This section of our website includes information on the Blue Cross Community MMAI (Medicare-Medicaid Plan) SM , Blue Cross Community Integrated Care Plan (ICP) SM , Blue Cross Community Family Health Plan SM (FHP) and Blue Cross Community Managed Long Term Supports and Services SM (MLTSS). Blue Cross and Blue Shield of Illinois (BCBSIL) has a network of independently contracted providers including physicians, hospitals, skilled nursing facilities, ancillary providers, Long-term Services and Support (LTSS) and other health care providers through which MMAI, ICP, FHP and MLTSS members may obtain covered services.
The Centers for Medicare Medicaid Services (CMS) and the State of Illinois have contracted with Blue Cross and Blue Shield of Illinois (BCBSIL) along with 5 other Managed Care Organizations to implement MMAI.
- MMAI is a 3-year demonstration plan developed to better serve individuals eligible for both Medicare and Medicaid.
- This combines Medicare and Medicaid funding under a blended payment agreement to provide integrated, comprehensive care to benefit dual-eligible enrollees.
- BCBSIL is one of 6 health plans in the Greater Chicago area to participate in the demonstration.
- BCBSIL will provide services to MMAI members in 6 counties: Lake, DuPage, Kane, Cook, Will and Kankakee.
The Illinois 2011 Medicaid Reform Law requires the Medicaid plan to enroll at least 50% of Medicaid members into coordinated care/managed care by Jan. 1, 2015.
- ICP is for seniors and adults, 19 and older, with disabilities and Medicaid only (no Medicare).
- BCBSIL will provide services to ICP members who live in Cook, DuPage, Kane, Kankakee, Lake and Will Counties.
The Illinois Department of Healthcare and Family Services (HSF) has entered into a contract with Blue Cross and Blue Shield of Illinois (BCBSIL) to offer the FHP beginning Oct. 1, 2014. FHP will be offered to eligible participants in six Illinois counties: Cook, DuPage, Kane, Kankakee, Lake and Will.
The Blue Cross Community Family Health Plan is a program for children under 19, their parents who live with them or a relative acting as caretaker, as well as pregnant women. FHP also covers the Affordable Care Act (ACA) expansion population, which includes the newly eligible adult population of Illinois residents between the ages of 19 and 64 whose monthly income is less than 138 percent of the federal poverty level.
MLTSS refers to the delivery of long term supports and services through Managed Care Organizations. It was designed to expand home and community based services, provide better care coordination and ensure quality and efficiency. MLTSS is a mandatory program for dual eligible members who have elected to opt out of the MMAI program and are receiving long term supports and services in the community or at a facility. The MLTSS program includes Home and Community Based Services, Nursing Home Care, Medicaid-Covered Services: Non-emergent Transportation, Behavioral Health, and Substance Abuse. Blue Cross Community MLTSS is available to members who live in Cook, DuPage, Kane, Kankakee, Lake and Will Counties of Illinois.
Objectives and Goals
Together, MMAI, ICP, FHP and MLTSS are designed to improve accessibility and availability of care with a focus on maintaining our members independence. Learn more
Potential Members and the Enrollment Process
Individuals may enroll for MMAI, ICP, FHP and MLTSS when specific criteria are met. Medicaid Waivers also may apply to MMAI, ICP, FHP and MLTSS members who meet all other criteria. According to State regulations, MMAI enrollment is voluntary; MLTSS is a mandatory program for dual eligible members who elect to opt out of the MMAI program and are receiving long term supports and services in the community or at a facility; ICP and FHP enrollment is required for Medicaid members. Learn more
Person Centered Practice, Care Coordination and the Interdisciplinary Care Team
A person centered practice involves primary health care that is relationship-based with a focus on the individual. Coordination by a health care team is critical to help ensure that each member receives all services as needed, according to their health benefit plan. Learn more
Critical Incidents Health, Safety and Welfare
To help ensure the health, safety and well-being of vulnerable individuals, it is important to report critical incidents of abuse, neglect and financial exploitation to the appropriate authorities. Learn more
Long Term Services and Supports, Home and Community Based Waivers
Under the Affordable Care Act (ACA), there will be greater access to Home and Community Based Services (HCBS) through Long Term Services and Supports (LTSS) providers who provide medical and non-medical services to seniors and people with disabilities in need of sustained assistance. Learn more
Provider Training Requirements and Resources
It is a CMS and State of Illinois requirement for BCBSIL to make available training on certain topics related to MMAI, ICP, FHP and MLTSS. Several training modules and other learning opportunities are available and completion of training is mandatory for specified provider types. Learn more