AgeOptions and other organizations that serve older adults have been following the development of this new project, as it will significantly affect the lives of our clients. Here is what we have learned about this new initiative from our research and communications with the entities involved, including the Illinois Department of Healthcare and Family Services and various managed care organizations:
The MMAI project is part of a national effort to better coordinate care for dual eligible beneficiaries. Dual eligibles tend to be sicker and cost more than other Medicare and Medicaid beneficiaries. To address this, as part of the Affordable Care Act, the Centers for Medicare and Medicaid Services created a Medicare-Medicaid Coordination Office (MMCO) to “make sure Medicare-Medicaid enrollees have full access to seamless, high quality health care and to make the system as cost-effective as possible.” One of the MMCO’s first projects has been working with states to implement initiatives to coordinate care for dual eligibles.
Currently, dual eligibles must navigate and manage multiple systems of coverage in order to access the health care they need (Medicare, Medicare Part D prescription drug plans, and Medicaid). This can be very complex and taxing for individuals who have multiple complex health needs. Therefore, the goals of the MMAI project are to simplify this process and provide higher quality and more coordinated care for dual eligibles.
In January 2014, dual eligibles in the greater Chicago area and parts of Central Illinois will be enrolled into managed care plans. These plans must provide care managers and other supports to coordinate their members’ care, in addition to paying for members’ medical services and long term services and supports (LTSS). In exchange, these plans will be paid a capitated rate by the state of Illinois and CMS. (“Capitated rate” means the plans will receive a flat rate for each member that they serve, instead of being paid for each individual service that a member receives.) The inclusion of long term services and supports in this project is significant, as these services may be ‘new territory’ to some managed care organizations. In addition to providing coverage for LTSS provided in long term care facilities, MMAI plans will be responsible for covering home and community based services, such as the Community Care Program. This may cause confusion for dual eligible beneficiaries who are used to receiving Community Care Program services through the existing system, so agencies working with older adults will have to provide education and assistance to help our clients understand these new changes.
Illinois has selected eight managed care plans to provide MMAI coverage. Those eight plans are:
- Chicago area: Aetna Better Health, Blue Cross/Blue Shield of Illinois, HealthSpring, Humana, IlliniCare (Centene), and Meridian Health Plan of Illinois
- Central Illinois: Molina Healthcare, Health Alliance
Counties that will be part of the MMAI project:
- Greater Chicago area: Cook, DuPage, Lake, Kane, Kankakee, and Will counties
- Central Illinois: Christian, Champaign, DeWitt, Ford, Knox, Logan, Macon, McLean, Menard, Peoria, Piatt, Sangamon, Stark, Tazewell, and Vermilion counties
For more information about the Illinois MMAI project, please see the following resources:
CMS fact sheet
Illinois Memorandum of Understanding
Illinois Department of Healthcare and Family Services webpage on Illinois Care Coordination Initiatives (see section on MMAI)
Written by Erin Weir, Manager of Health Care Access at AgeOptions