Medicare-Medicaid Alignment Initiative
Wednesday, December 11, 2013
Robert Mendonsa
HFS Deputy Administrator
• Overview
• MMAI Timeline
• Enrollment
• Care Management
• Managed Long-term Services and Supports
(MLTSS) Program
• Health plans will provide integrated benefits
to full-benefit dual eligible beneficiaries ages
21 and over:
– All Medicare and Medicaid services including long-term care
institutional and community-based services and supports
– Exclusions include individuals receiving institutional
developmental disability services or Adults with
Developmental Disabilities HCBS waiver services
• Capitated payment model
• Three-way contracts with CMS and Health Plans
• Voluntary program
• Passive enrollment process
• Robust care coordination
• Emphasis on quality measurement
Overview - Geography
• Greater Chicago Counties:
– Cook, Lake, Kane, DuPage, Will, Kankakee
• Central Illinois Counties:
– Knox, Peoria, Tazewell, McLean, Logan , DeWitt,
Sangamon, Macon, Christian, Piatt, Champaign,
Vermilion, Ford, Menard, Stark
Overview – Number Eligible
Geographic Region
Number of Dual
Beneficiaries Eligible
for MMAI
Greater Chicago
Central Illinois
Overview – Health Plans
• Greater Chicago:
– Aetna Better Health
– Blue Cross/Blue Shield
– Cigna HealthSpring
– Humana
– IlliniCare Health Plan
– Meridian Health Plan
Overview – Health Plans
• Central Illinois:
– Health Alliance
– Molina HealthCare
Overview: LTSS Definition
LTSS : Long Term Supports and Services
Under MMAI, the LTSS population includes nursing
home residents and those receiving Home and
Community Based waivers:
Elderly (Community Care Program participants)
Traumatic Brain Injury
Physically Disabled
Supportive Living Facility
MMAI Timeline
• February 1, 2014: Voluntary Enrollment for
Community Begins
• May 1, 2014: Passive Enrollment for Community
• July 1, 2014: Voluntary Enrollment for LTSS Begins
• September 1, 2014: Passive Enrollment for LTSS
Voluntary Enrollment: Community
• February – April, 2014
– Exceptions on Voluntary Enrollment: LTSS slide
• Late December, 2013 – Announcement Letter alerting
beneficiaries of voluntary enrollment period will be
– Notice includes general information on:
• Names of health plans participating in their area
• Choosing a health plan and PCP
• Calling the Illinois Client Enrollment Services for help in explaining
their choices
• How to enroll
• How to opt out
Passive Enrollment: Community
• Begins May 1, 2014
– 6-month phase-in
• 60 days prior to passive enrollment date, mail
notice to beneficiary, which includes:
– Name of health plan
– Option to change plans or opt-out at any time
• 30 days prior to passive enrollment, second
notice mailed
Voluntary Enrollment: LTSS
• Begins July 2014
• Announcement Letters for all LTSS individuals will
NOT be sent until early June 2014
• LTSS individuals can enroll as early as February
2014 if they learn about the program and wish to
enroll. Their announcement letters, however, are
not mailed until late June 2014
Passive Enrollment: LTSS
• Begins September 1, 2014
• Beginning June 2014, mail notice to
beneficiary, which includes:
– Name of health plan
– Option to change plans or opt-out at any time
• 30 days prior to passive enrollment, second
notice mailed
• Disenrollments are effective the first day of
the month following request
• Individuals can disenroll thru the ICES or
through 1-800-Medicare
• Those receiving LTSS and who disenroll from
MMAI will be required to enroll in the MLTSS
– To be discussed in more detail on the MLTSS
Program slide.
Care Management
• Within 90 days of enrollment, health plans
must complete:
– Health Risk Screening and Stratification
– Health Risk Assessment for those stratified as
moderate or high-risk
– Care Plans (including HCBS waiver service plan)
Care Management
• For individuals residing in NFs or receiving
HCBS services at the time of enrollment,
health plans must complete care plans within
180 days of enrollment
Care Management
• Health plans must complete reassessments:
– Every 30 days for those stratified as high-risk
– Every 90 days for those stratified as moderate
– Annually for all enrollees at a minimum
– Face-to-face reassessment for Enrollees receiving
HCBS Waiver services or residing in NFs each time
there is a significant change in the Enrollee’s
condition or an Enrollee requests reassessment.
MLTSS Program
• Begins September 1, 2014
• Beneficiaries receiving LTSS and who opt out of MMAI
• Mandatory enrollment in a health plan to receive:
– Behavioral Health
– Transportation
• Same health plans as MMAI
• MLTSS Program individuals are locked in for their LTSS
services for one year and cannot switch health plans until
their anniversary month

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