IDPH Title V Program

The Illinois Department of Healthcare and Family Services (HFS) administers the Medicaid, Child Health Insurance Program (CHIP) and All Kids medical assistance programs. The programs, jointly financed by State and federal funds, provide critical healthcare coverage to Illinois’ most vulnerable populations. HFS is Illinois’ largest insurer.

The State of Illinois has been engaged in a significant health care reform effort for the last several years. The Saving Medicaid Access and Resources Together, or SMART, Act, which, among many other provisions, established the goal of enrolling at least half of all Medicaid beneficiaries in a "care coordination," or managed care, plan by January 1, 2015. This led to a rapid expansion of Medicaid managed care within the state. Initially, HFS identified 30 counties in Illinois as "mandatory enrollment areas," meaning that virtually all Medicaid beneficiaries in those counties were required to enroll in a managed care plan when two or more plans were available to serve a targeted area and population. IDHFS issued a request for proposals in August 2013 to select Managed Care Organizations (MCOs) and enrollment began shortly thereafter.

A second request for proposals was issued in 2017 to reduce the number of plans and expand Medicaid managed care statewide. Currently, five managed care plans are serving the “Family Health” population (children, pregnant women, and childless adults eligible for Medicaid under the Affordable Care Act) statewide and two more plans are serving beneficiaries in Cook County.

Effective July 2018 the Centers for Medicare & Medicaid Services (CMS) approved an 1115 demonstration project, the Illinois Behavioral Health Transformation. Ten pilots will be implemented through the demonstration including Substance Use Disorder Case Management; Peer Recovery Support Services; Evidence–Based home visitation for children born dependent on opioids and Supportive Employment Services.

In 2017, HFS created a workgroup to design an Integrated Health Home model for the State of Illinois. Shannon Lightner, the Deputy Director of OWHFS, was part of the workgroup, representing the Title V Program and public health issues at large. HFS is preparing to launch integrated Health Homes with a projected start date January 1, 2020, as well as a quality incentive program that is still being finalized, for managed care organizations to increase the number of women who can deliver full term babies. This initiative will be outcome based and incorporate non-medical interventions to increase the likelihood of successful pregnancies.

Illinois’ Title V Program and Medicaid Agency have agreed, through an Inter‐agency Agreement (IGA), to partner and collaborate to improve the health status of Illinois’ women, infants and children, including children with special health care needs, by sharing data and assuring the provision of preventive services, health examinations, necessary treatment, support and follow‐up care allowed under the Social Security Administration (SSA) and enumerated in each program’s respective state plans. The two agree that by partnering they can enhance their abilities, maximize the utilization of care, increase effectiveness and protect against the duplication of efforts, expenditures and resource allocation. They further agree that by working together the Maternal and Child Health program and Medicaid Agency can promote the continuity of care, share expertise, and achieve greater accountability.

A new area of collaboration between the two agencies is regarding maternal mortality records. HFS has given IDPH staff access to Medicaid data, ensuring that for every maternal mortality case where the decedent was a Medicaid beneficiary we can have a full understanding of all her health encounters, providing for a more thorough case review. 

CYSHCN

Most CYSHCN who are eligible for Medicaid will be required to enroll in one of five managed care plans beginning November 1, 2019. (Last year, Illinois enacted legislation prohibiting children who receive in-home shift nursing services, as well as medically fragile and technology dependent children who are eligible for the home and community-based services waiver, from mandatory enrollment in a managed care plan.) UIC-DSCC will continue to provide care coordination to these families through contracts with each of the five managed care plans. Senior UIC-DSCC staff are communicating regularly with HFS leadership regarding this transition and on-going operation of various programs affecting CYSHCN to strengthen the partnership among Illinois’ Title V and Title XIX agencies.