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Potential Members and the Enrollment Process

MMAI members must meet the following criteria:

  • Age 21 or older at the time of enrollment
  • Entitled to Medicare Part A and enrolled under Medicare Parts B and D and receiving full Medicaid benefits
  • Enrolled for Medicaid Aid to the Aged Blind and Disabled (AABD)

ICP members must meet the following criteria:

  • Seniors and adults over the age of 19 with disabilities
  • Enrolled or eligible for Medicaid

FHP members must meet the following criteria:

  • Children, a parent or other caretaker relative eligible for covered services under Title XIX or Title XXI, or a pregnant woman.
  • The Affordable Care Act (ACA) expansion population, which includes the newly eligible adult population of Illinois residents between the ages of 19 and 64 whose monthly income is less than 138% of the federal poverty level.
  • Residents living in Cook, DuPage, Kane, Kankakee, Lake or Will counties can be homeless and still apply. Individuals must be eligible for Medicaid in the approved service area in the State of Illinois.

Additional eligibility criteria may apply for MMAI, ICP and FHP members who meet all other criteria and are in the following Medicaid Waivers (SP2):

  • Aging Waiver – For individuals 60 years and older that live in the community.
  • Individuals with Disabilities Waiver – For individuals who have a physical disability and are between the ages of 19 and 59
  • HIV/AIDS Waiver – For individuals who have been diagnosed with HIV or AIDS
  • Individuals with Brain Injury Waiver – For individuals with an injury to the brain
  • Supportive Living Facilities Waiver – For individuals who need assistance with daily living activities, but who do not need the care of a nursing facility

Enrollment Process

For MMAI ICP and FHP, Illinois Client Enrollment Services (ICES) assists potential members with the enrollment process by offering unbiased educational resources and information about the member’s health care benefit plan choices. ICES processes all enrollments and disenrollments for MMAI, ICP and FHP. 

For MMAI, voluntary enrollment is a 3-month period during which members may enroll in a health care benefit plan of their choice.

  • During passive enrollment, members who have not chosen a health care benefit plan will be automatically assigned by the State.
  • In the Greater Chicago region, the state will enroll a maximum of 5,000 members per month per Demonstration Plan over a 6-month period.
  • During the initial 90 calendar days after the effective date of enrollment – whether the member actively selected a benefit plan or was auto-assigned – the member has the opportunity to change plans.
  • After the 90-day enrollment period ends and the member has chosen or been assigned a health care benefit plan, members can switch plans or opt out of MMAI at any time, on a monthly basis.
  • If the choice to enroll is made by the 12th of the month, enrollment will be effective the first day of the following month. Enrollment requests received after the 12th of the month will be effective the first day of the second month following the request. 

MMAI members with LTSS Medicaid Waivers may choose to opt out of the Medicare side of MMAI; however, for their Medicaid services, these members must remain enrolled in the same managed care health benefit plan for one year. These members are allowed to change health care benefit plans once per year, during open enrollment

For ICP and FHP, enrollment is mandatory for Medicaid members.

  • The member can select a health care benefit plan of their choice or the State automatically enrolls the member into a plan. 
  • During the initial 90 calendar days after the effective date of enrollment – whether the member actively selected a benefit plan or was auto-assigned – the member has the opportunity to change plans.
  • If the member changes health care benefit plans during the initial 90 days, they have another 90 days after the effective date of enrollment to change back to their original plan.
  • For one year following the 90-day enrollment period, ICP and FHP members are locked into their chosen or assigned health care benefit plan.
  • At the end of a member’s enrollment year, they will be notified by ICES of open enrollment.  This is a 60-day period when ICP and FHP members are allowed to change health plans. 

If no plan is selected, ICES re-enrolls the member in their current health care benefit plan. The 60-day open enrollment period begins 90 days prior to the member’s anniversary date.