Date: April 7, 2017
To: All Medical Assistance Providers
Re: Integrated Care Program (ICP) - Central Illinois Region Suspension of Mandatory Managed Care Updates
This notice reminds providers that effective December 1, 2016, mandatory managed care enrollment in the Southern Central Illinois counties was suspended for the Integrated Care Program (ICP).
This notice also informs providers that effective May 1, 2017, Molina Healthcare of Illinois (Molina) will no longer be a Medicaid Managed Care health plan option for ICP members in the following Southern Central Illinois counties:
Christian, Logan, Macon, Menard, Piatt and Sangamon
The Department will disenroll Molina ICP members from the health plan on April 30, 2017. As Molina Healthcare members are disenrolled from the ICP health plan, they will be placed in the regular Medicaid fee-for-service program beginning May 1, 2017. In fee-for-service, individuals will use their Healthcare and Family Services (HFS) medical card to access services and providers should bill HFS in accordance with the fee-for-service guidelines. Individuals may also have co-pays for doctor’s visits, emergency room visits and prescription drugs. It is imperative for providers to check MEDI to determine if the individual is enrolled with a health plan or in fee-for-service on the date of service. Individuals in fee-for-service may need assistance in finding providers for their healthcare services. As such, individuals should be referred to the Illinois Health Connect helpline for assistance in finding a provider 877-912-1999 (TTY: 866-565-8577). This change does not affect an individual’s Medicaid eligibility.
Molina is committed to assisting its members during this time of transition to minimize disruptions in care or access to services. Molina is also in the process of issuing health plan termination notices to each enrollee. A sample Molina health plan termination notice can be found on the Department’s Care Coordination webpage. Members with questions about this transition process should be referred to Molina Member Services at
877-901-8181 (TTY: Illinois Relay at 7-1-1) through April 30, 2017.
Molina Healthcare of Illinois will remain a voluntary ICP Medicaid Managed Care health plan choice in the following Southern Central IL counties:
Champaign, DeWitt, Ford, McLean, and Vermilion
Current Molina members in these counties can remain enrolled with Molina to receive all their medical and care coordination services. Or, they can choose to disenroll from Molina and use their HFS medical card to access services as a fee-for-service client. Newly eligible participants in these counties can also choose to voluntarily enroll with Molina for care coordination services. Molina will be mailing notices to their members in these counties notifying them of their enrollment options.
Molina members who choose to remain enrolled with Molina do not need to do anything. They will continue to work with Molina, see providers in Molina’s network and use their Molina member ID card to access services. Molina members who need assistance should be referred to Molina Member Services at 855-687-7861 (TTY: Illinois Relay at 7-1-1).
Molina members who choose to dis-enroll from Molina and access services using their HFS medical card in fee-for-service must call Illinois Client Enrollment Broker (CEB) and ask to be disenrolled from Molina. The CEB representative will inform the client of their disenrollment date (always on last day of a month). Fee-for-service clients who need help finding providers should be referred to the Illinois Health Connect Helpline at
877-912-1999 (TTY: 866-565-8577).
Clients living in any Southern Central IL county listed above who were previously enrolled with Health Alliance up through December 31, 2016, will continue to access healthcare services using their HFS medical card in fee-for-service. These clients will receive an HFS Informational Notice explaining how to access healthcare services in fee-for-service. Former Health Alliance members living in Champaign, DeWitt, Ford, McLean or Vermilion can choose to voluntarily enroll with Molina. To voluntarily enroll, a client must call the Illinois Client Enrollment Broker (CEB) at 877-912-8880 (TTY: 866-565-8576) and ask to be enrolled.
It is imperative that providers always check MEDI to determine the client’s Medicaid eligibility, managed care enrollment or fee-for-service status on the date of service. General information regarding Medicaid Managed Care is on the Department’s website.
Questions regarding this notice may be directed to the Department’s Bureau of Managed Care at 217-524-7478.
Felicia F. Norwood
Director
Director
