The Illinois Department of Healthcare and Family Services (HFS) announced on September 9 that it has competitively selected two managed care organizations (Aetna and Centene-IlliniCare) to help it implement an integrated health care program for aged and disabled Medicaid recipients. The program will serve nearly 40,000 Medicaid recipients with complex needs in six suburban counties (Du Page, Kane, Kankakee, Lake, Will, and a part of Cook County) in the Chicago area beginning in early 2011. The program builds on HFS’s experience and accomplishments in primary care case management, home and community-based services, and MCO contracting, enrollment, and quality assurance. Illinois estimates that the new program will save up to $200 million over a five year period by reducing unnecessary hospitalizations, emergency room visits, nursing home placements, hospital lengths of stay, and duplicative diagnostic tests and procedures. Enrollees in the program will select one of the two MCOs and will be offered a choice of a medical home (either a physician or a clinic) within the selected MCO’s network.  HFS’s contracts with the MCOs will include a consumer-directed option under which recipients may select and hire their own personal care attendants. The contracts will also include pay-for-performance incentives tied to nationally recognized performance measures. HFS expects to finalize the terms of its contracts with the two MCOs by December 2010. The University of Illinois at Chicago will perform an independent evaluation of the program.        

About Tom Entrikin

A former policy specialist with the U.S. Health Care Financing Administration (now Centers for Medicare & Medicaid Services (CMS)), Tom Entrikin has vast experience providing technical assistance to states on Medicaid eligibility, coverage, and reimbursement; provider certification and enrollment; program integrity; recovery of third party liabilities; Medicaid Management Information System (MMIS) performance specifications and operations; interagency agreements; contracts with managed care organizations; and Medicaid waiver programs.

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