Illinois’ Health Benefits for Immigrant Seniors (HBIS) and Health Benefits for Immigrant Adults (HBIA) programs have operated in a fee-for-service environment since their inception. Recently, the Illinois Department of Healthcare and Family Services (HFS) announced that most HBIS and HBIA program enrollees will be moved to managed care beginning January 2024. Remaining within the fee-for-service program will be those customers who receive their health coverage through Spenddown (HBIS only), who have private health insurance that covers hospital and doctors’ visits, or who meet certain other specific criteria.

Background

On July 1, 2023, HFS issued emergency rules to address concerns that healthcare costs for HBIS and HBIA could exceed the allocated annual budget for these programs. The rules in part involved capping enrollment into the program and allowing providers to institute co-pays and other cost-sharing. Media reports at the time indicated that moving enrollees to managed care would also be pursued to contain costs.



HFS recently shared their plans for the transition of HBIS/HBIA customers to managed care starting January 1, 2024. To begin, HFS will first prioritize enrollment of those customers who have a family member already enrolled in a Medicaid Managed Care Organization (MCO), known in Illinois as a HealthChoice Illinois plan. Those with a family member in a HealthChoice Illinois plan will be assigned to that same plan. HFS will then transition clients alphabetically by last name. A detailed timeline describing client grouping, cutoff dates, and enrollment start dates can be found below and in this HFS slide deck.

Transition Timeline From HFS Slides

About six weeks before their transition, clients will receive a letter instructing them to choose a plan; if no decision is made by the 18th of the month prior to the managed care plan enrollment date listed on their notice, they will be auto-assigned to a plan. The enrollment start date will be the first day of the following month after the cut-off date. Clients will be given a 3-month period after their enrollment start date to switch plans. The next time they can choose a new plan will be during their annual open enrollment period.

In regards to the potential implementation of co-pays granted under the emergency rules, CountyCare has announced that they will not charge their HBIS/HBIA plan members copays. We await the publication of an expected HFS provider notice to learn if the remaining Health Choice Illinois plans will implement co-pays.

Additional details of the managed care transition, including sample notices, the enrollment process, care coordination, and language access can be found by clicking on the HFS slide deck. As always, if you have questions, please reach out to Avisery at 708-628-3440 or via email at avisery@ageoptions.org.

Avisery by AgeOptions provides tools and support to professionals serving older adults and people with disabilities, enabling them to help their clients access healthcare coverage that allows them to thrive as they age. To sign up for our Avisery email list and receive information on upcoming trainings, webinars and more, please click here.