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About Your Managed Long-Term Services and Supports (MLTSS) Plan
MLTSS provides health care that helps you do things you are no longer able to do for yourself. As part of this plan, you get access to:
- MLTSS providers
- Virtual care
- Behavioral health care
- Transportation to and from doctor visits
- Support from a Care Coordinator to help you reach your health care goals
- Care given in your home or in a supportive living facility
There are no copays for covered MLTSS services.
What Is Covered?
Your MLTSS plan covers:
| Covered Service | Details | Requires Prior Authorization? |
|---|---|---|
| Emergency Care | In an emergency, you can:
You don’t need a referral or approval. Please call us within 24 hours of emergency care. |
No |
| Nursing Care | The care focus is on members’ long-term needs rather than short-term acute care. Members with one of these waivers may qualify:
|
Depends on the service |
| Nursing Facility (NF) Services | A NF is a licensed facility that gives:
|
Yes |
| Physical Therapy, Occupational Therapy, Speech Pathology | Members with waivers to get care for Disabilities, HIV/AIDS and TBI may qualify. This requires a doctor’s order. | Yes |
| Behavioral Health Services (BH) | BH services can help those facing mental health conditions. The type of service you might need depends on your personal situation. Types of BH care include:
Some care may require prior authorization. You do not need a referral for a provider that is in our network. |
Depends on the service |
| Pathways to Success | This program is for Medicaid members under the age of 21. It offers some home and community-based services. The child must have major mental health needs to qualify. This can mean either a Serious Emotional Disturbance or Serious Mental Illness. Learn more about Pathways to Success. | No |
The Illinois Department of Healthcare and Family Services (HFS) has several waiver services for people who qualify. BCCHP supports these waivers. You can get services to help you stay in your own home or live in a community setting. Find out more about Home and Community-Based Waiver Services.
What is Not Covered?
This MLTSS plan does not cover:
- Medical benefits (For medical coverage, please contact your Medicare or Medicaid plan.)
- Prescription drugs (For prescription coverage, please contact your Medicare Part-D plan.)
- Emergency room visits (These are covered through Medicare, not MLTSS.)
- Dental or vision services.
- Services obtained outside the United States. For services outside of Illinois, a prior authorization will be needed.
This is not a full list of services not covered.
Want to know more about what your plan covers? Check your MLTSS Member Handbook . You can also call Member Services at 1-877-860-2837.
MEMBER RESOURCES
Helpful Tools and Resources
Find a Doctor or Hospital
Our Provider Finder® makes it easy to search for providers in your area.
Find a Provider
Transportation Services
Learn how you can get a no-cost ride to your medical appointments.
Schedule a Ride
Forms and Documents
For details about your plan, check your Member Handbook.
Go to Forms and Documents