Big changes are taking place for Illinois Medicaid recipients, and, like most changes, they can be confusing and frustrating. And for Medicaid recipients with epilepsy, the changes are also a cause for serious concern.
At the end of this past May, the Illinois Department of Healthcare and Family Services (HFS) announced its new Integrated Care Program (ICP). Initially, close to 40,000 adults who live in suburban Cook, DuPage, Kane Kankakee, Lake, and Will counties and who are enrolled in the state’s “Aid to the Aged, Blind, and Disabled” program are being automatically transitioned to the ICP. Participation in the ICP is mandatory. HFS has contracted with two health plans: Aetna Better Health and IlliniCare Health Plan.
Beginning on July 1, individuals who are being moved to the ICP have begun receiving letters from the state, informing them of this change. From the date they receive the letter, they will have 60 days in which to either choose a health plan and Primary Care Provider or ask in writing for a “Single Case Agreement” (this process is detailed below).
NOTE: If patients have an ongoing course of treatment and their provider is not in network, they will have 90 days to continue with their current providers once they are enrolled with one of the Managed Care Organizations. They must still select one of the two ICP plans.
While selected hospitals and medical providers are part of these two plans, a large number of hospitals and specialists—including epilepsy specialists—are not. For patients with epilepsy who are currently under the care of an epileptologist, this can presents a huge challenge, as consistency of care can be jeopardized.
So if you (or someone you know) is an ICP program participant with epilepsy, what can you do to protect yourself and to help maintain the level of epilepsy care you are currently receiving?
- The first thing to do is to talk to your doctor. Any doctor—no matter what their specialty—can join one or both of the approved plans, as can any hospital. Unfortunately, while this seems like a simple solution, many doctors and hospitals are reluctant to agree to the terms of the Aetna or IlliniCare plans, due to the reduced reimbursements these plans provide. This does not, however, mean that you should not try. Your doctors know your case better than anyone. And your voices are important. If enough patients make their needs known, it can be enough to encourage doctors and hospitals to take part in one or both of the ICP health plans.
- Another option is to appeal directly to the Illinois Department of Healthcare and Family Services to establish a “Single Case Agreement” with your current health care provider. This single case agreement must be submitted within 60 days of the receipt of the initial ICP enrollment letter. A sample “Single Case Agreement” request letter can be found here. (Courtesy of the Arc of Illinois)
- Finally, don’t be afraid to tell your story. Send letters to your local papers, and put a face on what would otherwise be a generic ‘issue.’ Let your community know that you’re being hurt in very real ways by decisions such as this one.
There are (and will continue to be) many questions surrounding this change to Medicaid. And as the program inevitably expands to more Medicaid recipients across Illinois, those questions will only increase. The Epilepsy Foundation of Greater Chicago is here to help answer those questions, to offer advice and guidance, and to assist you through this difficult transition. Please call our office at 312-939-8622 and ask to speak to a representative from our Case Management team.