Medicare-Medicaid Alignment Initiative- Illinois
Program Location:
Chicago, IL
Payer Type:
Medicare
Medicaid
Parent Program:
Payers:
Medicaid
Medicare
Reported Outcomes
Description:
On February 22, 2013, the Illinois Department of Healthcare and Family Services (HFS) received approval from the federal Centers for Medicare and Medicaid Services (CMS) to jointly implement the Medicare-Medicaid Alignment Initiative (MMAI). The MMAI is a groundbreaking joint effort to reform the way care is delivered to clients eligible for both Medicare and Medicaid Services (called “dual eligibles”). The MMAI demonstration project will provide coordinated care to more than 135,000 Medicare-Medicaid enrollees in the Chicago area and throughout Central Illinois beginning January 2014 through December 2016.
Under the Demonstration, health plans will be responsible for assessing Medicare-Medicaid enrollees’ medical, behavioral health, long-term services and supports, and social needs. Based on the results of the assessment and an analysis of available data, plans will stratify enrollees into three risk groups based on need. Medicare-Medicaid enrollees and their caregivers will work with an interdisciplinary care management team to develop person-centered, individualized care plans. Each health plan will also be responsible for developing and operating specialized programs to assist with transition of care and to reduce avoidable hospital and nursing facility admissions. Beneficiaries will also have 24-hour telephonic access to medical professionals.
Learn more about the program from this CMS Fact Sheet.
Payment Model:
CMS and the state of Illinois will each contribute to the global capitation payment. CMS and the state of Illinois will each make monthly payments to Demonstration Plans for their components of the captiated rate. Demonstration Plans will receive three monthly payments for each enrollee: one amount from CMS reflecting coverage of Medicare Parts A/B services, one amount from CMS reflecting coverage of Medicare Part D services, and a third amount from the HFS reflecting coverage of Medicaid services. Both baseline spending and payment rates are under the Demonstration for Medicare A/B services are calculated as PMPM standardized amounts for each Demonstration county. For more information on the payment model, review the HFS Rate Report
Fewer ED / Hospital Visits:
- Measured against the comparison group, the Illinois demonstration group had fewer monthly inpatient admissions, emergency room (ER) visits, and skilled nursing facility (SNF) admissions.
Cost Savings:
- The results of preliminary Medicare cost savings analyses using a difference-in-differences regression approach indicate savings due to the Illinois demonstration over the period March 2014-December 2015.
Other Outcomes:
- Enrollee ratings of their health plans improved from 2015 to 2016 for nearly all MMPs. In 2016, the proportion of enrollees rating their plans as a 9 or 10 on the CAHPS survey ranged from 49 to 66 percent.
Last updated June 2019
