Page Reviewed / Updated - February 18, 2020
The Illinois Medicare-Medicaid Alignment Initiative (MMAI) is a managed care program for individuals that are eligible for both Medicaid and Medicare (referred to as “dual eligibles”).
MMAI combines both medical care and non-medical “home and community-based services” into a single program. Therefore, traditional health care services such as hospital care, prescriptions, behavioral health and mental health are combined with non-medical supports such as adult day care, personal emergency response systems, personal care assistance, homemaker and chore services.
At the time of this writing, MMAI is not available statewide and is only available in Greater Chicago and Central Illinois. This includes the following counties: Champaign, Christian, Cook, DeWitt, DuPage, Ford, Kane, Kankakee, Knox, Lake, Logan, Macon, McLean, Menard, Peoria, Piatt, Sangamon, Stark, Tazewell, Vermilion, and Will. Please note that the MMAI program is set to expand statewide on January 1, 2021.
Currently, there are five managed care plans from which to choose: Aetna Better Health Premier Plan, Blue Cross Community, Humana Health Plan, Inc., IlliniCare Health, Meridian Complete, and Molina Healthcare. Please note that not all healthcare plans are available in all areas. For instance, the only health plan available in Central Illinois is Molina Healthcare.
MMAI is operated by the Illinois Department of Healthcare and Family Services (HFS).
To be eligible for the Medicare-Medicaid Alignment Initiative, Illinois residents must be at least 21 years of age and not be enrolled in private insurance. As mentioned earlier, individuals must live in one of the following counties: Champaign, Cristian, Cook, DeWitt, DuPage, Ford, Kane, Kankakee, Knox, Lake, Logan, Macon, McLean, Menard, Peoria, Piatt, Sangamon, Stark, Tazewell, Vermilion, or Will. In addition, applicants must be enrolled in both Medicaid and Medicare Parts A, B and D.
For seniors, aged 65 and older, there are both income and asset limits to be eligible for Medicaid. As of 2020, the income limit for an aged, blind, or disabled individual is set at 100% of the Federal Poverty Level (FPL), which is equivalent to $1,063 / month, or said another way, $12,760 / year. The asset limit is set at $2,000 for an individual. While this figure might seem low, several higher-level assets are not counted towards this limit. This includes one’s home in which he or she lives, given the equity value is not higher than $595,000, an automobile, a life insurance policy with a face value of less than $1,500, and funeral and burial plans.
If one is over the asset limit, it is important that assets not be given away or sold for less than they are worth in order to qualify for Medicaid. This is in violation of Medicaid’s 5-year Look Back Period and can result in ineligibility. If one is over the asset (or income) limit, contacting a professional Medicaid planner is the best course of action, as they can help reallocate income and assets in order to meet Medicaid’s limits.
All benefits available through Medicare and Medicaid are accessible through the Illinois Medicare-Medicaid Alignment Initiative. This may include care coordination, doctor visits, hospital stays, prescription drug/over the counter medications, mental health services, hearing / eye services, behavioral health services, laboratory services, dental care, hospice care, emergency/medical transportation, durable medical equipment, medical supplies, nursing home care, 24-hour nurse line, and Home and Community Based Services (HCBS) waiver benefits, such as home health care, adult day care, Personal Emergency Response Systems (PERS), and assistance with Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs), like bathing, personal hygiene, mobility, preparing meals, shopping for essentials, and light housecleaning.
Additional information about the Medicare-Medicaid Alignment Initiative can be found on the Illinois Department of Healthcare and Family Services website. One can also call the Illinois Department on Aging at 800-252-8966 for more information, or to enroll, one can call the Medicare-Medicaid Alignment Initiative at 877-912-8880. To see which managed care organizations serve the area in which you live, click here. (Remember, MMAI is not available statewide).
Please note, while some counties (Cook, DuPage, Kane, Kankakee, Lake, and Will) have mandatory enrollment, individuals can still opt-out of the program and receive Medicaid and Medicare benefits separately. That said, participants must enroll in a HealthChoice Illinois plan, such as the Medicaid Managed Long Term Services and Supports Program.