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Medicaid Managed Care in Illinois Frequently Asked Questions
- 1. What happens once I pick a health plan?
- 2. How do I know if I am required to enroll in a Managed Care Program?
- 3. How can I find out what Managed Care Health Plans are in my area?
- 4. Will my family and I qualify for the same Managed Care Program?
- 5. Can I change my health plan?
- 6. How can I contact my Health Plan?
- 7. Can I change my Primary Care Provider (P)
- 8. What happens if I don’t choose a health plan?
- 9. If my provider leaves my Health Plan’s network, what do I do?
- 10. What if I have a treatment plan when I first enroll in a health plan?
- 11. Can I keep my doctor as my Primary Care Provider (PCP)?
- 12. I recently moved. Does this affect my health plan enrollment?
- 13. I recently had a baby. How can I enroll my newborn in a Health Plan?
Once you enroll in a health plan, you will get a health plan member handbook and a member ID card. Look for them in the mail. You will work with your plan to get the healthcare services you need. To learn more, call your health plan member services number. If you are unsure of your health plan, call the Department of Healthcare and Family Services Client Hotline at: 1-800-226-0768. The call is free. They will give you the name and phone number of your health plan.
Most people with an HFS Medical card must enroll in (join) a health plan. When it is time to pick a health plan and Primary Care Provider (PCP), you will receive an enrollment packet in the mail from Illinois Client Enrollment Services. The enrollment packet will include the information you need to pick a health plan. There are some reasons you would not have to pick a health plan, such as:
- You are enrolled in the Spenddown Program
- You get temporary medical benefits
- You are getting care in the Illinois Breast and Cervical Cancer Program
- You already have private insurance (third party liability/TPL) through an employer that pays for hospital and doctor visits
You can see the mandatory counties on the map here. Or you can visit the website for Illinois’ Client Enrollment Services. Go to: www.enrollhfs.illinois.gov to compare health plans.
You and your family members may qualify for different programs. The program you qualify for is based on your health condition, your age and whether or not you have full Medicaid benefits and full Medicare benefits.
Yes. As a new enrollee you can change your health plan one time in the first 90 days. After that, you cannot change health plans for one year. Once each year, you can change health plans during the time called “open enrollment.” This is true for all programs except the Medicare Medicaid Alignment Initiative (MMAI), when you can change your health plan at anytime.
Yes. You can change your PCP once a month. To change your PCP, call your health plan.
If you don’t choose a health plan by the deadline listed in your enrollment letters, a health plan and a PCP will be picked for you.
You must contact your health plan as soon as possible. They will help you find a different provider that can meet your needs.
If you are in a current, ongoing course of treatment, you can continue with your provider for 90 days when first enrolling in a Health Plan - whether that provider is in network or not. You will need to work with your health plan.
Yes. Contact your PCP to see which health plan(s) they accept.
Yes, if your current health plan is not available in your new county. Make sure your Department of Human Services caseworker has your new address. You cannot pick a new health plan until your address is updated. You will get a new enrollment packet in the mail when your address has been updated. The enrollment packet will include your new health plan options and the date for when you must pick. You will need to use your HFS Medical Card to receive benefits until you are enrolled in a new health plan.
Ask the hospital to help you add your baby to your medical case right away. If you do not have a medical case, you can apply for an HFS Medical card for your baby by calling 1-800-843-6154 or online at https://ABE.illinois.gov
If your baby is added to your medical case in the first 90 days, the baby will be automatically enrolled in your health plan. You can keep your baby in your health plan or you can switch your baby’s health plans for any reason during the first 90 days. After that, your baby will remain enrolled in that health plan for 12 months. However, you can work with your health plan to change your baby’s PCP at any time.
If you do not have a medical case, or are not enrolled in a health plan at the time of the baby’s birth, you will receive an enrollment packet for your baby in the mail. The enrollment packet will give you your baby’s health plan options and a date for when you must decide.