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Medicaid managed care enrollment holds steady
HealthChoice Illinois, the state's revamped managed care program for Medicaid, finished its first year with a total of about 2.1 million enrollees

Friday, January 25, 2019
Crain's Chicago Business
by Stephanie Goldberg

Despite decreases in enrollment among several health insurance plans administering Medicaid benefits in Illinois, the total number of Medicaid enrollees in the state held steady during the first year for HealthChoice Illinois. Data from the Illinois Department of Healthcare & Family Services show the revamped Medicaid managed care program ended the year with about 2.1 million enrollees. Meridian Health—one of seven participating payers last year—had the largest share of Medicaid enrollees in 2018. The insurer, which WellCare acquired for $2.5 billion in September, finished the year with more than 613,000 members, or 28 percent of total HealthChoice Illinois enrollment. However, three health plans saw enrollment fall from January to December: Blue Cross & Blue Shield of Illinois had a nearly 11 percent drop; CountyCare, which is operated by the Cook County Health system, had a 14 percent drop; and NextLevel Health, started in 2014 by Cheryl Whitaker, had a 43 percent drop. “Individuals leave Medicaid for a variety of reasons,” including gaining access to employer-sponsored health care coverage or failure to complete required paperwork, Caryn Stancik, a spokesperson for Cook County Health, said in an email. What appear to be declines in enrollment could also just be members switching plans. Medicaid beneficiaries who were previously covered by Family Health Network, Community Care Alliance of Illinois, Aetna and Humana were transitioned to HealthChoice Illinois payers as of late 2017 or early 2018. Additionally, since CountyCare and NextLevel are available only to Cook County residents, beneficiaries who move to other counties must select a new health plan. NextLevel did not respond to requests for comment. Blue Cross, which operates statewide, was placed on an enrollment hold in April for not having enough doctors and hospitals in its network to ensure adequate access for members in certain areas, and failing to address a backlog of grievances and appeals from members. But sanctions against the largest insurer in the state were eased in October, enabling Medicaid enrollees to once again select the health plan. “When given the option to choose Blue Cross & Blue Shield of Illinois, we are consistently a top choice for Medicaid participants,” company spokeswoman Colleen Miller said in an email. Like Blue Cross, Harmony Health Plan was dinged for not having enough doctors and hospitals in its network to ensure adequate access. Healthcare & Family Services notified Harmony in May that it would no longer automatically enroll members in the plan. Harmony is a unit of WellCare, and its members were automatically transferred to Meridian on Jan. 1, after WellCare acquired Meridian. Healthcare & Family Services also fined Blue Cross, NextLevel and Molina Healthcare at least $100,000 each last year for failing to submit complete and comprehensive encounter data, or records of covered health care services.

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