Your Source for Health Reform

Topic: Medicaid Care Coordination



Illinois law requires 50% of Medicaid beneficiaries to be enrolled in coordinated care by 2015. Coordinated care plans include a choice of primary care physician, a care coordinator, and a provider network. They are available through managed care organizations or health provider groups. The plans vary by how they are reimbursed and designed, and some may offer some extra benefits, but all traditional Medicaid benefits are guaranteed.


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Advocating for Clients and Promoting Provider Networks in Medicaid Coordinated Care

This February 2013 presentation explains initiatives taking place in Illinois and offers key considerations regarding provider networks and client advocacy in the new delivery system. Presenters include representatives from from the Health Medicine Policy Research Group, Age Options, and Aetna Better Health of Illinois.

What Providers Need to Know about Care Coordination Entities

Care coordination entities work to form alternative models of delivering care to Medicaid clients through provider-organized networks, initially organized around the needs of Illinois’ most complex clients – seniors, and persons with disabilities, and children with complex medical needs. This 22-minute video of a webinar from the Illinois Department of Healthcare and Family Services was posted by Illinois Health Connect in December 2013.

Medicaid Integration Tracker Illinois

Watch for timely updates on implementation of Medicaid care coordination initiatives and other Illinois reforms such as the 1115 Waiver and the Balancing Incentive Program through this reform tracker from the National Association of States United for Aging and Disabilities.

Medicaid Consumer Engagement Toolkit

Federal guidance from the Centers for Medicare and Medicaid Services calls upon states to ensure the voices of older adults, persons with disabilities, and their caregivers, are heard in the design, implementation, and oversight of Medicaid demonstrations such as the Medicare Medicaid Alignment Initiative. This toolkit from Community Catalyst provides strategic guidance to providers and health plans on how to involve Medicaid consumers in developing a new delivery system.

Contract Negotiations with Health Plans

This article from a 2006 issue of the journal Family Practice Management shares still-pertinent recommendations for practicing health providers on how to successfully negotiate a contract with a health plan that protects provider interests. Included in this article are contract deal breakers and key parts of a contract that providers should seek before joining a network.

Types of Managed Care Entities

This concise two-page cheat sheet shared in September 2014 by the Children’s Services GOHIT subcommittee explains the differences among the various managed care entities.

Medicaid and Managed Care Toolkit

This collection of resources from the Make Medicare Work Coalition shares the ins and outs of Medicaid Care Coordination, including webinars, policy briefs, and fact sheets on the Integrated Care Program and the Medicare Medicaid Alignment Initiative.

The Who, What, and When of Medicaid Care Coordination

Medicaid in Illinois is moving into a care coordination system, but there are many new health plan options for Medicaid members. These health plan options vary by what Medicaid members are served, how the health plans are reimbursed, when they will start enrollment, and what additional services they provide. Learn the who, what, and when of Medicaid Care Coordination in this easy to navigate chart from Health & Disability Advocates.

Provider Network Options for Medicaid Care Coordination

This provider notice from HFS explains different care coordination models for family, children, and ACA adult Medicaid populations. It also provides contact information for providers to each of these health plans so they can contract to join provider networks.

Medicaid Managed Care Expansion Mail Schedule

This June 2014 chart from HFS details when letters will be sent to Medicaid members explaining mandated coordinated care options and how to enroll.

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