The Illinois healthcare landscape is evolving, and with it, the way Medicaid services are delivered. In 2018, Illinois expanded its Medicaid Managed Care Program to cover every county in the state under a new initiative called HealthChoice Illinois. This program, designed to be member-focused, consolidates the former Family Health Plan/Affordable Care Act (FHP/ACA) Managed Care Program, the Integrated Care Program (ICP), and the Long Term Services and Supports (LTSS) Program into a single, unified system. The primary goal of HealthChoice Illinois is to empower individuals to make informed decisions about their healthcare while ensuring they receive comprehensive and coordinated medical services.
Upon full implementation of this statewide managed care approach, it was anticipated that approximately 80% of all Medicaid beneficiaries in Illinois would receive their healthcare through HealthChoice Illinois plans. This shift significantly reduces reliance on the traditional Medicaid fee-for-service model, moving towards a more managed and coordinated care system.
Several health plans were selected to participate in HealthChoice Illinois, offering beneficiaries a range of choices depending on their location. These plans include:
| Choice of Health Plans | Regions |
|---|---|
| Blue Cross Blue Shield of Illinois | Statewide |
| CountyCare | Available in Cook County only |
| Harmony Health Plan | Statewide |
| IlliniCare Health Plan | Statewide |
| Meridian Health | Statewide |
| Molina Healthcare of Illinois | Statewide |
| NextLevel Health | Available in Cook County only |
Notably, Blue Cross Blue Shield of Illinois is a key participant, providing a statewide managed care option within the HealthChoice Illinois program. For individuals seeking a well-established and widely recognized health plan, Blue Cross Blue Shield (BCBS) represents a significant choice within the HealthChoice Illinois network.
Transitioning to HealthChoice Illinois: What You Need to Know
For those already enrolled in managed care programs like FHP/ACA, ICP, or LTSS with participating health plans, enrollment seamlessly continued under HealthChoice Illinois starting January 1, 2018. Members received official notifications confirming this transition and their continued coverage under their existing plan within the new program framework.
However, some health plans, including Family Health Network (FHN), Community Care Alliance of Illinois (CCAI), Aetna, and Humana, did not directly participate in HealthChoice Illinois from the outset. To ensure continuity of care, FHN, CCAI, and Aetna partnered with participating HealthChoice Illinois plans, facilitating a smooth transition for their members to these partner organizations. Humana members, who did not have a partner plan, were automatically assigned to another HealthChoice Illinois plan based on a pre-determined algorithm. All affected members received detailed notices regarding these transitions and their new plan assignments for January 1, 2018.
To ensure individuals had the opportunity to choose a plan that best suited their needs, a 90-day plan switch period was implemented from January 1, 2018, to March 31, 2018. During this time, anyone enrolled in HealthChoice Illinois could change their health plan by contacting the Client Enrollment Broker Call Center at 1-877-912-8880 (TTY: 1-866-565-8576) or visiting the Enrollment Portal online at www.enrollhfs.illinois.gov. This flexibility allowed members to explore their options and select a different HealthChoice Illinois plan if desired.
For individuals newly eligible for Medicaid and not yet enrolled in HealthChoice Illinois as of January 1, 2018, enrollment packets were sent out starting the week of January 8, 2018. These packets provided a 30-day period for new enrollees to choose a health plan and a Primary Care Provider (PCP). The enrollment materials included comprehensive information about available plan choices, the PCP they would be automatically assigned if no selection was made, and guidance on how to obtain further information and assistance with making informed decisions. New enrollees who made their plan and PCP selections during this initial period began receiving services through their chosen HealthChoice Illinois plan on April 1, 2018. Similar to existing members, new enrollees also had a 90-day period after April 1, 2018, to switch to a different plan if needed.
The rollout of HealthChoice Illinois also included a phased approach for specific populations. Enrollment for children with special needs into the HealthChoice Illinois Program was scheduled to begin in May and June 2018, with an effective enrollment date of July 1, 2018.
The End of Illinois Health Connect Program
The Illinois Health Connect (IHC) Program concluded at the end of 2017 (December 31, 2017), and it is no longer an available plan option. Individuals previously enrolled in IHC began the process of selecting HealthChoice Illinois plans and PCPs starting the week of January 8, 2018, for an enrollment effective date of April 1, 2018. IHC proactively sent notifications to its members regarding the program closure and the transition process to HealthChoice Illinois.
Medicare-Medicaid Alignment Initiative (MMAI) Program: A Separate Initiative
It’s important to note that the Medicare-Medicaid Alignment Initiative (MMAI) Program is distinct from HealthChoice Illinois. MMAI continued to operate in its existing counties in 2018 and was not expanded as part of the HealthChoice Illinois rollout. The health plans participating in MMAI in 2018 remained consistent and included Aetna Better Health, Blue Cross Blue Shield of Illinois, Humana Health Plan, IlliniCare Health Plan, Meridian Health, and Molina Healthcare of Illinois. Therefore, individuals eligible for both Medicare and Medicaid should understand that MMAI and HealthChoice Illinois are separate programs designed to address different aspects of their healthcare needs.
Need More Information?
For the latest updates and detailed information about the managed care program, please visit the Department’s Care Coordination website at: https://www.illinois.gov/hfs/MedicalProviders/cc/Pages/default.aspx/.
If you have specific questions regarding the managed care programs or participating health plans, you can contact the Department’s Bureau of Managed Care directly at 217-524-7478.
