At the direction of Gov. Pat Quinn, Illinois is transforming its
Medicaid system from a program that simply pays medical bills, to a
"Illinois intends to be a national leader in reforming the health
care system that cares for the most vulnerable members of our
population," Quinn said. "By aligning the state-operated Medicaid
system with the federal Medicare system, we will provide seamless
and coordinated care for this population and create an incentive for
health care providers to do a better job of keeping people healthy
and treating them when they do become sick."
The state announced that the following six managed care
organizations will serve clients in the greater Chicago area,
consisting of Cook, Lake, Kane, DuPage, Will and Kankakee counties:
Aetna Better Health, IlliniCare Health Plan (Centene), Meridian
Health Plan of Illinois, HealthSpring of Tennessee dba HealthSpring
of Illinois, Humana Health Plan, and Health Care Service Corp. dba
Blue Cross/Blue Shield of Illinois. The state also announced the
selection of Molina Healthcare of Illinois and Health Alliance
Medical Plans to serve clients in central Illinois, which includes
Knox, Peoria, Tazewell, McLean, Logan, DeWitt, Sangamon, Macon,
Christian, Piatt, Champaign, Vermilion, Ford, Menard and Stark
"Medicare and Medicaid too often work at cross purposes," said
HFS Director Julie Hamos. "We know that by aligning Medicare and
Medicaid so that they are working together in concert and providing
each client with a medical home and a patient-centered team of
health care experts, we can provide better care and achieve better
outcomes while lowering costs for a segment of the population that
needs a great deal of care."
The demonstration project, which is designed for clients who are
eligible for both Medicare and Medicaid -- known as "dual eligible,"
is a key component of the state's transition to greatly expanded
coordinated care for Medicaid clients by 2015. In addition, the
following plans will also serve other seniors and people with
disabilities in the Medicaid program as the state expands the
Integrated Care Program that was implemented in suburban Cook County
and five collar counties in May of 2011.
The state estimates that approximately 136,000 seniors and adults
with disabilities will be eligible for care under the
Medicare-Medicaid Alignment Initiative. Dual eligibles account for a
high proportion of spending in Medicaid. In 2010, for example, dual
eligibles made up 9 percent of the population and 27 percent of the
costs of the program.
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Under a solicitation released in May, HFS sought proposals from
health plans that will be responsible for the full range of Medicare
and Medicaid benefits and services, robust care coordination
efforts, use of community-based services to maintain independence in
the community, and comprehensive provider networks to meet
individual needs. HFS selected the eight proposals that presented
the most comprehensive models and took a holistic approach to
serving clients and coordinating services for all of their needs.
Under the initiative, the state and CMS will enter into three-way
contracts with health plans that will be responsible for the
provision of all Medicare and Medicaid services afforded to
individuals eligible for both programs. The Medicare-Medicaid
Alignment Initiative is subject to federal approval.
Health plans will be accountable for integrated care delivered to
dual-eligible clients, as performance will be measured and payment
will be tied to performance measurement goals. Health plans will be
paid a single capitation rate, jointly funded by the state and CMS
for all Medicare and Medicaid benefits and services, with full
payment contingent on meeting annual performance measure targets.
The maximum initial term of the three-way contracts is three years.
Upon receiving federal approval to implement the initiative,
Illinois will be among the first states in the country to offer such
a benefit to clients.
The MMAI is one of several initiatives the state is employing to
meet the requirements of the state's 2011 Medicaid reform law to
enroll 50 percent of clients into care coordination. The goal is to
redesign the health care delivery system so that it is more
patient-centered, with a focus on improved health outcomes and
evidence-based treatments, enhanced patient access and patient
For more information about the MMAI and the Care Coordination
Innovations Project, go to
Department of Healthcare and Family Services
file received from
Illinois Office of
Communication and Information]