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Elizabeth M. Whitehorn, Director

Provider Notice Issued 04/07/2017

Medicaid Managed Care Transformation​

 

Date:  April 7, 2017

 

To:     All Medical Assistance Providers

 

Re:     Medicaid Managed Care Transformation

 

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