State launches project for those eligible for Medicare and Medicaid

CHICAGO — If you think your health coverage gets complicated, imagine being in two different government health programs that don't work together.

There's the state's Medicaid program for the needy and the federal government's Medicare program for seniors and disabled adults, and no coordination for the so-called "dual-eligibles" qualified to enroll in both, state officials say.

That's going to change, for at least some of those folks in both the Medicare and Illinois Medicaid programs.

The state is launching a demonstration project with eight managed-care companies, among them Urbana's Health Alliance Medical Plans, to provide that coordinated care for about 136,000 dual-eligible Medicare and Medicaid patients.

Health Alliance and Molina Health Care of Illinois were chosen to serve Medicare-Medicaid clients in 15 counties in central Illinois, including Knox, Peoria, Tazewell, McLean, Logan, DeWitt, Sangamon, Macon, Christian, Piatt, Champaign, Vermilion, Ford, Menard and Stark counties.

Six other managed-care organizations were selected to coordinate care for Medicare-Medicaid clients in the greater Chicago area.

The idea behind coordinating the Medicaid and Medicare systems is to provide coordinated care for Illinois's most vulnerable patients, state officials say — the elderly and adults with disabilities.

Health Alliance and the other managed-care organizations will be responsible for providing a full array of Medicare and Medicaid-covered services through one integrated system, according to the Illinois Department of Healthcare and Family Services.

The state also sees potential cost savings: In 2010, the dual-eligibles represented 9 percent of the state's Medicaid population, but 27 percent of the program costs, according to the agency.

"They are seniors and adults with disabilities so they have the greatest need for health care," said agency spokesman Mike Claffey.

The managed-care contracts selected are subject to federal approval.

Health Alliance General Counsel Lori Cowdrey Benso said by providing a medical home and patient-centered team of health care 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."

Sinead Madigan, director of government relations for Health Alliance, said she'll be working with area agencies on aging to coordinate services for Medicaid-Medicare patients in the program.

The Department of Healthcare and Family Services says Illinois will be among the first states to reform the way care is delivered to clients in both the Medicare and Medicaid systems.

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