What is the Medicare-Medicaid Workforce Initiative?
Jointly administered by the Centers for Medicare & Medicaid Services (CMS) and the Illinois Department of Healthcare and Family Services (HFS), MMAI allows eligible beneficiaries in Illinois to receive their Medicare Parts A and B benefits, Medicare Part …
What is the Medicare-Medicaid alignment initiative?
The Medicare-Medicaid Alignment Initiative is one of Illinois' managed care programs. This program is for seniors and persons with disabilities who have full Medicaid and Medicare benefits. The Medicare-Medicaid Alignment Initiative started in Illinois in 2014. The program expanded to operate statewide effective 07/01/2021. Click here to see the counties with …
What are the State Plan amendments for Medicaid?
The Medicare-Medicaid Alignment Initiative is one of Illinois' managed care programs. This program is for seniors and persons with disabilities who have full Medicaid and Medicare benefits. The Medicare-Medicaid Alignment Initiative started in Illinois in 2014. It operates in the Greater Chicago and Central Illinois Regions.
When will Medicaid Managed Care become available in Illinois?
Medicare-Medicaid Alignment Initiative. On February 22, 2013, the Illinois Department of Healthcare and Family Services (HFS) received approval from the federal Centers for Medicare and Medicaid Services (CMS) to jointly implement the Medicare-Medicaid Alignment Initiative (MMAI). The MMAI is a groundbreaking joint effort to reform the way care is delivered to …
Is Mmai mandatory in Illinois?
Is enrollment in MMAI mandatory? MMAI is a mandatory program, but individuals can opt-out of the program at any time and receive their Medicare and Medicaid benefits separately, as they do today.
What does Mmai mean in insurance?
The Medicare-Medicaid Alignment Initiative (MMAI) is a statewide program for adults who are enrolled in both Medicare and Medicaid. When you enroll, you will choose a primary care provider (PCP) and health plan to cover all your healthcare.
What is Mmai in Illinois?
The Illinois Medicare-Medicaid Alignment Initiative (MMAI) is a managed care program for individuals that are eligible for both Medicaid and Medicare (referred to as “dual eligibles”). MMAI combines both medical care and non-medical “home and community-based services” into a single program.
What is the goal of Medicare and Medicaid?
Advancing Care for People with Medicaid and Medicare Our goal is to make sure dually eligible individuals have full access to seamless, high quality health care and to make the system as cost-effective as possible.Mar 10, 2022
Is Mmai better than Medicare?
MMAI plans should have more benefits, meaning they cover more services than traditional Medicare/Medicaid. However, they may not cover the same prescriptions that Medicare/Medicaid covered. In order to understand the coverage differences, you may contact any MMAI plan for details.Jun 10, 2021
What is Humana Gold Plus integrated?
The Humana Gold Plus Integrated plan combines your Medicare and Medicaid services, PLUS it includes coverage for prescription drugs. Some advantages include: You get the coverage of original Medicare PLUS extra benefits like rides to medical appointments, and added vision, hearing, and dental coverage.Jan 1, 2022
Can you have both Medicare and Medicaid in Illinois?
Illinois residents who are eligible for Medicare and Medicaid coverage and benefits can get it all through Humana Gold Plus® Integrated Medicare-Medicaid in Illinois. Through Humana Gold Plus Integrated, your Medicare and Medicaid coverage and benefits are combined into one plan—PLUS you get prescription drug coverage.Jan 1, 2022
What is the income limit for Medicaid in Illinois 2022?
This may include medical care/treatment/supplies, nursing home services, in-home personal care, Medicare premiums, and prescription drugs. Effective April 2022 – March 2023, the medically needy income limit (MNIL) in IL is $1,133 / month for an individual and $1,526 / month for a couple.Mar 25, 2022
What is Medi Illinois?
The Department of Healthcare and Family Services maintains a web site for the Medical Electronic Data Interchange (MEDI), on which registered users may verify an individual's Medicaid eligibility status. The web site contains information on how to use the system.
What are the differences between Medicare and Medicaid?
Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income.
How does the funding of Medicaid differ from the funding for Medicare?
Medicare is federally administered and covers older or disabled Americans, while Medicaid operates at the state level and covers low-income families and some single adults. Funding for Medicare is done through payroll taxes and premiums paid by recipients. Medicaid is funded by the federal government and each state.
Is Medicare a successful program?
Medicare's successes over the past 35 years include doubling the number of persons age 65 or over with health insurance, increasing access to mainstream health care services, and substantially reducing the financial burdens faced by older Americans.
What is the Medicare-Medicaid Alignment Initiative?
The Medicare-Medicaid Alignment Initiative is one of Illinois' managed care programs. This program is for seniors and persons with disabilities who have full Medicaid and Medicare benefits.
Why is the Medicare-Medicaid Alignment Initiative important for me?
The Medicare-Medicaid Alignment Initiative brings together all of your Medicare, Medicaid, and prescription drug benefits into one health plan. In the Medicare-Medicaid Alignment Initiative, you choose a health plan that is best for you.
Can I enroll in the Medicare-Medicaid Alignment Initiative?
Getting full Medicaid and Medicare benefits (Medicare Parts A and B and Medicaid without a spenddown),
How do I know which health plan is the right plan for me?
To choose the best health plan for you, you should think about your answers to these questions:
How do I enroll in the Medicare-Medicaid Alignment Initiative?
You can enroll in the Medicare-Medicaid Alignment Initiative at any time. To enroll in this program, call Illinois Client Enrollment Services at 1-877-912-8880 (TTY 1-866-565-8576). Call Monday to Friday, 8 a.m. to 7 p.m. The call is free!
What happens after I enroll in the Medicare-Medicaid Alignment Initiative?
Once you enroll in a Medicare-Medicaid Alignment Initiative health plan, you will get a health plan member handbook and a member ID card. Look for them in the mail. You will work with your health plan care coordinator to get the health care services you need. To learn more, call your health plan member services number.
Medicaid Managed Care Program Map
Find out which health plans serve your area. View the managed care program and plan choices by county on the Medicaid Managed Care Program Map.
Health plan choices
The links below will help you find out more about the health plans that serve your area. Each health plan has a network of providers including primary care providers (PCPs), specialists, hospitals and long term care facilities that you must use. You can find out more information using the plan links below.
What is a QIO in Medicare?
QIOs can assist Medicare beneficiaries and their caregivers understand and use quality measures information in their healthcare decision making process. For more information about QIOs or CMS survey and certification activities, see the " Related Links " section, below.
What is MACRA RFI?
The Centers for Medicare & Medicaid Services (CMS) announced today a Request for Information (RFI) for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). There will be a 30-day opportunity for responses.
What is CCSQ in healthcare?
CMS' Center for Clinical Standards & Quality (CCSQ), led by the CMS Chief Medical Officer and the CCSQ Leadership Team, is a cadre of professionals with diverse backgrounds in clinical, scientific, public health, legal, IT, project management, academic, and business management fields. We serve CMS, HHS, and the public as a trusted partner with a steadfast focus on improving outcomes, beneficiaries' experience of care, and population health, while also aiming to reduce healthcare costs through improvement.
What is CMS practice transformation?
Practice Transformation is a process that results in observable and measurable changes to practice behavior.
What is the CMS quality strategy?
The CMS Quality Strategy pursues and aligns with the three broad aims of the National Quality Strategy and its six priorities. Each of these priorities has become a goal in the CMS Quality Strategy. To learn more about the CMS Quality Strategy, and to provide feedback and public comment, please click on the following link: CMS Quality Strategy
What is a physician quality reporting program?
The Physician Quality Reporting Programs Strategic Vision (or “Strategic Vision”) describes a long-term vision for CMS quality measurement for physicians and other health care professionals and public reporting programs, and how they can be optimized and aligned to support better decision-making from doctors, consumers, and every part of the health care system . This Strategic Vision articulates how we will build upon our successful physician quality reporting programs to help achieve the CMS Quality Strategy’s goals and objectives, and therefore contribute to improved healthcare quality across the nation. Access the Strategic Vision by clicking this link: Physician Quality Reporting Programs Strategic Vision (PDF)
What is CMS quality management system?
Known as the Measures Management System (MMS), this system is composed of a set of business processes and decision criteria that CMS funded measure developers follow in the development, implementation, and maintenance of quality measures. The steps in the measure development process are summarized in the document " Quality Measures Development Overview, " which is available as a downloadable file in the " Downloads " section, below.
How long does it take to get medicaid?
The Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed even further. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, despite the law, applications are sometimes delayed even further.
How long does it take for a medicaid application to be approved?
In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, despite the law, applications are sometimes delayed even further.
What is an MCO in Illinois?
A MCO is essentially a private healthcare company. The MCO has a network of care providers and program participants receive services via these providers. Within several counties of Illinois, there are a few managed care plans from which to choose. The Medicare-Medicaid Alignment Initiative is a mandatory Medicaid program for persons who require ...
How to apply for MMAI in Illinois?
To apply for the MMAI, one must apply for IL Medicaid. This can be done via one’s local Department of Human Services’ Family Community Resource Center (FCRC). One can find their local office here. Alternatively, persons can call the Bureau of Customer Inquiry and Assistance at 1-800-843-6154 to locate one’s local office. A needs assessment will be completed as part of the application process to determine if the nursing home level of care need is met.
What counties are eligible for Medicare in Illinois?
At the time of this writing, one must reside in one of the following 21 counties: Champaign, Christian, Cook, DeWitt, DuPage, Ford, Kane, Kankakee, Knox, Lake, Logan, Macon, McLean, Menard, Peoria, Piatt, Sangamon, Stark, Tazewell, Vermilion, or Will. Please note that this program will be available statewide beginning July 1, 2021. Additional eligibility criteria are as follows, alternatively one can take a quick, non-binding IL Medicaid eligibility test here.
What is the income limit for 2021?
In 2021, an applicant, regardless of marital status, can have a monthly income up to $1,073. When both spouses are applicants, the monthly income limit for the couple is $1,452.
How much can a spouse keep on Medicaid?
In this case, the applicant spouse can retain up to $2,000 in assets and the non-applicant spouse can keep up to $109,560. This larger allocation of assets to the non-applicant spouse is called a community spouse resource allowance. Some assets are not counted towards Medicaid’s asset limit.
How does CMS work with Massachusetts?
CMS and Massachusetts will work together to ensure there are multiple communication points for providing understandable information to beneficiaries. Clear notices – at multiple points and times – will be required to ensure that beneficiaries know of their benefits, rights, and choices and can make an informed decision about whether to remain in the assigned plan, choose a different plan, or opt-out. In addition, CMS has announced, in concert with the Administration for Community Living, a new funding opportunity to support outreach, education and counseling for Medicare-Medicaid enrollees eligible for the new programs through the State Health Insurance Programs (SHIPs) and the Aging and Disability Resource Centers (ADRCs).
What is SCO in Massachusetts?
The Senior Care Options (SCO) program in Massachusetts is a comprehensive, integrated and coordinated managed care plan that includes all services covered by Medicare and MassHealth (Medicaid) and currently enrolls low-income seniors ages 65 and older. Medicare-Medicaid enrollees in Massachusetts who are under age 65 do not currently have access to this integrated care program; therefore, the Demonstration is focusing on this population.
What is financial alignment?
The Financial Alignment Demonstration seeks to better serve people who are enrolled in both Medicare and Medicaid by testing a person-centered, integrated care model that provides a more easily navigable and seamless path to all Medicare and Medicaid services. Expected outcomes include: improved beneficiary experience of care, fewer avoidable hospitalizations and emergency room visits, and greater independence in the community and at home for seniors and people with disabilities.
Does CMS monitor the demonstrations?
Yes. CMS is funding and managing the evaluation of each state Demonstration. CMS has contracted with an external independent evaluator, RTI International, to measure, monitor, and evaluate the overall impact of the Demonstrations, including impacts on Medicare and Medicaid expenditures and service utilization. There will be a unique, Massachusetts-specific evaluation plan for the Demonstration, as well as a meta-analysis that will look at the Demonstration overall.
What are NCCI edits?
The NCCI contains two types of edits: 1 NCCI procedure-to-procedure (PTP) edits that define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported. 2 Medically Unlikely Edits (MUEs) define for each HCPCS/CPT code the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service.
What is the NCCI methodology?
Section 6507 of the Affordable Care Act requires states to use “compatible” NCCI methodologies in paying applicable Medicaid claims. If a state determines and documents that there is no other feasible way to comply with Medicaid NCCI edits, the state can send a request to deactivate that edit or those individual edits to the NCCI Contractor using the NCCI mailbox at [email protected] . States are no longer required to send NCCI deactivation requests to CMS Regional Offices.
