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Update on Eligible Medicaid Patients Under the Affordable Care Act
Posted on: 12/20/2013

With the projected influx of new Medicaid patients under the Affordable Care Act, here's what you need to know regarding how these patients will be assimilated into Illinois' Medicaid program.

  • Newly eligible patients must select a primary care physician (PCP) or a voluntary managed care option (MCO).

For those patients who do not make a selection to either a PCP or MCO, Medicaid will automatically assign the patient to a PCP through Illinois Health Connect. Patients may be able to select or transition to an Accountable Care Entity (ACE) - sometime in the summer of 2014.

The ACE is a new model of an integrated delivery system with a network of primary care physicians, hospitals, behavioral health care professionals and medical specialists. During a three-year period, this model will transition from fee-for-service to full risk contracts.

  • Medicaid also began implementing the Care Coordination Entity (CCE) programs last fall, which includes networks to deliver care to seniors and adults with disabilities. Medicaid currently has five CCEs in place.
  • Due to the anticipated enrollment of nearly 200,000 new Medicaid patients in Illinois, newly eligible patients in Cook County must select a PCP, a voluntary MCO or CountyCare.

With all the new choices open for Medicaid patients, be sure you know what plan your new and existing Medicaid patients are enrolled with, and whether you are participating in that plan.  

Learn more details about Illinois Health Connect's role with Accountable Care Entities and Care Coordination Entities.

Questions? Call your ISMS Advocacy Team at 800-782-4767 ext. 1470 or send an email.

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