The Medicare Medicaid Alignment Initiative (MMAI):

1. The Medicare Medicaid Alignment Initiative (MMAI): A Healthcare Option for People with Medicare and Medicaid in Illinois Updated June 2018

2. What We Will Discuss Today • What is the Medicare Medicaid Alignment Initiative (MMAI) and what does it cover? • Can I join an MMAI plan and how? • What should I consider before choosing an MMAI plan? • What are my rights in an MMAI plan?

3. What is the Medicare Medicaid Alignment Initiative (MMAI)?

4. What is the Medicare Medicaid Alignment Initiative (MMAI)? Original Medicare + Medicaid MMAI home health doctor visits lab tests skilled nursing medical equipment hospital dental care prescription drugs transportation Long term care In MMAI, you can receive all health benefits through oneplan and just use one card when you go to the doctor, hospital, or pharmacy.

5. What Services Does MMAI Cover? MMAI health plans must cover all of the services that Medicare and Medicaid cover, including: • Doctor visits • Hospital stays • Home health • Medical equipment • Lab tests • Ambulance • Skilled nursing care • Prescription drugs • Hearing and vision services • Mental/behavioral health and substance use services • Transportation • Long term services and supports (LTSS) - services provided in a nursing home, supportive living facility (SLF) or in your home through the Community Care Program or Department of Rehabilitative Services

6. Additional Services MMAI Covers All MMAI plans offer Care Coordination services to help with: • Navigating the healthcare system and scheduling appointments • Managing chronic health conditions • Finding resources • Requesting coverage for services/prescription drugs that are not typically covered by the plan

7. Additional Services MMAI Covers • Additional Benefits that MMAI plans maycover: • Extra dental, vision, or transportation services • $0 copay for prescription drugs • Over-the-counter (OTC) medications and supplies • Gym memberships or fitness classes • Gift cards for receiving certain preventive healthcare services

8. What Does MMAI Cost? • MMAI plans are not allowed to charge you more than what you would be charged under Medicare or Medicaid • Some MMAI plans offer $0 copays for prescription drugs or other services that would have a copay under traditional Medicare and Medicaid coverage • You may have to follow certain rules in your plan, such as going to in-network doctors and providers

9. Can I join an MMAI plan and how?

10. Who Can Join an MMAI Plan? • To enroll in an MMAI health plan, you must: • Have Medicare Part A and Medicare Part B AND • Have full Medicaid benefits (no spenddown) AND • Be age 21 or older AND • Live in one of these counties: • Chicago area: Cook, DuPage, Kane, Kankakee, Lake, Will • Central Illinois: Champaign, DeWitt, Ford, Knox, McLean, Peoria, Stark, Tazewell, Vermilion

11. Who Cannot Join an MMAI Plan? You cannot enroll in MMAI if you have: • Medicaid with a spenddown • Temporary Medicaid benefits • Medicaid benefits through the Breast and Cervical Cancer program or Health Benefits for Workers with Disabilities program • Private “third party” insurance (such as an employer or retiree health plan) Adults with developmental disabilities (DD) who receive care through Medicaid DD Waiver programs (Home and Community Based Services (HCBS) or Institutional) are also not currently allowed to enroll in MMAI.

12. How do I join an MMAI plan? • Call Illinois Client Enrollment Services (CES):(877)912-8880 TTY: (866)565-8576 • For help comparing MMAI plans and considering your options, call the Illinois Senior Health Insurance Program (SHIP) at (800)252-8966.

13. What MMAI Plans Can I Choose? • Kankakee: • Aetna Better Health • Blue Cross Community MMAI • Humana Health Plan • IlliniCare Health • Cook, DuPage, Kane, Will: • Aetna Better Health • Blue Cross Community MMAI • Humana Health Plan • IlliniCare Health • Meridian Complete • Champaign, DeWitt, Ford, Knox, McLean, Peoria, Stark, Tazewell, Vermilion: • Molina Healthcare • Lake: • Blue Cross Community MMAI • Humana Health Plan • IlliniCare Health

14. Do I Have to Join an MMAI Plan? • Joining an MMAI plan is voluntary. No one is required to enroll in MMAI. • If you enroll in MMAI, you can change your plan or opt of the program at any time. • If you opted out of MMAI in the past, you can still voluntarily enroll at any time.

15. MMAI Automatic Enrollment • Cook, DuPage, Kane, Kankakee, Lake and Will Counties have automatic enrollment. • When you first become eligible and live in these counties, you will get a letter telling you that you will be automatically enrolled into an MMAI plan. • You can choose to “opt out” of the program or join a different MMAI plan than the plan listed in your automatic enrollment letter.

16. What Should I Consider Before Choosing an MMAI Plan?

17. What Should I Consider Before Choosing an MMAI Plan? • Are your health care providers in the plan’s network? • Does the plan cover your prescription drugs? • Does the plan require prior authorization or other restrictions on any of your prescription drugs? • Does the plan offer extra benefits that might be helpful to you? Check all of these by calling Illinois Client Enrollment Services at (877)912-8880 TTY: (866)565-8576) or visiting the Illinois Client Enrollment Services website at https://enrollhfs.illinois.gov.

18. Consider If You Have Long Term Services and Supports • Long Term Services and Supports (LTSS) are services that help with activities of daily life, like bathing, dressing, eating, cleaning/doing laundry, etc. • LTSS are provided in Illinois… …in long term care facilities (nursing homes) …in Supportive Living Facilities (SLF) …through in-home services programs called “Medicaid Waiver” programs, such as the Community Care Program and several programs that are run by the Department of Rehabilitative Services (DRS) (the Persons with Disabilities Waiver, the Waiver for individuals with Traumatic Brain Injury (TBI), and the AIDS Waiver) • All MMAI plans cover LTSS for members who need them.

19. HealthChoice Illinois for Long Term Services and Supports • You must enroll in a managed care plan from HealthChoice Illinois for LTSS if: • You live in Cook, DuPage, Kane, Kankakee, Lake, or Will countiesand • Are eligible for MMAI but not in an MMAI plan,and • Receive long term services and supports

20. HealthChoice for Long Term Services and Supports • People who are eligible for MMAI, receive Long Term Services and Supports and live in Cook, DuPage, Kane, Kankakee, Lake and Will Counties have TWO options: • Enroll in an MMAI plan to cover all healthcare services, including LTSS or • Stay in Original Medicare and Medicaid for your medical services and enroll in a HealthChoice Illinois plan for Long Term Services and Supports.

21. Example: Mr. and Mrs. Smith Choose Their Health Coverage

22. Mr. and Mrs. Smith • Mr. Smith and Mrs. Smith are both eligible for MMAI and live in Cook County. • They have a worker who comes into their home to help with cooking and cleaning through the Community Care Program. • Mr. and Mrs. Smith opted out of MMAI in the past and have been receiving their Community Care Program Services through a HealthChoice Illinois plan.

23. Mr. and Mrs. Smith After talking with a SHIP counselor about their options… • Mr. Smith decides to enroll in an MMAI plan to receive all of his healthcare services through one managed healthcare plan. • Mrs. Smith decides not to enroll in an MMAI plan because three of her doctors will not join any of the MMAI plan networks. She will continue to receive her healthcare services through regular Medicare and Medicaidand her Community Care Program services through her HealthChoice Illinois plan.

24. Mr. and Mrs. Smith Mr. and Mrs. Smith will use these cards to access their healthcare services: Mr. Smith Mrs. Smith Medicaid HealthChoiceIllinois

25. What are my rights in MMAI?

26. Your Rights in MMAI You have the same rights in MMAI as you have in Medicare and Medicaid.

27. What if My Healthcare Provider is Not in My Plan’s Network? • You can keep seeing providers who are not in your plan’s network for 180 days from the day you joined the plan. • The provider can bill the plan during this 180 days. • After 180 days, the provider will need to join your plan’s network or sign an agreement with your plan to keep seeing you.

28. What If I Am Not Happy with My MMAI Plan? • Start by contacting your plan to file a complaint (also called a “grievance.”) • Contact the Home Care Ombudsman program at (800)252-8966. • If the problem cannot be resolved, you can contact Illinois Client Enrollment Services to change MMAI plans or opt out of MMAI at any time.

29. MMAI Recap • Remember…. • In MMAI, you have one card to cover all your health care needs. • MMAI also has care coordination. • When considering whether to join an MMAI plan or not, think about: • Provider Network • Prescription Drugs • A Plan’s Extra Benefits MMAI

30. Questions? To get help considering your MMAI plan options, call the Illinois Senior Health Insurance Program (SHIP) at (800)252-8966 Funding provided in whole or in part by the Illinois Department on Aging.