HFS Awards New HealthChoice Illinois Medicaid Managed Care Contracts

New contracts will make significant long-term improvements to the Medicaid program

The Illinois Department of Healthcare and Family Services (HFS) has awarded new HealthChoice Illinois (HCI) contracts to six Medicaid Managed Care Organizations (MCOs). The new contracts will make significant improvements to the way that the Medicaid program operates by holding the MCOs accountable for how they serve customers by promoting whole person care. The new contracts now require MCOs to improve the integration of physical and behavioral healthcare with a focus on health-related social needs that drive health outcomes, ensure equitable access to quality care and culturally competent services, pay for value to drive health outcomes, and nurture strong partnerships with providers, community members, MCOs and other stakeholders.

"These contracts represent a commitment to the millions served by the Illinois Medicaid program," said HFS Director Elizabeth M. Whitehorn. "Accountability for health outcomes and collaboration focused on improving patient care are central to our efforts to promote greater transparency and state oversight. Increased resources and a better customer experience overall are keenly reflected, ensuring awards for measurable improvements."

With approximately 2.4 million Medicaid customers enrolled with a HealthChoice Illinois plan, this program impacts nearly 20% of Illinois residents and serves the majority of the Illinois Medicaid program's roughly 3.1 million enrollees. The new contracts mark a major milestone for the HCI program, representing the first competitive procurement of these contracts under the Illinois Procurement Code and the first procurement of the HCI contracts since 2018. Contract development included extensive stakeholder and subject matter expert feedback in an effort to strengthen the HCI program across the board.

Contracts were formally awarded on June 8 to the following vendors:

• Aetna Better Health of Illinois Inc.
• Blue Cross and Blue Shield of Illinois
• Humana Benefit Plan of Illinois, Inc.
• Meridian Health Plan of Illinois, Inc.
• Molina Healthcare of Illinois, Inc.
• CountyCare Health Plan (For Cook County only)

Vendors were selected through a competitive procurement process based on their commitments to provide high-quality, accessible and accountable managed care services to Illinois Medicaid customers. The initial contract term is 4.5 years, with an opportunity to renew for an additional 5.5 years.

Under the new contracts, customers will have more supportive and integrated care coordination with improved screenings and targeted resources to support their needs in their communities. They will also have improved access to needed appointments in a timely manner near their homes with tightened minimum time and distance standards, as well as a more accessible call centers with expanded hours and increased access to resources that address health-related social needs. Customers with long-term care needs will be enabled to live in their chosen setting through additional access to Home and Community-Based Services, promoting quality of life and wellbeing.

Providers will see a lower burden through a more streamlined administrative process and strengthened provider technical assistance, which includes a requirement for MCO-provided training for a variety of provider types, including doulas, midwives and behavioral health providers.