Provider Notice issued 12/28/2023

This notice informs providers that customers in the Health Benefits for Immigrant Adults (HBIA, ages 42-64)) and Health Benefits for Immigrant Seniors (HBIS, ages 65+) programs will transition from the Department of Healthcare and Family Services’ fee-for-service (FFS) program to a HealthChoice Illinois (HCI) managed care organization (MCO) beginning January 1, 2024.

The HBIA and HBIS programs are state-funded programs that were created to provide medical coverage for immigrant adults and seniors who are ineligible for Medicaid due to their immigration status. When the programs were initiated, customers were covered under HFS’ FFS program model. The June 28, 2022 provider notice supplied additional information and medical coverage limitations on the HBIA and HBIS programs. Coverage has since been clarified to allow medically necessary rehabilitation services at a long term care facility, limited to no more than 90 days per episode.

Member Enrollment in an MCO

HFS has initiated the transition of these customers over the next several months from FFS to managed care. Enrollment packets are being mailed over the next three (3) months according to the schedule below. Once received, customers will have about 30 days to choose an MCO. Those who do not choose will be assigned to the MCO and primary care provider (PCP) listed on their notice. New enrollees also have 90 days after enrollment to change MCOs.

Checking Eligibility in MEDI

Providers should check the MEDI system for eligibility verification and confirmation of customers in the HBIA/HBIS program and their MCO. In MEDI, providers will see:

Case Type:  IMMIGRANT ADULTS, FULL COVERAGE

or

Case Type:  IMMIGRANT SENIORS, FULL COVERAGE

A small number of customers may remain in the FFS program. Providers must check the MEDI system for customer eligibility and coverage verification for each service date.

Note: New customer enrollment in both programs remains paused, pursuant to Public Notices dated June 16, 2023, and October 20, 2023.

Cost Sharing

Medical benefits under the MCOs remain the same as under the FFS program. However, per emergency rule filings to 89 Ill. Admin. Code sections 118.760 and 118.860, hospitals and ambulatory surgical treatment centers (ASTCs) may collect copayments and coinsurance on the following services:

·Non-emergency inpatient hospitalizations: $250 copay

·Non-emergency hospital emergency room visits: $100 copay

·Hospital or Ambulatory Surgical Treatment Center outpatient services set forth at 89 Ill. Adm. Code 148.140(b): 10% of the Department rate

Not all MCOs will be charging copayments on non-emergency services, but those that are will begin February 1, 2024. None of the MCOs will assess cost sharing on services that can qualify as emergency services. MCO claim processing systems will automatically deduct any applicable copayment or cost sharing amount from the provider’s final payment. Questions about whether a copayment should be charged should be directed to the MCO. 

The FFS program will also begin charging copayments on non-emergency services February 1, 2024.

Providers are responsible for collecting copayments from the customers. Providers may elect not to charge copayments, but if they are charged, the copayment may not exceed the amounts established above.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.

Kelly Cunningham, Administrator
Division of Medical Programs