The Illinois Department of Healthcare and Family Services has selected eight managed care companies to coordinate health care for about 136,000 Medicaid-Medicare eligible patients, as part of the federal government's dual eligible demonstration with the states.
The dual-eligible project, called the Illinois Medicare-Medicaid Alignment Initiative, is part of a dual eligible demonstration project overseen by the Centers for Medicare & Medicaid Services, and it is also part of Illinois' plans to have at least half of the state's Medicaid recipients be moved into managed care by 2015.
"By aligning the state operated Medicaid system with the federal Medicare system we will provide seamless and coordinated care for this population and create an incentive for healthcare providers to do a better job of keeping people healthy and treating them when they do become sick," Democratic Governor Pat Quinn said in a media release.
In Illinois, dual eligible patients made up about 9 percent of the Medicaid population, while accounting for 27 percent of its costs in 2010.
Illinois Healthcare and Family Services director Julie Hamos said that "Medicare and Medicaid too often work at cross purposes," or as CMS officials have said, the two programs are financially misaligned and never designed to share benefit coverage.
With costs for America's dual eligible patients rising, the agency is looking for more effective care models. 26 states applied to run demonstration programs, testing variations of coordinated care models using either the capitated rate or fee-for-service.
So far, CMS has approved Massachusetts to test the capitated model and Washington State to test the fee for service model.
Illinois is using the capitated model, and the eight managed care plans will coordinate health and wellness services for dual-eligible patients, with the help of community-based organizations that focus on promoting independence and reduced hospitalizations.
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With a dual eligible coordinated care program modeled after the patient-centerred medical home, Hamos said the aim is to "provide better care and achieve better outcomes while lowering costs for a segment of the population that needs a great deal of care."
The health plans will enter into three-way contracts with Illinois and CMS, and the managed care companies be paid based on performance measurement goals, and the contracts will last a maximum of three years.
For greater Chicago Medicare-Medicaid eligible patients, the state selected Aetna Better Health, IlliniCare Health Plan, Meridian Health Plan of Illinois, HealthSpring of Illinois, Humana Health Plan and Blue Cross/Blue Shield of Illinois. For central Illinois, the state chose Molina Healthcare of Illinois and Health Alliance Medical Plans.