Date: April 7, 2017
To: All Medical Assistance Providers
Re: Medicare-Medicaid Alignment Initiative (MMAI) - Central Illinois Region Managed Care Updates
Effective January 1, 2016, Molina Healthcare of Illinois became the only MMAI health plan choice in the Central Illinois Region. This notice informs providers that effective May 1, 2017, Molina Healthcare of Illinois (Molina) will no longer be a Medicare-Medicaid Managed Care health plan option for MMAI members in the following Central Illinois counties:
Christian, Logan, Macon, Menard, Piatt and Sangamon
The federal Centers for Medicare & Medicaid Services and the Department will disenroll Molina MMAI members residing in these six counties from the health plan effective April 30, 2017. When Molina Healthcare members are disenrolled from the MMAI health plan, they can choose to enroll in Original Medicare (Medicare fee-for-service) or Medicare Advantage for their Medicare and prescription drug benefits. If they choose Original Medicare, they will need to join a separate Medicare Part D plan for prescription drug benefits. As dual eligible beneficiaries, they will also receive Medicaid benefits through the regular Medicaid fee-for-service program beginning May 1, 2017.
Beneficiaries who enroll in Original Medicare will use their red, white, and blue Medicare card for healthcare services and a Medicare Part D plan card for prescription drugs benefits. Beneficiaries who enroll in a Medicare Advantage plan will use their Medicare Advantage plan card for healthcare services and prescription drug benefits. They also will be in Medicaid fee-for-service and use their Healthcare and Family Services (HFS) medical card to access Medicaid services that are not covered by Medicare.
Providers should bill for Medicare-covered services in accordance with Medicare billing guidelines. Providers should bill for Medicaid-covered services that are not covered by Medicare in accordance with the HFS Medicaid fee-for-service guidelines. Beneficiaries 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 beneficiary is enrolled with a managed care health plan or in fee-for-service on the date of service. Beneficiaries in fee-for-service may need assistance in finding providers for their healthcare services.
Beneficiaries should be referred to Medicare at 800-MEDICARE (800-633-4227; TTY: 877-486-2048) for assistance finding a Medicare provider or to the Illinois Health Connect helpline at 877-912-1999 (TTY: 866-565-8577) for assistance in finding a Medicaid provider. This change does not affect a beneficiary’s Medicare or 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 an MMAI Managed Care health plan choice in the following Central IL counties:
Champaign, DeWitt, Ford, Knox, McLean, Peoria, Stark, Tazewell, and Vermilion
Questions regarding this notice may be directed to the Department’s Bureau of Managed Care at 217-524-7478.
Felicia F. Norwood
Director
Director
