illinois: Champaign, DeWitt, Ford, Knox, McLean, Peoria, Stark, Tazewell, Vermilion
To enroll in an MMAI plan, you must be enrolled in Medicare Part A & Part B (or a Medicare Advantage plan) and enrolled in full Medicaid (be on Medicaid without a spenddown). You must also be age 21 and over and live in one of these counties: Cook, DuPage, Kane, Kankakee, Lake, Will, Champaign, DeWitt, Ford, Knox, McLean, Peoria, Stark, Tazewell, or Vermilion.

11. Who Cannot Join an MMAI Plan?
You cannot enroll in MMAI if you have:
Medicaid with a spenddown
Temporary Medicaid benefits
Medicaid benefits through the Breast and Cervical Cancer program or Health Benefits for Workers with Disabilities program
Private “third party” insurance (such as an employer or retiree health plan)
Adults with developmental disabilities (DD) who receive care through Medicaid DD Waiver programs (Home and Community Based Services (HCBS) or Institutional) are also not currently allowed to enroll in MMAI.
You cannot enroll in MMAI if you are enrolled in Medicaid with a spenddown, if you are receiving temporary Medicaid benefits or if you are eligible for Medicaid through the Breast and Cervical Cancer Program or the Health Benefits for Workers with Disabilities program. People who have third party insurance (such as employer or retiree coverage) and people who receive care through an Illinois waiver program for individuals with Developmental Disabilities are also not eligible to enroll in MMAI.
In the future, people who receive Medicaid Waiver services for individuals with Developmental Disabilities may be allowed to enroll in MMAI health plans, but for now, these individuals are not allowed to enroll.

12. How do I join an MMAI plan?
Call Illinois Client Enrollment Services (CES): (877) TTY: (866)
For help comparing MMAI plans and considering your options, call the Illinois Senior Health Insurance Program (SHIP) at (800)
To enroll in MMAI, call Illinois Client Enrollment Services at (TTY: ). If you want to check to see if your doctor or hospital is in an MMAI plan’s network, Client Enrollment Services can help with that, too.
If you need help in another language, you can request an interpreter when you call Client Enrollment Services. You will first need to be able to say your name and the language that you speak in English. If you are not able to do that, you can sign an “authorized representative” form to have someone else (like a family member or counselor that you trust) speak to Client Enrollment Services for you. You can also ask Client Enrollment Services to send you information about MMAI in other languages or formats (such as large print).
If you would like help comparing MMAI plans (or comparing MMAI to your current coverage), you can also speak with an Illinois Senior Health Insurance Program (SHIP) Counselor. The SHIP program is a volunteer-based program through the Illinois Department on Aging that provides information and assistance with Medicare options. To find a SHIP counselor in your area, call

13. What MMAI Plans Can I Choose?
Kankakee:
Aetna Better Health
Blue Cross Community MMAI
Humana Health Plan
IlliniCare Health
Cook, DuPage, Kane, Will:
Aetna Better Health
Blue Cross Community MMAI
Humana Health Plan
IlliniCare Health
Meridian Complete
Champaign, DeWitt, Ford, Knox, McLean, Peoria, Stark, Tazewell, Vermilion:
Molina Healthcare
Lake:
Blue Cross Community MMAI
Humana Health Plan
IlliniCare Health
There are six companies in Illinois that currently offer MMAI health plans. Those companies are Aetna Better Health, Blue Cross Blue Shield of Illinois, Humana, IlliniCare, Meridian, and Molina Healthcare. Which of these six companies you can choose from depends on which county you live in. For example, someone who lives in Cook County can choose from Aetna Better Health, Blue Cross, Humana, IlliniCare, or Meridian. Someone who lives in Champaign County may choose to enroll in an MMAI plan through Molina Healthcare.
The plans that are currently available in each MMAI county are listed on this page/slide.

14. Do I Have to Join an MMAI Plan?
Joining an MMAI plan is voluntary. No one is required to enroll in MMAI.
If you enroll in MMAI, you can change your plan or opt of the program at any time.
If you opted out of MMAI in the past, you can still voluntarily enroll at any time.
One thing that makes the MMAI program different from other Medicaid managed care programs in Illinois is the fact that the MMAI program is voluntary. No one is required to enroll in or stay in MMAI. If are enrolled in an MMAI plan, you call Client Enrollment Services to change your plan or to opt of the MMAI program and return to Original Medicare and Medicaid at any time.
Anyone who is eligible to enroll in MMAI can call Client Enrollment Services to enroll, even if you have opted out of MMAI in the past. That door is always open to you if you are eligible.

15. MMAI Automatic Enrollment
Cook, DuPage, Kane, Kankakee, Lake and Will Counties have automatic enrollment.
When you first become eligible and live in these counties, you will get a letter telling you that you will be automatically enrolled into an MMAI plan.
You can choose to “opt out” of the program or join a different MMAI plan than the plan listed in your automatic enrollment letter.
In some counties (Cook, DuPage,Kane, Kankakee, Lake and Will), people who are eligible for MMAI may be automatically enrolled into a MMAI plan when they first become eligible. If you will be automatically enrolled into MMAI, you will receive a letter. (Note that it is VERY important to make sure that the Illinois Department of Healthcare and Family Services always has your current address, so that you receive important letters like this!)
If you get an automatic enrollment letter for MMAI and you would like to join a different MMAI plan than the plan listed in your letter, you can call Client Enrollment Services and tell them that you want to join a different plan. You can also call Client Enrollment Services and tell them that you do not want to enroll in the program at all. This is called “opting out” of MMAI. If you opt out of MMAI, you will keep your current coverage (through original Medicare and Medicaid, or through a Medicare Advantage plan and Medicaid). However, if you decide later that you want to enroll in an MMAI plan, you can contact Client Enrollment Services to enroll at any time.
People with Medicare and Medicaid living in Champaign, DeWitt, Ford, Knox, McLean, Peoria, Stark, Tazewell and Vermilion Counties are not currently being automatically enrolled into MMAI, but are still eligible for the MMAI program. If you live in one of these counties and wish to enroll in MMAI, you can call Client Enrollment Services at any time to enroll.

16. What Should I Consider Before Choosing an MMAI Plan?
We now know who can join MMAI and how they do it. If you are eligible and thinking of joining an MMAI plan, let’s talk about some things you might want to consider.

17. What Should I Consider Before Choosing an MMAI Plan?
Are your health care providers in the plan’s network?
Does the plan cover your prescription drugs?
Does the plan require prior authorization or other restrictions on any of your prescription drugs?
Does the plan offer extra benefits that might be helpful to you?
Check all of these by calling Illinois Client Enrollment Services at (877) TTY: (866) ) or visiting the Illinois Client Enrollment Services website at
When choosing an MMAI plan, consider these three things:
Providers
Prescription Drugs
Plan’s Extra Benefits
Each MMAI health plan has a large list of doctors, specialists and hospitals (called a “network”) that you can choose from to receive your care. In MMAI, you must choose a primary care provider who you will see for most of your healthcare needs and for referrals when you need to see a specialist.
Before choosing an MMAI plan, you should check to see if your doctor(s) and/or hospital are in the MMAI plan’s network. You should also check to see if your prescription drugs are on the plan’s list of covered drugs.
Finally, you may want to consider what extra benefits the plan offers beyond what Medicare and Medicaid offer.
You can check to see if your doctor or other health care provider is in an MMAI plan’s network and if your prescription drugs are covered by the plan by calling Illinois Client Enrollment Services. You can also access information about MMAI plan networks, as well as the MMAI plans’ prescription drug lists, on the Illinois Client Enrollment Services website, which is enrollhfs.illinois.gov.

18. Consider If You Have Long Term Services and Supports
Long Term Services and Supports (LTSS) are services that help with activities of daily life, like bathing, dressing, eating, cleaning/doing laundry, etc.
LTSS are provided in Illinois…
…in long term care facilities (nursing homes)
…in Supportive Living Facilities (SLF)
…through in-home services programs called “Medicaid Waiver” programs, such as the Community Care Program and several programs that are run by the Department of Rehabilitative Services (DRS) (the Persons with Disabilities Waiver, the Waiver for individuals with Traumatic Brain Injury (TBI), and the AIDS Waiver)
All MMAI plans cover LTSS for members who need them.
Before joining or leaving an MMAI plan, you should think about whether or not you have long term services and supports or LTSS. Let’s talk about long term services and supports. They are services that are not necessarily “medical” services, but they help you accomplish activities that are important to your daily life, such as bathing, dressing, or eating.
In Illinois, you can receive LTSS in one of three ways. First, if you live in a long term care facility (sometimes called a nursing home), the services you get in the long term care facility are LTSS. Second, you may also receive LTSS by living in a Supportive Living Facility, or SLF. If you do not live in a nursing home or a Supportive Living Facility, you may still receive LTSS through an in-home care program known as a Medicaid Waiver program. The Community Care Program is an example of a Medicaid Waiver program, and there are also several in-home care Medicaid Waiver programs in Illinois that are managed by the Department of Rehabilitative Services (such as the Waiver program for Persons with Disabilities, the Waiver program for people with Traumatic Brain Injury, and the Waiver program for people with AIDS).
If you are in an MMAI plan, that plan covers your LTSS.

19. HealthChoice Illinois for Long Term Services and Supports
You must enroll in a managed care plan from HealthChoice Illinois for LTSS if:
You live in Cook, DuPage, Kane, Kankakee, Lake, or Will counties and
Are eligible for MMAI but not in an MMAI plan, and
Receive long term services and supports
In Illinois, if you live in certain counties, are MMAI eligible (but not in an MMAI plan) and receive LTSS, you must enroll in a HealthChoice Illinois managed care plan to cover your LTSS services. Those counties are Cook, DuPage, Kane, Kankakee, Lake, and Will County.

20. HealthChoice for Long Term Services and Supports
People who are eligible for MMAI, receive Long Term Services and Supports and live in Cook, DuPage, Kane, Kankakee, Lake and Will Counties have TWO options:
Enroll in an MMAI plan to cover all healthcare services, including LTSS or
Stay in Original Medicare and Medicaid for your medical services and enroll in a HealthChoice Illinois plan for Long Term Services and Supports.
If you have Medicare and Medicaid, you are currently receive long term services and supports, and live in Cook, DuPage, Kane, Kankakee, Lake or Will County, you have two choices:
The first option is to enroll in an MMAI plan and receive all of your healthcare services through your MMAI plan.
The second option is to enroll in a HealthChoice Illinois plan for your long term services and supports, and remain in regular Medicare and Medicaid (or a Medicare Advantage plan) for your medical services. Your HealthChoice Illinois plan will cover your LTSS services, as well as your transportation, and certain mental health and substance use treatment services.
You can never have both an MMAI plan and a HealthChoice Illinois plan for LTSS at the same time – you can have only one or the other.
If you choose to enroll in an MMAI plan, but later disenroll from your MMAI plan, you will have to enroll in a HealthChoice Illinois plan for your long term services and supports. Once you have enrolled in a HealthChoice Illinois plan (or have been automatically enrolled into one), you will have a 90-day period to switch plans. After that time, you will be locked into that plan for one year. However, you can switch back to an MMAI plan, because in MMAI, you can join, opt out, or change plans at any time.

21. Example: Mr. and Mrs. Smith Choose Their Health Coverage
Now we will walk through an example of two people choosing MMAI or HealthChoice Illinois for LTSS.

22. Mr. and Mrs. Smith
Mr. Smith and Mrs. Smith are both eligible for MMAI and live in Cook County.
They have a worker who comes into their home to help with cooking and cleaning through the Community Care Program.
Mr. and Mrs. Smith opted out of MMAI in the past and have been receiving their Community Care Program Services through a HealthChoice Illinois plan.
Mr. and Mrs. Smith are both eligible for MMAI, receive long term services and supports, and live in Cook County. Through the Community Care Program, Mr. and Mrs. Smith receive help from a worker who comes into their home to help them both with cooking and cleaning and a few other basic activities. A few years ago, Mr. and Mrs. Smith received letters about the MMAI program. At the time, they called Illinois Client Enrollment Services to opt out, because they didn’t know what MMAI was and they didn’t want to make any changes in their health coverage.

23. Mr. and Mrs. Smith
After talking with a SHIP counselor about their options…
Mr. Smith decides to enroll in an MMAI plan to receive all of his healthcare services through one managed healthcare plan.
Mrs. Smith decides not to enroll in an MMAI plan because three of her doctors will not join any of the MMAI plan networks. She will continue to receive her healthcare services through regular Medicare and Medicaid and her Community Care Program services through her HealthChoice Illinois plan.
Recently, Mr. and Mrs. Smith heard about MMAI again from a neighbor, who has been very happy with her plan. The neighbor said that her plan’s care coordinator has really helped her control her diabetes, and the plan helps her make sure that she has transportation to all of her medical appointments. She also likes the extra benefits she is able to get through the plan, like an over the counter medication allowance of $20 a month.
After speaking with this neighbor, Mr. and Mrs. Smith called the Illinois Senior Health Insurance Program (SHIP) for help finding out if MMAI might work well for them. After talking with a SHIP counselor, Mr. Smith decides to enroll in an MMAI plan to receive all of his healthcare services through one plan, and to access the care coordination services that their neighbor told them about. Mrs. Smith decides not to enroll in MMAI because she has several doctors who still have not joined MMAI plan networks. Because she receives long term services and supports through the Community Care Program, Mrs. Smith will continue to receive most of her healthcare services through her Medicare and Medicaid, her prescription drugs through her Medicare Part D plan, and her Community Care Program and transportation services through her HealthChoice Illinois plan.

24. HealthChoice Illinois
Mr. and Mrs. Smith
Mr. and Mrs. Smith will use these cards to access their healthcare services:
Mr. Smith
Mrs. Smith
Medicaid
HealthChoice Illinois
Because Mr. Smith enrolled in MMAI, he can use his MMAI plan ID card any time he accesses healthcare services, no matter what the service is. Mrs. Smith will have to use four separate cards, depending on what kind of service she is getting. She will use her Medicare and Medicaid cards for most healthcare services, her Part D card at the pharmacy (for prescription drugs), and her HealthChoice Illinois card for her Community Care Program and transportation services.

25. What are my rights in MMAI?
Before we end, let’s talk about your rights and protections in an MMAI plan.

26. You have the same rights in MMAI as you have in Medicare and Medicaid.
Your Rights in MMAI
You have the same rights in MMAI as you have in Medicare and Medicaid.
People in MMAI have the same rights as someone in Medicare and Medicaid. In fact, you have some additional rights and protections.

27. What if My Healthcare Provider is Not in My Plan’s Network?
You can keep seeing providers who are not in your plan’s network for 180 days from the day you joined the plan.
The provider can bill the plan during this 180 days.
After 180 days, the provider will need to join your plan’s network or sign an agreement with your plan to keep seeing you.
If you enroll in an MMAI plan and your doctor or another healthcare provider is not in your MMAI plan’s network, you can keep seeing that provider for at least 180 days from the day you joined the plan (as long as your provider is willing to send a bill for the services to your plan). In the meantime, you should tell your providers that you have joined an MMAI plan. This provides time for the provider to join your plan’s network or for you to find a different provider that is in your plan’s network. Even if your provider does not join the plan’s network, they may sign an agreement with your plan to keep seeing you after the 180 days, if they wish. If your doctor or another health care provider has questions about this, they can call your MMAI plan for more information.

28. What If I Am Not Happy with My MMAI Plan?
Start by contacting your plan to file a complaint (also called a “grievance.”)
Contact the Home Care Ombudsman program at (800)
If the problem cannot be resolved, you can contact Illinois Client Enrollment Services to change MMAI plans or opt out of MMAI at any time.
If you have a problem with your plan, start by calling your plan to file a complaint (called a “grievance”). The State of Illinois also has a Home Care Ombudsman program to help people who are having problems with their MMAI plans. You can reach the Ombudsman program by calling Press 4 for Other and ask for the “Home Care Ombudsman.”
If these steps do not work and you are still unhappy, remember that you can change your MMAI plan or opt out at any time if you are not happy with your plan and want to go back to using regular Medicare and Medicaid for your health care services. You can switch MMAI health plans or “opt out” of the program by calling Client Enrollment Services at (TTY: ).
(Note: You can also call the Home Care Ombudsman if you are in a HealthChoice Illinois plan for LTSS.)

29. MMAI Recap
Remember….
In MMAI, you have one card to cover all your health care needs.
MMAI also has care coordination.
When considering whether to join an MMAI plan or not, think about:
Provider Network
Prescription Drugs
A Plan’s Extra Benefits
MMAI
Let’s recap what we have covered today.
You are eligible for MMAI if you are over 21, enrolled in Medicare Part A & Part B and enrolled in full Medicaid and live in Cook, DuPage, Kane, Kankakee, Lake, Will, Champaign, DeWitt, Ford, Knox, McLean, Peoria, Stark, Tazewell, or Vermilion County.
MMAI is a way to get all of your health care services in one plan with one card. MMAI also has care coordination.
If you are thinking about joining and MMAI plan, consider the following three things:
Are your providers and doctors in the plan’s network?
Are all of your prescription drugs covered by the plan?
Does the plan have extra benefits beyond what Medicare and Medicaid cover?
For help comparing your MMAI plan options, you can connect to a SHIP counselor by calling (800)

30. Questions?
To get help considering your MMAI plan options, call the Illinois Senior Health Insurance Program (SHIP) at (800)
Funding provided in whole or in part by the Illinois Department on Aging.
Thank you for listening. Are there any questions?
[Take questions. Thank the audience again and refer any further questions to Illinois SHIP either the toll free number or if you are a SHIP site, you can share site specific information.]