Yesterday, Dec 8th, The Arc and other advocates met with Health and Family Services Director Hamos and Jim Parker to discuss implementation of Phase One of the Integrated Care Pilot. Representatives from Aetna and Illini Care were also there to discuss issues with the advocates.

The biggest concern about the implementation of Phase One of the Integrated Care Pilot remains the recruitment of physicians, specialists and hospitals into the networks of Aetna and Illini Care. Both of these Managed Care Organizations are currently engaged in aggressive recruitment strategies with health care providers.

It appears that the main objection physicians have to Integrated Care is that they will be overwhelmed with Medicaid patients if they join either network. This is in fact untrue. Physicians can limit the number of Medicaid patients they serve. They can also limit the Medicaid patients they serve to current patients. If the physicians join the network, they are paid promptly by Aetna and Illini Care and do not have to wait for months to be paid by the state. It is unfortunate that groups like Loyola continue to oppose the Integrated Care Pilot.

Jim Parker stated that “out of network” services are coming to an end unless your services are part of your continuity of care. After the first of the new year, Aetna and Illini Care will begin redirecting Medicaid patients into “network” only health care providers. So, it is in your best interest to advocate with your physician to join the network,or you should be seeking other physicians for your health care needs. There are, of course, exceptions to this policy.

There has been considerable growth of the physician and hospital network in the first year of operation. Here are some figures:

Aetna Network June, 2011 Nov, 2011

Primary Care Physicians 659 1,850
Specialists 758 3,227
Hospitals 29 50

Illini Care Network June, 2011 Nov, 2011

Primary Care Physicians 708 1,651
Specialists 1,063 3,600
Hospitals 37 47

Both MCO’s indicated that Provenia St. Joseph in Joliet has joined the networks, and they, both expect Silver Cross in Joliet to join shortly.

To date, about 35,000 Medicaid individuals have been signed up into the networks. About 63% were automatically enrolled into a network because they did not choose a specific network.

Once you have selected a network or have been automatically enrolled into a network, you must wait one year to select another network. You are only able to choose another network on your anniversary date of enrollment.

Phase Two of the Integrated Care Pilot, which includes all long term care, home services and other waiver services except developmental disabilities, is scheduled to begin in the summer of 2012.

Phase Three of the Integrated Care Pilot, which includes all developmental disability services, is scheduled to begin in the summer of 2013. The Arc of Illinois continues to oppose Phase Three of the Integrated Care Pilot.

HFS will also be issuing another request for proposals on Integrated Care for Dual Eligibles (persons eligible for both Medicare and Medicaid), sometime after the beginning of the new year.

Our staff at Illinois Life Span and our Family to Family Health Education Center will be there to provide you with additional information on the Managed Care Pilot.
Tony Paulauski
Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423
815-464-1832 (OFFICE)
815-464-1832 (CELL)