Potential Members and the Enrollment Process

Individuals may enroll for BCCHP and MMAI when specific criteria are met. Medicaid waivers also may apply to BCCHP and MMAI members who meet all other criteria. According to State regulations, MMAI enrollment is voluntary. ICP and FHP eligible members must enroll in BCCHP.

BCCHP Member Criteria:

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

MLTSS members in BCCHP must meet the following criteria:

• Eligible for Medicare and Medicaid age 65 or older, or have a disability and are age 21 or older:
• Enrolled in Medicare Part A, Part B and Part D
• Enrolled in the Medicaid Aid to the Aged, Blind, and Disabled (ABD)
• Opted out of MMAI or do not have the MMAI program available to them in the county that they live
• Residence living in Cook, DuPage, Kane, Kankakee, Lake or Will Counties.

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)

Additional eligibility criteria may apply for BCCHP and MMAI 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 BCCHP and MMAI 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 BCCHP and MMAI. 

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

• 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 12^th of the month, enrollment will be effective the first day of the following month. Enrollment requests received after the 12^th 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 the ICP and FHP populations in BCCHP, 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.

Enrollees are allowed to change plans within the initial 90-day enrollment period, but locked in after 90 days. However, enrollees are allowed to disenroll from MLTSS and enroll in MMAI at any time during the year.

Dual eligible members requiring LTSS services and not enrolled in MMAI must enroll with a MCO offering a MLTSS product in order to continue receiving LTSS services.