Wednesday, January 30, 2013

State Initiating Care Coordination

In Illinois, care coordination will be provided by traditional insurance-based HMOs, Managed Care Community Networks, (MCCN), and Care Coordination Entities (CCE). CCEs are provider-organized networks providing care coordination for risk and performance-based fees but with medical and other services paid on a fee-for-service basis.

An initial group of six CCEs and MCCNs recently were awarded contracts under the state Department of Healthcare and Family Services (HFS) Care Coordination Innovations project. This program is expected to grow in order to provide care coordination for children with complex health needs.

Illinois Medicaid’s two year draft plan “Care Coordination Roll-Out Plan from January 2013 to January 2015” centers on how to meet the state law that requires at least 50 percent of their Medicaid clients to move into care coordination by January 1, 2015. Under this plan, the goal is to have about two million out of three million clients or 66 percent in care coordination by the deadline.

The major roll-out plan will focus on Seniors and Persons with Disabilities (SPD) who comprise 16 percent of the Medicaid population but incur 55 percent of Medicaid costs. Since some of the SPD population includes dual-eligibles, the state expects the federal government to partner with Illinois Medicaid to provide better coordination of services under the unique demonstration program called the “Medicare-Medicaid Alignment Initiative” (MMAI).

The state estimates that approximately 136,000 seniors and adults with disabilities will be eligible for care under the MMAI program. The MMAI demonstration, a joint effort with CMS is a key component of the state’s transition to expanded coordinated care for Medicaid clients by 2015.  In November, HFS named eight health plans to partner with the state as the majority of people covered by Medicaid will be moved to the system of coordinated care.