Illinois Medicaid Overhaul to take effect in 2018


2018 will see an overhaul in the state of Illinois’ Medicaid Healthcare. This past spring, Republican Gov. Bruce Rauner announced he wanted to rebid Medicaid managed care contracts to squeeze out more savings. He did so while Illinois was without a budget for two years (one was passed in July) as the Republican governor and Democrat-controlled General Assembly bickered over forging a deal.

The new Medicaid Managed Care Program is named “HealthChoice Illinois,” reflecting the goal of helping beneficiaries make smart healthcare decisions. In total, nine health plans bid for contracts to oversee the coverage of most of the state’s 3.2 million recipients on Medicaid. In what’s known as managed care, insurers are paid by the state to focus on prevention and steer enrollees away from expensive ER and hospital visits. The overall goal is to keep Medicaid recipients healthy, ultimately saving taxpayers money.

The following health plans are scheduled to begin operating as part of HealthChoice Illinois throughout Illinois starting in 2018:

  • Blue Cross Blue Shield of Illinois
  • CountyCare (available only in Cook County)
  • Harmony Health Plan
  • IlliniCare Health Plan
  • Meridian Health
  • Molina Healthcare of Illinois
  • NextLevel Health (available only in Cook County)

In the coming weeks, HFS will work closely with health plans, providers and clients to ensure a smooth transition to HealthChoice Illinois. HFS encourages providers to understand the benefits of this new program and to contract with available health plans.

“The reboot brings enhanced care coordination and stronger quality controls to fulfill the promises of managed care to Medicaid beneficiaries,” Felicia Norwood, director of the state healthcare and family services department, said in a statement. “By operating with an ideal number of plans, overhead costs will be reduced while we make sure every beneficiary receives powerful choice. This means more of the program’s money going to real people instead of bureaucracy.”

Recipients in counties where managed care already exists will become part of new health plans on Jan. 1. Enrollees who will be new to managed care will join on April 1, 2018. See instructions for recipients listed below. 

The new contracts are expected to save between $200 million and $300 million a year through such things as cost-cutting incentives for the insurers, the healthcare and family services department said in its statement.

When the carriers bid, they committed to getting paid less money per enrollee, department spokesman John Hoffman added in an interview. There will be efficiencies too, such as a universal credentialing process for doctors to participate in insurers’ networks, rather than each carrier having its own process.

Visit the Illinois Healthcare and Human Services Department online, to learn more about Illinois’ Medicaid managed care.

For Patients Transitioning:

Individuals who are now enrolled with a FHP/ACA, ICP, or MLTSS managed care health plan will transition to the new program on January 1, 2018. If an individual is currently enrolled with one of the health plans selected and listed above, the individual will remain with that current plan in the new program. Managed care clients currently enrolled in a health plan that is not part of the new program will be transitioned to one of the newly awarded health plans. All clients will receive notice of the transition and their plan assignment for January 1, 2018. Regardless of which health plan a client is in on January 1, 2018, all clients will have 90 days with the option to switch to another plan.

Eligible Medicaid clients not currently participating in managed care will be provided with a 30-day enrollment choice period in early 2018 and will need to select a new health plan. These clients will begin receiving services in the newly selected health plan on April 1, 2018. Regardless of which health plan a client is in on April 1, 2018, all clients will have 90 days with the option to switch to another plan

A detailed client transition timeline will be provided prior to the transition along with a sample of the communications that will be mailed to affected clients.

Health plans are in the process of building their networks to ensure adequate coverage for clients. Providers that are not contacted by plans in the coming weeks are strongly encouraged to reach out to them and establish their relationships under HealthChoice Illinois. A provider notice with further details will be forthcoming.

In the coming weeks, HFS will be sending provider notices to discuss other specific aspects of the program reboot and answer questions. The Department believes that HealthChoice Illinois will significantly reduce administrative requirements, allowing providers to focus on client care.

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