Resource Center

Welcome to the Client Enrollment Services resource center. The resource center has helpful information about managed care, the HealthChoice Illinois program and the Medicare-Medicaid Alignment (MMAI) program.  

What is managed care?

Managed care is a kind of health insurance program. When you enroll in managed care, you become a member of a health plan. The health plan you choose will offer you a full range of services and help you coordinate your health care.

HealthChoice Illinois

Illinois has expanded Medicaid managed care to all counties in the state. The name of the expanded program is HealthChoice Illinois. Every county in the state will have 4 health plans to choose from. Cook County will have the same 4 plus 2 more plans to choose from. Learn more about HealthChoice Illinois.

You can also learn more by visiting the Illinois Department of Healthcare and Family Services website to read about HealthChoice Illinois. 

Medicare-Medicaid Alignment Initiative

The Medicare-Medicaid Alignment Initiative is a special managed care program for seniors and persons with disabilities who have full Medicare and Medicaid benefits. The Medicare-Medicaid Alignment Initiative started in Illinois in 2014. It operates in the Greater Chicago and Central Illinois regions. Learn more about MMAI.  

Open Enrollment

Open enrollment is the one time each year when you can change your HealthChoice Illinois health plan. It is only once a year. When it is time for open enrollment, we will send you an open enrollment letter. This letter will be mailed to you approximately two months before your anniversary date and any change you make will be effective on your anniversary date. For a sample open enrollment letter, go to Enrollment Materials.

Medicaid Managed Care Program Map

See the managed care program and plan choices by county as of November 1, 2020, on the Managed Care Program Map.

Care Coordination

Your health plan will offer education and help. This is called Care Coordination. With Care Coordination you will have a Care Coordinator who can help you get the care you need. Find out more about Care Coordination.

Care coordination through your health plan can help you:  

• Find a primary care provider (PCP) who will get to know you and your health care needs
• Manage your health care conditions like diabetes, high blood pressure or asthma
• Get information you need to stay healthy
• Identify your health goals and create a care plan to reach those goals

What can a care coordinator help you do?

Some persons get a care coordinator to help reach their health goals.  A care coordinator can:

• Answer questions about your care
• Help you find a doctor or specialist
• Help you transition out of a hospital or facility
• Help connect you with community resources

If you do not have a care coordinator, you can call your health plan’s member services helpline and ask for one. The member services phone number is on your health plan member ID card and in your health plan member handbook. You can also find the phone number in the Health Plan Contacts list.

Illinois Medicaid Managed Care Health Plans Report Card

The 2020 HealthChoice Illinois Plan Report Card is for people in the HealthChoice Illinois program. The report card shows how the health plans compare for care and services. The ratings for each plan will help you choose a plan that is best for you. To help you choose a plan, the report card includes tips under “Choosing a HealthChoice Illinois Plan” on the last page. The same 4 health plans are in every county in the state. Cook County has the same 4 statewide plans plus 1 more plan. 

• View the HealthChoice Illinois Report Card for Cook County.
• View the HealthChoice Illinois Report Card for all other counties.

Personal Representative (Authorized Rep) Designation Form

You can choose someone else to speak on your behalf and be given information about your Medicaid benefits and managed care enrollment. Just call us at 877-912-8880. Or fax the Personal Representative Designation Form to us at 1-312-596-0249.

The Managed Care Program Enrollment Packet

You can see sample enrollment letters, brochures, health plan comparison charts and other enrollment materials for each managed care program. They are all designed to help you choose the right health plan for you and your family. See all enrollment materials.

2018 Health Plan Sanctions

Find out more about Plan Sanctions. 

Health Plans’ Preferred Drug Lists

A Health Plan’s Preferred Drug List (PDL) is a list of prescription drugs and over-the-counter (OTC) medicines the health plan covers. It is also called a Drug Formulary. To be covered, medications on the PDL must be prescribed by doctors in the plan’s network. Health plans do not all have the same drugs on their PDLs. 

Want to contact a Medicaid managed care health plan?

See a list of Health Plan Contacts list.   

Updating your address

If you get medical benefits such as Medicaid or All Kids from the State of Illinois, you must be sure the State always has your correct address. To change your address, send an email to dhs.localofficehelp@illinois.gov. 

Redeterminations

A redetermination is a review to see if you still qualify for Medicaid, All Kids, SNAP or cash assistance. You must have this eligibility review for Medicaid and All Kids at least once a year. The State must decide whether a member meets the rules to keep getting benefits. Through the Illinois Medicaid Redetermination Project, the State decides whether members continue to qualify for Medicaid or All Kids. The project is also called IMRP. Find out more about Redeterminations.     

Grievances and appeals for Fair Hearings

A grievance is a written complaint. You can file a grievance if you think you were treated unfairly. An appeal is a complaint you make when you think an action about your benefits or covered services is wrong. Learn more about grievances and appeals for Fair Hearings.

Frequently Asked Questions (FAQ)

You can find answers to common questions about Medicaid managed care at FAQ.

You can also find helpful links at Illinois.gov.   

News

Discover what is going on in health news.