Illinois' Managed Care Programs

Welcome to the Managed Care section of the Illinois Department of Healthcare and Family Services (HFS) website.

What is Managed Care?

Managed care is a kind of health insurance program. It offers quality health care and care coordination. When you enroll in Managed Care, you become a member of a Health Plan. You will have at least four (4) Health Plans to choose from, depending on where you live. The Health Plan you choose will offer you a full range of services while helping you coordinate your health care.

What is Care Coordination and why is it important?

Serving members through care coordination is an effective way to provide health care services to you. Included here are some of the ways care coordination through your Health Plan can help you:

• Find a primary care provider (PCP) who will get to know you and your health care needs
• Help you manage your health care conditions like diabetes, high blood pressure, or asthma
• Give you information you need to stay healthy
• Help you identify your health goals and create a care plan to achieve those goals

What can a Care Coordinator help me do?

Some individuals get a care coordinator to help you reach your goals. A care coordinator can:

• Answer questions about your care
• Help you find a doctor or specialist
• Help you transition out of a hospital or facility
• Help connect you with community resources

Managed Care Programs

The Department operates three distinct care coordination programs within the broader Illinois Medicaid Managed Care program: HealthChoice Illinois (HCI), YouthCare, and the Medicare Medicaid Alignment Initiative (MMAI).

HealthChoice Illinois (HCI)

In FY 2022, HFS held contracts with a total of five (four statewide, plus one Cook County only) qualified, experienced, and financially sound Managed Care plans to serve the HCI population, including:

• Families and children;
• Adults eligible for Medicaid under the Affordable Care Act;
• Seniors and adults with disabilities who are not eligible for Medicare;
• Dual Medicare-Medicaid eligible adults receiving certain Long Term Services and
  • Supports, referred to as the MLTSS population;
  • Special needs children, which includes Former Youth in Care and Youth in Care.

  The Managed Care map provides more information about the MCOs that are operating in the HCI program, click here.

  HCI covers a comprehensive set of benefits for all enrolled customers except the MLTSS population. MLTSS customers receive some long term services and supports, along with some mental health and transportation services, from their HCI health plan. All other services for MLTSS customers are covered by Medicare and Medicaid fee for service.

  HealthChoice Illinois - YouthCare

  The statewide, specialized HCI health plan, operated by Meridian Health, provides services to DCFS Youth in Care as well as DCFS Former Youth in Care. YouthCare works to improve access to care through active coordination and through a more robust provider network. With YouthCare, DCFS youth receive additional benefits, such as trauma-informed care coordination for behavioral health needs. YouthCare provides specialized programming for adoptive families, including an adoption-competent network of therapists to support the different phases of adoption and child development. The Department continues to work closely with the DCFS and YouthCare and various stakeholders to support program initiatives and workgroups to enhance the quality of care for DCFS youth.

  Youth in care are youth for whom the Illinois Department of Children and Family Services has legal responsibility, living with foster parents, in group homes, or in residential settings.

  Former Youth in Care

  Former youth in care are youth who have been adopted, are living with kinship providers, have returned to biological parents, and/or have left the DCFS system. All of these youth were in the care of DCFS previously.

  Medicare/Medicaid Alignment Initiative (MMAI)

  The Medicare/Medicaid Alignment Initiative is an on-going three-way partnership between HFS, the federal Centers for Medicare and Medicaid Services (CMS), and health plans. MMAI reformed the way care is delivered to customers who are eligible for both Medicare and Medicaid services (dually eligible) by providing coordinated care and became a statewide program on July 1, 2021, In FY2022, a total of five (5) MCOs contracted to provide services under MMAI. The Managed Care map provides more information about the MCOs that are operating in the MMAI program by county, click here.

  MCOs providing services under MMAI are responsible for covering all Medicare and Medicaid services, including Long Term Services and Supports. Customers can opt out of MMAI at any time, as well as re-enroll at any time; however, customers that receive services in a nursing facility or under one of the Home and Community Based Services (HCBS) Waivers and request to opt out of MMAI are required to participate in the HCI program under MLTSS. More information can be found on the MMAI section of the HFS website.