Healthcare Reform

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For years, the largest per capita cost for Medicare and Medicaid has been generated by the nine million individuals who qualify for both programs—referred to as “dual eligibles.” Both the federal Medicare and state Medicaid programs have historically struggled to create integrated and cost-effective programs.

The combination of Illinois’ budget shortfalls and rising cost of entitlement programs like Medicaid are causing leaders to consider new ways of managing care to improve access and control costs. Better coordination of health care delivery and spending on dual eligible beneficiaries has the potential to improve their quality of life and health outcomes while generating tremendous cost savings.

The Medicare-Medicaid Alignment Initiative (MMAI) demonstration project, which is designed for most beneficiaries who are eligible for both Medicare and Medicaid (known as “dual eligible”), is a key component of the state’s transition to greatly expanded coordinated care for Medicaid clients by 2015. Over 80% of MMAI participants live in Chicago metropolitan area. During the first half of 2014, MMAI participants will elect or be auto-enrolled in a health plan.

For more information about the the MMAI Demonstration project please visit this link at the Department of Healthcare and Family Services (HFS) website.

For information about MMAI enrollment please visit: enrollhsf.illinois.gov

In addition to the Medicare-Medicaid Alignment Initiative (MMAI) project, which addresses the dual-eligible population, there are additional changes coming to other parts of Medicaid for other beneficiaries including children, mothers and other qualifying disabled adults. The ultimate goal of is to reform the healthcare system that cares for the most vulnerable members of our population and transform the Medicaid system from a program that simply pays medical bills to a better coordinated wellness system.

For more information for all Illinois Medicaid programs visit:

Medicaid Legislative Reforms and Budget

Care Coordination

Integrated Care Program

MMAI Award Announcement

“Medicare and Medicaid too often work at cross purposes. We know that by aligning Medicare and Medicaid so that they are working together in concert and providing each client with a medical home and a patient-centered team of healthcare experts, we can provide better care and achieve better outcomes while lowering costs for a segment of the population that needs a great deal of care.”

~ Julie Hamos, Director of the Illinois Department of Healthcare and Family Services

Supportive Living provides senior citizens and disabled individuals in need with a highly satisfactory, sensible and cost-effective solution for affordable, residential living and support services. Administered through the Illinois Department of Healthcare and Family Services, the Supportive Living program combines apartment-style living with personal care and other services covered by the state’s Medicaid program. Because of this unique state program, Supportive Living residents can live affordably and independently in an environment where personal choice, dignity, privacy and individuality are emphasized.

For more information on the the Illinois Supportive Living Program visit:

Affordable Assisted Living Coalition

The Medicare/Medicaid dual-eligible segment represents:

  • 15% of Medicaid enrollment and 39% of spending.
  • Dual eligibles are 20% of enrollment and 31% of spending for Medicare.
  • The total cost for dual eligibles across both programs is estimated to be over $300 billion and is one of the fastest growing segments of health insurance spending.
  • The average annual cost per dual eligible is estimated at more than $55,000.

Source: Navigant Healthcare