Illinois

Medicare-Medicaid Alignment Initiative (MMAI)

MMAI is a capitated duals demonstration program for Illinois adults eligible for both Medicare and Medicaid. It is offered in two regions of the state: the greater Chicago area and Central Illinios. The demonstration began enrollment in 2014 and is targeted to adults in the "Aged, Blind, and Disabled" Medicaid eligibility group. People receiving Medicaid institutional or Waiver services for intellectual and developmental disabilities are excluded.

Capitation rates for MMAI depend on age group (working age versus elderly), region of the state (Greater Chicago versus Central Illinois), and LTSS recipiency and setting. Prior to September 2016, the rate structure was as follows:

The Nursing Facility rate applies only after the first 90 days of institutionalization. During the first 90 days, the prior capitation rate remains in effect.
The Waiver Plus rate applies to two categories of members receiving HCBS Waiver services:
- Those within 3 months of transition out of an institution.
- Those within 3 months of eligibility determination for HCBS or nursing facility, as long as the person remains in the community.
The Waiver rate is for all others on an HCBS waiver.
The Community Plus rate is for community residents not receiving HCBS Waiver services, for the first 3 months following return to the community after a nursing home stay of longer than 90 days.
The Community rate is for others not receiving HCBS Waiver services.

In September 2016, the rate structure was simplified to eliminate the "Plus" rate categories. There is now one category for nursing home residents, a second for people on HCBS waivers, and a third for everyone else.