Provider Notice Issued 09/16/2019

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Date:    September 16, 2019

To:       All Medical Assistance Program Providers

Re:      HealthChoice Illinois – Special Needs Children Implementation November 1, 2019

This notice informs providers of an update in the Department of Healthcare and Family Services (HFS) HealthChoice Illinois managed care expansion for the Special Needs Children population. Enrollment of Special Needs Children will begin effective November 1, 2019.

Special Needs Children include children under the age of twenty-one (21) who meet any of the following criteria: 

·         are eligible for Supplemental Security Income (SSI) under Title XVI;

·         receive Title V care coordination services through the Division of Specialized Care for Children (DSCC) (also known as the CORE Program);

·         qualify as disabled;

·         are under the legal custody or guardianship of the Illinois Department of Children and Family Services (DCFS); or

·         formerly were under the legal care of DCFS and are receiving assistance through Title IV-E.

Children Excluded from this Expansion:

Public Act 100-0990 prohibits HFS from requiring that “children made eligible for medical assistance through a home and community-based services waiver program for Medically Fragile and Technology Dependent children under the Social Security Act” enroll in or transition to the State’s managed care medical assistance program. The legislation also excludes children approved for the Nursing and Personal Care Services (NPCS) program from mandatory enrollment in managed care.

In addition to the exclusions above, the following groups are excluded from this expansion:

·         American Indian/Alaskan Natives unless they voluntarily enroll in an MCO;

·         participants with a Spend-Down;

·         participants with comprehensive third-party insurance.

Provider IMPACT Enrollment and Contracts with the HealthChoice Illinois Plans

Providers are encouraged to begin contract discussion with the managed care plans in order to continue serving the Special Needs Children population. Providers who are not enrolled to participate in the HFS’ Medical Programs must go through IMPACT enrollment prior to pursuing contracts with the plans.  

Questions regarding this notice may be directed to the Department’s Bureau of Managed Care at 217-524-7478.

Doug Elwell

Medicaid Director