Medicaid Managed Care Transformation

Date:  Ap

Date: April 7, 2017

To: All Medical Assistance Providers

Re: Medicaid Managed Care Transformation

Date:  Dat
The Illinois Department of Healthcare and Family Services (HFS) is transforming its current managed care program. HFS intends to extend its Medicaid managed care program into every county in Illinois beginning on January 1, 2018.
HFS has recently issued a Request for Proposal (RFP) with the intent to award contracts to no fewer than four (4) and no more than (7) qualified, experienced, and financially sound Managed Care Organizations (MCOs) to enter into risk-based contracts for the Medicaid managed care program.  
The program will expand managed care coverage to additional populations including special needs children and children under the care of the Department of Children and Family Services (DCFS). Through this transformation, more than 80 percent of Medicaid beneficiaries will transition into a managed care health plan, an increase from the 65 percent who are currently enrolled in a managed care health plan.
HFS recognizes that providers are an important part of the overall transformation process. HFS encourages providers to begin contract discussions when MCOs are reaching out to establish networks. Providers who have contracted with MCOs that are awarded a contract will be able to seamlessly serve Medicaid participants during this period of transformation. In addition, the only way for providers to ensure payment for services rendered to clients enrolled with MCOs under the transformed Medicaid Managed Care Program is to contract with the MCOs.
The RFP webpage can be accessed for additional information including the draft model contract and also includes Frequently Asked Questions. Continue to visit the Medicaid Managed Care Program RFP webpage for updates, including contract award notices and transformation timelines.
 
Thank you for your continued support of the Illinois Medicaid Managed Care Program.  
Felicia F. Norwood
Director

IMPORTANT: Molina HealthCare of Illinois MMAI coverage will end on 05/01/2017

This Molina Action affects Macon and Piatt Counties beginning May 1, 2017

 
Molina HealthCare of Illinois MMAI will no longer provide coverage through the Medicare-Medicaid Alignment Initiative (MMAI) program after April 30, 2017. However, you will still have Medicare and Medicaid benefits, including prescription drugs. You will be automatically enrolled in the regular Medicaid fee-for-service program. Unless you make another choice, you will be automatically enrolled in the Original Medicare fee-forservice program and a SilverScript Insurance Company Medicare Part D prescription drug plan effective May 1, 2017. If you do not want to be automatically enrolled in Medicare coverage, you have options, which are listed below.
What are my options?
1. Original Medicare and a Medicare Prescription Drug Plan
You can get your Medicare services, such as doctor visits, through Original Medicare. If you choose Original Medicare, you need to join a separate Medicare prescription drug plan, also known as a “Part D plan” to get prescription drug coverage. If you don’t choose a drug plan on your own, Medicare will enroll you in a SilverScript Insurance
Company Medicare Part D prescription drug plan.
 
2. Medicare Advantage
You can enroll in a Medicare Advantage health plan to get your Medicare services. A Medicare Advantage plan is offered by a private company that works with Medicare to provide benefits. Medicare Advantage plans cover all services that Original Medicare covers and may offer extra coverage such as vision, hearing, or dental. Most include prescription drug coverage as well. If you choose a Medicare Advantage plan, check with your current providers to see if they are part of the new plan. You should also ask the new plan to see if your current medications will be covered. You can call the new plan or look at the plan’s provider directory and prescription drug list online.
 
If you want help, you can get free, confidential assistance by calling the Senior Health
Insurance Program at 1-800-252-8966, or 1-888-206-1327 (TTY) Monday through Friday between 8:30 a.m. and 5:00 p.m.
No matter what choice you make, you will still have Medicare and Medicaid benefits, including prescription drugs.
 

Weigh in on ACA Repeal Next Week!

advocacy.alert.benefit

Weigh in on ACA Repeal Next Week!

Call Congress Tuesday & Wednesday to Raise Concerns

January 27, 2017

As covered in our January 18 Legislative Update to members, one of the largest issues facing Congress right now is how exactly to repeal the Affordable Care Act and what exactly to replace it with (and when!).  

n4a’s recent Policy Brief, entitled “What Would ACA Repeal Mean for Older Adults, Caregivers and the Aging Network” details some of the programs at risk and issues at play. The Brief concludes with a list of questions for advocates to use when working with policymakers on any replacement legislation, as it’s important for all aging advocates to vocalize our concerns about ACA repeal.

As a first step, the Leadership Coalition of Aging Organizations (LCAO), of which n4a is an active member, is hosting two call-in days next week, sharing a toll-free number for all advocates to use to reach their Senators and Representatives.  

n4a encourages you to reach out to Congress on Tuesday or Wednesday (Jan. 31 and Feb. 1) and SHARE THIS ALERT WIDELY in your community to drive more calls.

Action Steps

1. STEP 1: On Tuesday or Wednesday, call 866-426-2631 and enter your zip code to be connected to your Senators’ and Representative’s offices.

Tell your Member of Congress why certain provisions in ACA are so important to older adults, people with disabilities and caregivers in your community!  

Here are some key talking points you may wish to use, but feel free to personalize your appeal with your own professional or personal experiences with the provisions in ACA that are critical to helping older adults, to mention local aging programs supported by the ACA or otherwise adapt your message.

    • Maintain successful programs in ACA that help seniors stay healthy, such as falls prevention and chronic disease self-management programs (funded by the ACA’s Prevention and Public Health Fund), care transitions innovations and multiple rebalancing efforts that create more home and community-based services.
    • Preserve Medicaid and Medicare for current and future older adults and people with disabilities.
      • Medicaid is the primary public source of funding for long-term services and supports and older adults and people with disabilities account for two-thirds of Medicaid spending. Program cuts, along with block grant or per capita cap proposals, would hurt people who have no alternative means of paying for essential services.
      • Medicare is a huge success story, with strong support from all Americans. Premium support and other restructuring proposals to shift more costs onto beneficiaries would make health care far less affordable and accessible to seniors and people with disabilities.

2. STEP 2: Engage your community! Please encourage your providers, advisory boards and partners, and consumers to take action by reaching out to Members in the House and the Senate today! 

(Note: If you don’t want to use the 1-800 number for any reason or want to call now or Monday, you can always use the U.S. Capitol Switchboard: (202) 224-3121 or send an email: www.house.gov and www.senate.gov.)

Thank you for your advocacy on this important issue! There will be more to come from n4a as ACA repeal and replace measures advance in the coming weeks and months.  

If you have questions or concerns about this Advocacy Alert or n4a’s policy positions, please contact Autumn Campbell at This email address is being protected from spambots. You need JavaScript enabled to view it. and Amy Gotwals at This email address is being protected from spambots. You need JavaScript enabled to view it..

Grandparents Raising Grandchildren: Input needed

We need your help!

In case you missed our last e-mail, Cohen Children’s Medical Center is conducting a national study focused on grandparents raising their grandchildren. The number of children in “grand-families” has increased dramatically in recent years, and studies suggest that this responsibility poses unique challenges to grandparents who assume this role.  We at Cohen Children’s Medical Center are conducting a national study and would like to hear from as many grandparents as possible. 

Please… forward this information about our research study to any and all grandparents raising their grandchildren.  

We are asking grandparents that are raising grandchildren to complete an anonymous, on-line questionnaire at www.GrandparentingResearch.comOur research study has been approved by our Institutional Review Board.  (A copy of the IRB determination letter is available on request).

Thank you for assistance in sharing information about our research study with grandparents raising grandchildren.  Of course, we would be happy to answer any questions you may have. 

Sincerely,

Laura McLaughlin

Research Assistant, on behalf of

Andrew Adesman, MD3

Chief, Developmental & Behavioral Pediatrics Steven & Alexandra Cohen Children's Medical Center of New York New Hyde Park, NY

Professor of Pediatrics

Hofstra Northwell School of Medicine

Congress Punts Decisions on FY 2017 Funding to Late April

n4a legislative update

Congress Punts Decisions on FY 2017 Funding to Late April

Last-Minute Deal Avoids Shutdown as Lawmakers Head Home for the Holidays      

December 13, 2016

Following Donald Trump’s victory in November and the request of the incoming Trump Administration, Republican leaders in Congress deferred major decisions on FY 2017 federal funding by passing a bill late last week to extend current funding levels until April 28, 2017. This strategy, known as a continuing resolution (CR), means that federal agencies and programs have funding certainty through most of April. However, a priority item for the 115th Congress, beginning in January, will be to figure out a longer-term funding strategy for a fiscal year that will be half-over by the time the next funding deadline arrives.  

What Does a Continuing Resolution Mean for OAA and other Aging Programs?  

Passage of the CR holds some good news for advocates who were concerned about the Senate’s proposed elimination of the State Health Insurance Assistance Program (SHIP) and cuts to senior employment programs. Approval of the CR means that those cuts are off the table—at least in the near-term. However, the CR also means that House-proposed increases for some OAA programs, including Title III B Supportive Services and Title III C Nutrition Services will not be a reality in the near future.   I

n order to stay under the budget caps for FY 2017, which were established in the 2015 Bipartisan Budget Agreement, an across-the-board cut of 0.19 percent was included in the bill. How this cut will be distributed across programs, however, will be determined by individual agencies, so we don’t have details at this point about what ongoing funding levels for OAA programs will be.  

Federal Funding Outlook for the 115th Congress  

The move to punt finalizing FY 17 funding until the spring means that the 115th Congress will have homework from the current Congress. The incoming Trump Administration, eager to have a say in spending levels, asked leading Congressional Republicans to leave long-term decisions about FY 17 until next year.  

However, this move also complicates the list of necessary legislative action early in the new year. Not only must Congress work to either finalize or further extend funding for the current fiscal year, but as of early spring, lawmakers on the budget and appropriations committees will begin their annual work to work to determine funding levels for FY 2018 as well.  

Congress and the Trump Administration will also have to deal with the politically contentious move to increase the country’s borrowing authority when the current debt ceiling is reached in March. Additionally, the current budget agreement, which raised the budget caps for FY 2016 and FY 2017, expires at the end of FY 17, and lawmakers will have to decide what—if anything—to do about drastically lower spending authority next year for federal defense and non-defense discretionary programs.  

We also expect to see another layer of complexity in early year spending negotiations as lawmakers consider the unusual possibility of passing two Congressional budget resolutions next year. Doing so would prompt two opportunities to use a complicated budgeting process, known as reconciliation, to pass controversial, but filibuster-proof, legislation. We expect Affordable Care Act repeal (and possibly broad structural changes to the Medicaid and Medicare programs) could be achieved through this process next year. If lawmakers proceed with that strategy, we would anticipate ACA repeal early in the year through a budget reconciliation process for FY 2017 (the current budget year) and possible FY 2018 reconciliation proposals in the late summer or fall detailing other major changes to Medicaid and possibly Medicare.  

What Can Aging Advocates Do?  

At this point, predictions are, at best, just that—predictions. We are not sure of the exact course lawmakers will take to both finalize federal funding and make major changes to health care programs. However, we do know it is more critical than ever that local aging advocates weigh in with lawmakers and stress the need to protect and adequately funding OAA programs. It is also critical that we keep up the drumbeat about the need for funding increases for OAA and other aging programs. Stay tuned for updates about the FY 2017 and FY 2018 appropriations process as they are available, and continue to contact your Members of Congress with these important messages!

----

This Legislative Update is an n4a membership benefit. For more information about these and other federal aging policy issues, please contact n4a’s policy team: Amy Gotwals (This email address is being protected from spambots. You need JavaScript enabled to view it.) and Autumn Campbell (This email address is being protected from spambots. You need JavaScript enabled to view it.), 202.872.0888.

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