Dear Avisery Members,
In November 2021, HFS mailed out the last group of Medicare-Medicaid Alignment Initiative (MMAI) passive enrollment letters, directed primarily at about 4500 beneficiaries receiving Medicaid Managed Long Term Services and Supports (MLTSS) who have not yet been enrolled in MMAI plans. This coverage will be effective February 1, 2022. This Avisery alert provides some background on these two types of plans and answers common questions that professionals and beneficiaries may have about them.
BACKGROUND
MMAI is a Medicaid managed care program in Illinois that combines an individual's Medicare, Medicaid and prescription drug coverage together with their long-term services and supports (LTSS) under one plan. LTSS services include HCBS waiver benefits, like homemakers, adult day services, and emergency home response, as well as coverage of custodial nursing home care, transportation, and some behavioral health services. In Illinois, all LTSS services are managed either through an MMAI plan or through a Medicaid Long-Term Services and Supports (MLTSS) plan.
Prior to July 2021, MMAI plans operated only in certain counties of the state, and residents of non-MMAI counties had access to long-term services and supports through MLTSS plans only. Since July, 2021, Illinois has been expanding passive enrollment into MMAI plans for dually-eligible Medicare/Medicaid beneficiaries in all counties except for Wabash, Massac, and Rock Island Counties. In every county in Illinois, individuals may “opt-in” (enroll voluntarily) into MMAI.
COMMON QUESTIONS ABOUT MMAI AND MLTSS PLANS
If a dually-eligible person who is currently receiving long-term services and supports through an MLTSS plan receives an MMAI letter, what are their options?
If they take no action, they will be enrolled in the MMAI plan specified in the passive enrollment letter, and the new plan will become effective as of February 1, 2022. At any time, they may also choose a different MMAI plan or opt out of MMAI and stay with their MLTSS plan. They can compare HealthChoice Illinois MLTSS plans and MMAI plans at https://www.enrollhfs.illinois.gov/en/Compare-plans. To opt out of MMAI or choose a different plan, they must call Client Enrollment Services at 1-877-912-8880.
If a dually-eligible person who is currently receiving long-term services and supports through an MLTSS plan is passively enrolled into their assigned MMAI plan, or if they choose to enroll in a different MMAI plan, what happens if they later decide they want to leave their MMAI plan?
Beneficiaries may leave their MMAI plan at any time and return to original Medicare with Part D or a Medicare Advantage plan and fee-for-service Medicaid. However, beneficiaries who receive LTSS and opt out of MMAI cannot opt out of Medicaid managed care for coverage of their LTSS and therefore must enroll in an MLTSS plan. When someone with LTSS services managed by their MMAI plan calls Client Enrollment Services to opt out of MMAI, Illinois Client Enrollment Serices will ask the beneficiary to select a MLTSS plan. If the beneficiary does not a enroll in an MLTSS plan that they choose on their own, HFS will enroll them into an MLTSS plan. The beneficiary is additionally auto-enrolled into a Medicare Part D stand-alone drug plan if they do not select and enroll in a Part D or Medicare Advantage plan on their own.
In the future, if a dually-eligible Medicare/Medicaid member becomes eligible for LTSS, what will their options be?
As stated above, beneficiaries cannot opt out of Medicaid managed care for coverage of their LTSS. If they are already receiving Medicare and Medicaid through an MMAI pan, they will begin to receive their new LTSS services through their current MMAI plan. If they have chosen instead to keep separate Medicare and fee-for-service Medicaid, they must enroll in an MLTSS plan to get their new LTSS services. Their third option is that they can elect to switch into an MMAI plan, even if they previously opted out of MMAI. They can compare HealthChoice Illinois MLTSS plans and MMAI plans at this link or they can call Client Enrollment Services at 1-877-912-8880. Regardless of which option they choose for receiving their new LTSS services, switching into or out of an MMAI plan will be possible at any time.
Click here to access the HFS explanation of the MMAI program: MMAI Brochure
As always, if you have any questions, please do not hesitate to contact us at avisery@ageoptions.org or call 708-628-3440.
