IPHCA works to provide members information on both Medicaid and Medicare Managed Care matters.
Beginning in 2014 Illinois state Medicaid began the initiative to provide services for over 50% of the state’s Medicaid eligible patients through contracted Managed Care Organization (MCO) plans. Illinois defined six mandatory managed care areas throughout the state. In addition to those mandatory areas, there were voluntary MCO or Accountable Care Entity (ACE) opportunities in nearly 50% of the non-mandatory counties. In 2018 Illinois plans for the transition of 80% of the Medicaid population located in all 102 counties to newly contracted Medicaid Managed Care plans. Medicaid populations include the family & children eligible for Medicaid through Title XIX or Title XXI; Affordable Care Act expansion Medicaid-eligible adults; Medicaid-eligible adults with disabilities who are not eligible for Medicare; Medicaid-eligible older adults who are not eligible for Medicare; dual-eligible adults who are receiving long term services and supports (LTSS) in an institutional care setting or through an Home and Community Based Services (HBCS) waiver, excluding those receiving partial benefits; and special needs children.
Centers for Medicare and Medicaid Services (CMS) began the staged implementation of the Medicare FQHC Prospective Payment System (PPS) starting October 1, 2014 and rolled it out according to FQHC provider cost reporting schedules throughout the fiscal year.
Medicare Advantage plans provide Medicare beneficiary services through Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and HMO Point of Service plans. Like managed care Medicare pays these private companies to cover Medicare benefits.
FQHCs providing services under contract with Medicare Advantage (MA) organizations are eligible for supplemental payments.
IPHCA Medicare Advantage Wrap Webinar
Medicare Advantage Wrap Webinar