Illinois Care Coordination: MMAI Enrollment Strategies

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Transcript Illinois Care Coordination: MMAI Enrollment Strategies

Illinois Department of
Healthcare and Family Services
August 2014
MMAI is a 3 year demonstration program that is currently
enrolling clients in two regions of IL:
Greater Chicago – Cook, DuPage, Kane, Kankakee, Lake and Will
Central Illinois – Champaign, Christian, DeWitt, Ford, Knox, Logan,
Macon, McLean, Menard, Peoria, Piatt, Sangamon, Stark, Tazewell and
Vermilion Counties
There are no plans to expand to any other regions during this
demonstration period.
The number of potential enrollees is approximately 148,000
with the highest potential enrollment Greater Chicago- 128,000.
MMAI – Who is eligible to enroll?
Medicare Medicaid Alignment Initiative (MMAI) eligibles
Medicare Part A
Medicare Part B
Open Medicaid eligibility through the AABD (Aid to the Aged, Blind and
Disabled) program.
Exclusions include:
Individuals on Spenddown (met or unmet)
Those with high level TPL or in partial benefit programs
Individuals receiving institutional developmental disability services
or Adults with Developmental Disabilities HCBS waiver services
MMAI- Enrollment Materials
Clients receive an announcement letter providing basic
information about the program.
Clients next receive an initial enrollment packet, which provides
the client with a list of health plans to choose from and the name
of the plan and PCP to whom the client will be passively enrolled
if no voluntary choice is made.
Clients will receive a reminder notice approximately 14 days
after receipt of the initial enrollment packet.
Finally, clients will receive a secondary enrollment packet
approximately 30 days after receipt of the initial enrollment
packet. The secondary enrollment packet provides the same
information as the initial enrollment packet.
MMAI- Enrollment
How does a client enroll?
Who can answer questions about choices
available such as which plan has the clients
PCP in network?
MMAI- IL Client Enrollment Services (ICES)
ICES (i.e., MAXIMUS, the enrollment broker) is responsible for
providing unbiased education to clients about their health plan
choices and conducting all enrollments into the MMAI program.
The enrollment broker can assist clients in searching available
health plans to determine which plan or plans their PCP
participates in.
Web enrollments are not permitted for the MMAI program.
Clients and their families or individuals assisting them should
call to enroll:
1-877-912-8880 (TTY: 1-866-565-8576)
Voluntary vs. Passive Enrollment
MMAI is a voluntary program with passive enrollment.
The client can voluntarily select a health plan. Enrollment is
prospective and will begin on a future date.
The client can choose to keep all benefits the same by opting –
out of MMAI.
If a client does not make an active choice by either selecting a
plan or opting out of the program, a choice is made for them.
The choice or assignment made is based on all sorts of data
including current PCP, claims history, and geography.
MMAI- Disenrollment
Disenrollments are effective the first day of the month
following request
Individuals can disenroll thru ICES or through
Those receiving LTSS and who disenroll from MMAI
will be required to enroll in the MLTSS program.
MMAI- Community Members
Mailings and enrollments for clients living in the community began earlier
this year.
Can enroll at any time. If a voluntary choice is not made within the
timeframe provided in the initial enrollment packet, the client will be
passively enrolled with the “best fit” health plan and PCP.
Can change MMAI plans at any time. Enrollment in new plan will be
effective on a future date.
Can opt out at any time. Client will be disenrolled from the MMAI plan on
the first day of the following month.
Clients who are already enrolled in a Medicare Advantage or DSNP plan
should not be passively enrolled out of their current plan. However, if a
client is enrolled in an MA plan operated by a parent company that also
offers an MMAI plan, the client will be moved to the coordinating MMAI
plan unless a different, voluntary choice is made.
MMAI- LTSS Members
Mailings to LTSS clients are scheduled to begin later this month
If a voluntary choice is not made within the timeframe provided in the initial
enrollment packet, the client will be passively enrolled with the “best fit”
MMAI plan and PCP.
Clients may opt out of the demonstration portion of the MMAI program at
any time but LTSS clients are required to be enrolled in an MLTSS plan.
Client will have 90 days from the effective date of the enrollment to switch
to a different MLTSS plan.
After 90 days, client will be locked in to their MLTSS plan for 12 months.
Clients may switch to a new MLTSS plan during their annual open enrollment
MMAI- Roles in the Enrollment Process
The Client Enrollment Broker (CEB), Maximus, mails enrollment
materials to potential enrollees, provides unbiased information, as
well as enrollment and disenrollment of clients.
HFS IL Health Benefits Hotline helps people enrolled in Medicaid
with service or billing problems. They can help members with
enrollment issues, and with health plan complaints.
Medicare helps clients resolve enrollment issues, and can disenroll
clients from MMAI.
SHIP counselors can help clients understand your plan choices,
answer questions about changing to a new plan
Advocates such as the Ombudsman, can help clients each step of the
MMAI- Resources
The member handbook is a valuable resource including these
chapters in particular:
Chapter 2 – important contact numbers for members
Chapter 4 – covered services
Chapter 9 – grievances and appeals
HFS IL Health Benefits Hotline : 1-800-226-0768 (TTY1-877204-1012 )
Medicare: 1-800-MEDICARE (1-800-633-4227), (TTY 1-877486-2048 )
SHIP: 1-800-548-9034 (TTY1-866-323-5321 )