Medicaid Changes Ahead: Need Help Navigating HealthChoice Illinois?

The State of Illinois has made some big changes to Medicaid this year, expanding its HealthChoice Illinois managed care program to all counties statewide. HealthChoice Illinois has been in place for several years in more densely populated areas like Winnebago and Cook counties.

What does that mean for me?

If you're covered by Medicaid, you may have a bit more paperwork to do this year. As you have in the past, you'll need to continue to choose your Primary Care Provider. In addition, beginning this year, you'll need to choose a Health Plan.

HealthChoice Illinois is working with 5 insurance companies to coordinate care for Medicaid residents throughout the state in 2018. FHN is working on a contract with Meridian Health Plan.

Your choice of Health Plan affects what providers you can receive healthcare from, so choosing your Health Plan is an important step!

If you haven't already, you will soon receive a packet in the mail from the State of Illinois. This packet outlines the new HealthChoice Illinois program and automatically assigns you to one of the 5 insurance companies providing care (Health Plans) and a healthcare provider (Primary Care Provider).

Why do I need to choose a Health Plan if I've already been assigned to one?

You have 30 days after the date on the letter to call in and request the Health Plan and Primary Care Provider of your choice. If you are assigned to a Health Plan that doesn't have a contract with FHN, you won't be able to receive your healthcare from an FHN provider. Until contracts are signed, you will need to let the auto-assignment take place. FHN will send letters and publish when contracts are completed. At that time, members will want to call back to update their health plan and/or their Primary Care Provider.

When does the new plan go into effect?

The HealthChoice Illinois plan goes into effect April 1.

What if I don't do anything?

For the first 90 days of coverage, current members and any new Medicaid member can call in and change his or her Health Plan to one that meets your needs. After that, you will have to remain with your current Health Plan until the new enrollment period at the end of the year. If you are assigned to a Health Plan not under contract with FHN and do not call in to change your Health Plan, you will have to receive your healthcare from a provider who is contracted with your plan.

Do I have to keep the Primary Care Provider I am assigned?

No. You can change your Primary Care Provider every 30 days.

Will some patients have different or additional requirements?

Yes. Patients covered under the Medicaid program who have Medicare as their primary will not have to move to managed care at this time with exception of those covered under Medicaid for long term care like a nursing home. They will have the effective date of 4/1 and should receive an enrollment packet.

Also, patients qualifying for Medicaid under the DCFS Youth or Special Needs Children programs will transition to managed care later this year.

Where can I get the most up-to-date information?

You can call the FHN Central Business office at 815-599-7950 for more information. We will be mailing out a letter to our current Medicaid members soon to let you know what contracts are signed and which Health Plans we are working with.

You can call in to HealthChoice Illinois toll-free 1-877-912-8880, 8 a.m. to 7 p.m. each Monday through Friday for more information or to choose your Health Plan and Primary Care Provider.

You can also choose your Health Plan and Primary Care Provider online at enrollhfs.illinois.gov.