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The Launch of Avisery’s New Blog: The Intersection
Hello Reader,
Welcome to The Intersection, Avisery’s new advocacy blog! Professionals and advocates can visit this blog regularly to stay up to date on changes in affordable health coverage options for older adults and adults with disabilities. We will particularly focus attention on an upcoming coverage option change for dually eligible individuals (those with Medicare and Medicaid): Medicare Advantage Dual Eligible Special Needs Plans (D-SNP). This blog aims to host information and resources regarding Illinois’ planned 2026 D-SNP transition and related efforts so informed stakeholders can advocate for decisionmakers to ensure the best integrated care possible for dually eligible individuals.
UPCOMING CHANGES TO MEDICARE-MEDICAID COVERAGE OPTIONS IN ILLINOIS
First, let’s start with a little background on integrated care for individuals with Medicare and Medicare in Illinois. In 2014, Illinois began implementing the Medicare- Medicaid Alignment Initiative as part of the Financial Alignment Initiative, a demonstration project lead by the Center of Medicare and Medicaid Services (CMS) to test integrated care models for Medicare and Medicaid enrollees. The FAI aimed to provide more integrated care, create better health outcomes, and produce cost savings. Under MMAI in Illinois, managed care plans cover all Medicare and Medicaid benefits and provide a care coordinator to help enrollees navigate their health needs. MMAI launched initially only in certain counties and went statewide in 2021.
In April 2022, CMS issued a final rule that ended the FAI program by December 2023 and also modified regulations for standard integrated care plans known as Medicare Advantage Dually Eligible Special Needs Plans (D-SNPs). CMS offered states participating in the FAI demonstration a two-year extension if they agreed to transition to more highly integrated D-SNP models and submitted a written transition plan by October 2022. Because Illinois chose this course of action, D-SNPs will not launch in Illinois until January 1, 2026.
Illinois released their transition plan, which contains several considerations of what the state will require from D-SNPs including the specific level of integration. Additionally, the plan lays out how the state will engage with stakeholders. At the November 2023 meeting of the Medicaid Advisory Committee, Avisery made a public comment to express concerns that HFS has thus far not invited the voice of community organizations who serve dually eligible individuals to the table.
AVISERY’S EFFORTS TO BRING COMMUNITY STAKEHOLDER’S VOICE TO THE TABLE
During the planning stage of this transition, Avisery has taken several actions to press for the inclusion of community stakeholders’ concerns and feedback. Avisery hosted an Advocacy Call on May 17, 2023, where Avisery staff presented information on the transition to D-SNPs and attendees shared their concerns about the upcoming changes. Potential transition-related issues that the audience raised included, among others: the provision of sufficient consumer and provider education, maintaining consistent care coordination, and the potential loss of certain MMAI features that enhanced convenience. Avisery then shared this feedback with representatives from the Department of Healthcare and Family Services (HFS) and CMS.
At our annual advocacy forum Tell Us About It! Advocate for Integrated Care for Illinois Duals we focused on the State Medicaid Agency Contract (SMAC) that D-SNPs must sign. There are minimum federal requirements that every D-SNP must follow and additional strategies that states can use to provide higher integrated care. States can use their SMAC to ensure that duals receive more integrated care through their D-SNPs. The forum attendees also heard from Tiffany Huyenh-Cho from Justice in Aging about what California stakeholders ahd advocated for during their 2023 transition to D-SNPs. California advocacy wins included establishing a statewide Ombudsman program, enhanced continuity of care protections, and an aligned network. After the presentations, forum attendees gave feedback on strategies they thought should be included in Illinois’ SMAC. Avisery shared with HFS and CMS our participants’ calls for contract provisions that ensure person-centered care, continuity of care, and transparency/ oversight.
HOW TO USE THIS BLOG FOR YOUR ADVOCACY
Going forward, Avisery will continue monitoring HFS’s plans for the D-SNP transition. Follow along with this blog to learn more information on D-SNPs, how they will operate in Illinois, and related advocacy efforts! Avisery invites professionals and community organizations that serve this population to join us to make sure that dually eligible Illinois residents receive the highest quality integrated coverage.
— by Stella Van den Eeden, Avisery Training Specialist
Thanks for establishing this blog. I am excited for the 2026 D SNPs and am thrilled to have partners like you to advocate for dual eligibles.