Medicare Medicaid Financial Alignment Initiative (MMAI) Webinar November 18, 2013

Who We Are: Leadership AgeOptions –Area Agency on Aging (AAA) for suburban Cook County Health & Disability Advocates –Policy and advocacy group Progress Center for Independent Living –Cross-disability, non-residential – suburban Cook County

MMW work is supported by grants from: The Chicago Community Trust Michael Reese Health Trust The Retirement Research Foundation

What We Do Gather and create practical, accessible information and materials Educate Medicare consumers, service providers and policymakers Problem solving – individual and systemic Provide training and technical support for professionals and volunteers Advocate for consumer focused laws and policies Target underserved groups

What We Will Cover Today Background of Illinois Managed Care Transitions Medicare Medicaid Financial Alignment Initiative – Program eligibility – Services covered under MMAI – Enrollment & Disenrollment

6 Background of Illinois Managed Care

Background - Illinois Managed Care Transitions State Initiatives – Public Act , January 2011: Illinois must move 50% of all Medicaid recipients into “risk- based care coordination” by 2015 – Save Medicaid Access and Resources Together Act (SMART Act), May 2012: Save $16.1 million by integrating care for most complex Medicaid beneficiaries (acute, primary, behavioral, and long- term services and supports)

Background - MMAI Centers for Medicare and Medicaid Services (CMS) issued demonstration project to increase care coordination for dual eligibles (people with Medicare and Medicaid) Illinois application approved February 22, 2013 Memorandum of Understanding between CMS and state of Illinois available here: ounter= ounter=4547

Illinois Managed Care Initiatives Integrated Care Program (ICP) – Seniors and Persons with Disabilities with Medicaid ONLY (no Medicare) – Phase 1 began in May 2011, Phase 2 in February 2013 – Currently only in suburban Cook, DuPage, Kane, Kankakee, Lake, and Will Counties and the following regions: Rockford, Central IL, Quad Cities and Metro East. Scheduled to begin in Chicago February Medicare/Medicaid Alignment Initiative (MMAI) – Target start date: voluntary enrollment in February 2014 – 135,000 dual eligibles in Chicago region and Central Illinois Innovations Project – Demonstration projects – provider-based networks testing innovative models of care coordination – Targeted to begin summer 2013 (4 in Chicago area, 2 downstate), but projects have not yet begun

10 Medicare/Medicaid Financial Alignment Initiative

Who Will MMAI Affect? Full benefit dual eligible beneficiaries (people with Medicare and full Medicaid benefits – not “spenddown”) who are: – Over the age of 21 and in the “Seniors and Persons with Disabilities (SPD)” Medicaid category (also known as AABD) – Living in Chicago area or Central Illinois: Chicago: Cook, Lake, Kane, DuPage, Will, and Kankakee counties Central IL: Knox, Peoria, Tazewell, McLean, Logan, DeWitt, Sangamon, Macon, Christian, Piatt, Champaign, Vermilion, Ford, Menard, and Stark counties About 135,000 people

How Will MMAI Work? HFS will contract with managed care companies to coordinate all medical, pharmaceutical, behavioral health, and long term services and supports (like Phase 1 and 2 of the ICP combined). – One plan will cover all services (Medicare Parts A, B, D, and Medicaid) - members will no longer need to find providers who accept Medicare and Medicaid (will need to use plan’s network instead)

How Will MMAI Work? Plans may not charge higher cost-sharing than traditional fee-for-service Medicaid Consumers must use plan network providers 180 day transition period Must cover out of network emergency care Plans will have some flexibility to provide services that are not currently covered by Medicare and Medicaid (if they choose)

How Will MMAI Work? Managed care companies will use a “medical home” model – Team-based approach; focus on integrating primary, behavioral health, and acute care services across providers – Plans will use several components to coordinate care, including health information technology (HIT), risk assessments, care management, and multi-disciplinary care teams – Members will choose a “medical home” and Primary Care Provider (PCP)

MMAI Enrollment Enrollment will be conducted through the Client Enrollment Broker (just like ICP) – Will be able to view minimal information about the MMAI plans on the Medicare Plan Finder, but cannot enroll on the Plan Finder – Must use Enrollment Broker website or phone number to enroll Enrollment will be “voluntary” and “passive”

Voluntary Enrollment Begins February 2014 Clients begin receiving letters about 30 days before voluntary enrollment begins explaining the program and their options Clients can respond to letter by: 1) Choosing to voluntarily enroll in an MCO of their choice, OR 2) Wanting to opt out of the program entirely (for all care besides LTSS)

Passive Enrollment Begins May 2014 for those who did not respond to Voluntary Enrollment letters Passive enrollment is expected to be conducted in phases (with a maximum enrollment of 5,000 beneficiaries/month in the Chicago area, and a maximum of 3,000 beneficiaries/month in Central Illinois) Clients will begin receiving a notice about 60 days before they are passively enrolled into a plan. Clients have the option to… 1) Not respond to the letter and be automatically enrolled in the MCO listed on the notice 2) Respond to the letters by choosing an MCO of their choice 3) Opt out of the program entirely to continue to receive regular Medicare and fee-for-service Medicaid (unless receiving LTSS)

Once Enrolled Once a client is enrolled into an MCO, they can change plans on a monthly basis throughout year – will not be “locked” into a plan (unless receiving LTSS) Can opt out of the program at any time of the year to receive regular Medicare and fee-for-service Medicaid (unless receiving LTSS) Can change PCP at any time (changes will occur within 30 days)

MMAI & LTSS Individuals receiving LTSS services will be “locked in” to whatever plan they choose for one year after an initial 90 day election period and will not be able to switch their MCO throughout the year They can opt out for medical services at any time of the year, but not for their LTSS services If a client chooses to opt out of their MCO, they will receive Medicare and Medicaid (fee-for-service) for all of their hospital and medical care claims, but their LTSS services will be paid by the MCO.

MMAI Plans Illinois Department of Healthcare and Family Services has chosen 8 plans to provide MMAI services: Chicago area (Chicago and surrounding suburbs): – Aetna Better Health – IlliniCare (Centene) – Meridian Health Plan of Illinois – HealthSpring – Humana – Blue Cross/Blue Shield of Illinois Central Illinois: – Molina Healthcare – Health Alliance

21 For More Information

Illinois Department of Healthcare and Family Services (HFS) Care Coordination Roll-Out Plan: HFS website on Care Coordination: (MMAI proposal and information, information about Innovations Initiative)

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