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Medicaid Mandatory Managed Care

    • MedicaidMMCAs required by Illinois law PA 96-1501, the Illinois Medicaid Reform Act, the Illinois Department of Healthcare and Family Services (DHFS) will transition at least 50 percent of the enrolled Medicaid population to some form of coordinated care organization by January 2015. 

      Additionally, the DHFS and the State of Illinois have begun to embrace the “triple aim” outlined by the Affordable Care Act’s Centers for Innovation: to improve quality of care provided to Medicaid patients, improve the health status of certain populations and reduce overall costs of the program. 

      These initiatives signal a major system redesign for the Illinois Medicaid program. By the time all eligible recipients are enrolled in care coordination, DHFS will have moved nearly two million Medicaid recipients into some form of managed care – approximately 66 percent of its enrolled population.

      How does Medicaid Managed Care impact your patients? As of summer 2014, DHFS began to require Medicaid enrollees residing in one of five geographic regions to select or be assigned to one of several managed care entities in those regions. Patients are given the opportunity to select a plan in their region, along with a primary care provider (PCP) associated with that plan.

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