|
This alert contains updates to the Health Benefit for Immigrant Adults (HBIA) and Health Benefits for Immigrant Seniors (HBIS) program that are going into effect this year. These updates include 1) the implementation of copays for some participants beginning February 1st and 2) the availability of care in a skilled nursing facility under certain circumstances.
BACKGROUND ON HBIA AND HBIS
Health Benefits for Immigrant Seniors (HBIS) and Health Benefits for Immigrants Adults (HBIA) are state-funded programs that provide health care coverage for those who do not qualify for federally funded Medicaid in Illinois due to their immigration status. For more information on the programs, click here for HBIS and here for HBIA.
On June 16, 2023, the Department of Healthcare and Family Services (HFS) filed emergency rules for the HBIS and HBIA programs that, among other chances, authorized the implementation of copays for certain services. Click here to read the full notice.
HFS also recently announced that HBIS and HBIA will transition to managed care starting January 1, 2024. Click here to read Avisery’s alert on the phased enrollment of participants into HealthChoice Illinois plans. A small number of individuals will remain in Fee-For- Service (FFS). For example, those who are in HBIS due to Spenddown will not be eligible for Medicaid managed care.
UPDATES ON COPAYS
In a recent Provider Notice, HFS stated that copays for the HBIS/HBIA programs will begin February 1, 2024. These copays include:
- Non-emergency inpatient hospitalization: $250
- Non-emergency emergency room visit: $100
- Hospital or Ambulatory Surgical Treatment Center Outpatient Services: 10% of Department rate.
For individuals that remain in FFS Medicaid, there may be some providers that elect to not charge any copays. For individuals in Medicaid managed care, HFS has released a comparison chart that shows which HealthChoice Illinois plans are waiving all or some of the copays. Click here for the comparison chart (on page 2). Currently, only CountyCare is waiving all copays.
The copays are only applicable to non-emergency hospital billed services. For example, if an individual sees a physician in a hospital setting and the physician is in a physician group but the physician bills under the physician group National Provider Identifier (NPI), the individual will not have a copay.
HFS is doing a phased transition into Medicaid managed care for HBIS/HBIA individuals. Individuals are notified about the transition by having an enrollment packed sent to them. The first two cohorts of the transition did not have information regarding copays included in their enrollment packet. HFS has sent a letter to the first two cohorts regarding copays. Click here to see the sample letter of the copayment. This letter is now included in enrollment packets moving forward. HFS is encouraging MCOs to educate providers about the copays, so providers can understand and inform HBIA and HBIS individuals about the cost of their medical care.
COVERAGE FOR 90 DAYS IN A SKILLED NURSING FACILITY
Before the transition to managed care, rehabilitation care was only covered in a hospital, not a skilled nursing facility. According to a December 28, 2023 Provider Notice, individuals that are a part of the HBIA and HBIS program who are in a Managed Care Organization (MCO) are eligible as of January 1, 2024, to receive coverage for 90-days at a skilled nursing facility per episode when they require medically necessary rehabilitation services. There may be prior authorization for this benefit. This benefit does not apply to those individuals in FFS Medicaid and does not cover Long Term Services and Supports in such facilities.
HBIA AND HBIS LANDING PAGE
HFS has created a landing page on their website for the HBIA and HBIS program that can be found under “MyHealthcare”. On the website there is information on HBIA, HBIS, the MCO enrollment sample letter, MCO copay comparison chart, and copayment sample letter. Also, users can use the translation widget to translate in many languages. The translation widget is a drop-down menu located in the top right corner of the site labeled “Select Language”.
Click here to visit the webpage.
If you have any questions, please feel free to email avisery@ageoptions.org
| 
