Illinois

Illinois Capitated Financial Alignment Model Demonstration (Medicare-Medicaid Alignment Initiative) 

SPOTLIGHT & RELEASES

Key Dates

February 22, 2013 - CMS and Illinois sign MOU

March 1, 2014 - Start of opt-in enrollment

June 1, 2014 - Start of passive enrollment

September 14, 2016 - CMS, Illinois, & participating plans execute an updated three-way contract

September 1, 2019 - CMS, Illinois, & participating plans execute three-way contract amendment

July 1, 2021 - CMS, Illinois, & participating plans execute an updated three-way contract

October 1, 2023 - CMS, Illinois, & participating plans execute an updated three-way contract

MMAI Model

On February 22, 2013, the Department of Health and Human Services announced that the State of Illinois will partner with the Centers for Medicare & Medicaid Services (CMS) to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience.

Under the demonstration, also called the "Medicare-Medicaid Alignment Initiative," Illinois and CMS will contract with health plans to coordinate the delivery of and be accountable for all covered Medicare and Medicaid services for participating Medicare-Medicaid enrollees. 

More information from CMS:

• Fact Sheet
• Three-Way Contract (Word) (PDF)
  • Three-Way Contract Summary of Changes (10/01/2023) (PDF)
• MOU (PDF)
• State Proposal (PDF)
• Third (Preliminary) Evaluation Report for the Illinois capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (04/12/2023)
  • Findings at a Glance
• Second Evaluation Report for the Illinois capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (09/15/2021)
  • Findings At-a-Glance
• First Evaluation Report for the Illinois capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (11/29/2018)
• Readiness Review Tool (PDF)
• Illinois Evaluation Design Plan (PDF)
• Letter of Intent to Extend Scheduled End Date (PDF)
• Illinois Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 1 (PDF)
• Illinois Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 2 (PDF)
• Illinois Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 3 (PDF)
• Illinois Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 4 (PDF)
• Illinois Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 5 (PDF)
• Illinois Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 6 (PDF)
• Illinois Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 7 (PDF)
• Illinois Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 8 (PDF)

Information for Plans:

• All state-specific information and guidance for plans is available on the Information and Guidance for Plans page.

Information for Beneficiaries and Providers:

• Illinois Medicare-Medicaid Alignment Initiative Ombudsman Program
• Illinois Medicare-Medicaid Alignment Initiative Provider Frequently Asked Questions (FAQs) (PDF)
• Illinois Medicare-Medicaid Alignment Initiative Continuity of Care Provisions (PDF)
• Illinois Medicare-Medicaid Alignment Initiative and Medigap FAQs (PDF)
• Illinois Medicare-Medicaid Alignment Initiative Pharmacist Provider FAQs (PDF)

Information from the state of Illinois:

• Illinois Medicare-Medicaid Alignment Initiative  

Funding Support:

• Beneficiary Counseling & Ombudsman Programs

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