Illinois care coordination: MMAI Enrollment Strategies

1. Illinois Department of Healthcare and Family Services Illinois care coordination: MMAI Enrollment Strategies August 2014

2. MMAI • 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 Counties • 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.

3. MMAI – Who is eligible to enroll? • Medicare Medicaid Alignment Initiative (MMAI) eligibles include: • 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

4. 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.

5. MMAI- Enrollment • How does a client enroll? • Who can answer questions about choices available such as which plan has the clients PCP in network?

6. 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)

7. 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.

8. MMAI- Disenrollment • Disenrollments are effective the first day of the month following request • Individuals can disenroll thru ICES or through 1-800-Medicare • Those receiving LTSS and who disenroll from MMAI will be required to enroll in the MLTSS program.

9. 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.

10. 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 period.

11. 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 way.

12. 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 (TTY1-877-204-1012 ) • Medicare: 1-800-MEDICARE (1-800-633-4227), (TTY 1-877-486-2048 ) • SHIP: 1-800-548-9034 (TTY1-866-323-5321 )