HealthChoice Illinois (HCI), the state's mandatory statewide Medicaid managed care program, is administered by HFS. Per CMS's most recent managed care enrollment data, report year 2024, Illinois's managed care programs covered approximately 2.6 million members. A second, smaller integrated-care track covers full dual eligibles through a Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) model, a federally required CMS structure.
HCI is mandatory in all 102 counties, delivered by five MCOs: Aetna Better Health of Illinois, Blue Cross Community Health Plans, Meridian Health Plan of Illinois (a Centene company), Molina Healthcare of Illinois, and CountyCare Health Plan (a Cook County-only safety-net plan affiliated with the county health system). YouthCare, operated by Meridian/Centene, is a separate statewide specialty plan for DCFS youth and former youth in care. HCI covers a comprehensive benefit package for most enrollees; the MLTSS (dual-eligible LTSS) population receives a narrower carve of benefits from their HCI plan since Medicare remains primary for most of their care. HFS has announced its intent to award new HCI contracts to the five incumbent MCOs plus Humana as a new entrant, effective January 1, 2027; the current MCO lineup remains in effect until then.
For Medicaid-only LTSS beneficiaries, long-term services and supports are integrated directly into their regular HealthChoice Illinois MCO plan. For dual-eligible members, LTSS is instead delivered through a distinct MLTSS plan choice, separate from their Medicare coverage; most duals who want fully integrated Medicare-Medicaid coverage instead enroll in a FIDE SNP covering LTSS, Medicare, and Medicaid benefits through one plan, offered statewide by four carriers: Aetna Medicare FIDE, Humana Dual Fully Integrated, Molina Medicare Complete Care Plus, and Wellcare Meridian Dual Align. Effective January 1, 2027, CountyCare and Blue Cross Blue Shield will no longer be MLTSS plan options; members in those two plans must select a new MLTSS plan by December 31, 2026.
Partially integrated into managed care
Behavioral health is carved into HCI: it's part of each MCO's comprehensive benefit package for full-benefit (non-MLTSS) enrollees, not managed by a separate statewide behavioral health organization. Certain state-funded substance use disorder services that fall outside the Medicaid benefit continue to be administered separately by DHS's Substance Use Prevention and Recovery (SUPR) division, distinct from HFS's Medicaid MCO contracts.
Carved in
Dental is not carved out to a single statewide vendor. Fee-for-service dental claims are administered through DentaQuest, HFS's FFS dental benefit administrator. The large majority of members are in HCI managed care, where dental is a covered in-plan benefit delivered through each MCO's own subcontracted dental network rather than through DentaQuest.
Pharmacy is carved in to managed care (each MCO processes and pays its own members' pharmacy claims), but all plans, including fee-for-service, are required to follow one Uniform Preferred Drug List (UPDL), which Illinois adopted effective January 2020 to standardize coverage across MCOs. MCOs may layer their own additional prior authorization and utilization management on top of the shared PDL.
Non-emergency medical transportation is not administered by a single statewide broker. For fee-for-service members, Transdev administers prior authorization only under the NETSPAP program; enrolled transportation providers bill HFS directly. Each HCI MCO separately contracts its own transportation broker for its own enrollees (ModivCare, MTM, or First Transit, depending on the plan).
Providers enroll and revalidate through IMPACT, HFS's provider enrollment system. Eligibility verification and claims-related lookups run through MEDI (Medical Electronic Data Interchange), distinct from each MCO's own portal.
201 agency updates tracked for Illinois. Available with Pro.
See them with ProThe Illinois Health Facilities and Services Review Board approved Ann & Robert H. Lurie Children's Hospital of Chicago's certificate of need application for a pediatric hospital and outpatient center in Downers Grove on Nov. 5. The approximately 298,000-square-foot facility, a roughly $480 million investment, will be Lurie Children's first inpatient hospital outside its main Chicago location, featuring an emergency department, 48 inpatient beds, operating rooms, imaging, and specialty care including oncology, cardiology, gastroenterology and orthopedics. Pending a village permit, site excavation is planned for December, with the hospital expected to see its first patients in spring 2029.
Roseland Community Hospital, a safety-net hospital in Chicago, filed for Chapter 11 bankruptcy protection on Nov. 4 to restructure its debt while continuing normal operations, according to a hospital news release. The hospital cited a recent medical malpractice settlement, threatened lawsuits over service agreements, decades of underfunding for safety-net hospitals, and potential Medicaid cuts under HR 1 as reasons for the filing. The petition, filed in the U.S. Bankruptcy Court for the Northern District of Illinois, lists estimated assets and liabilities each between $10 million and $50 million, and the hospital expects to submit a reorganization plan within 120 days. The filing comes a month after the hospital announced plans to close its labor and delivery unit, and the hospital said it will continue working with Illinois to keep its grant agreements in compliance, including an August "Pivot Plan" to expand behavioral health, same-day surgery, and maternal-fetal services.
At Becker's CEO+CFO Roundtable, Skokie Hospital president Gus Granchalek described how Endeavor Health's orthopedic hospital is preparing for CMS' Comprehensive Care for Joint Replacement Expanded Model (CJR-X), which takes effect Jan. 1, 2028. The mandatory model expands joint-replacement bundled payment accountability from about 800 hospitals to more than 2,200, covering Original Medicare patients' hip, knee and ankle replacements plus 90 days of post-acute care. Hospitals will bear financial risk for complications, extra inpatient nights, skilled nursing stays and emergency visits, even though independent surgeons often drive care decisions. Granchalek said Skokie is building a value-based enterprise to align gainsharing with its largely employed physician staff and expanding its preferred skilled nursing facility network to manage costs and reduce bounce-backs.
SEIU Local 73, representing about 200 advanced practice providers at Chicago's UI Health, filed a 10-day notice of intent to strike, with a potential walkout starting on or after Nov. 11. Members authorized a strike in October after seeking a 2% wage increase already given to other campus workers, plus changes to pay transparency, staffing, meal breaks and sick time. UI Health says an Illinois Appellate Court order has temporarily paused collective bargaining obligations and considers a strike unlawful while that order stands, though it has contingency plans to maintain hospital operations. The union says it remains open to mediation rather than a picket line.
Becker's Hospital Review reports that four Chicago-area hospitals, Roseland Community Hospital, Saint Joseph Medical Center, Mercy Medical Center and Resurrection Medical Center, suspended labor and delivery services over the past month. Hospital leaders cited low Medicaid reimbursement, rising costs to staff OB units and declining birth volumes as common drivers. Prime Healthcare is consolidating obstetrics from three suspended sites into two designated centers of excellence and committed $1 million in grants to community maternal health nonprofits. Since 2020, 16 Illinois hospitals have discontinued obstetric services, with the state hospital association noting more than half of Illinois births are covered by Medicaid, making reimbursement levels central to the closures.
17 active waivers tracked for Illinois. Available with Pro.
See them with Pro2 active solicitations tracked for Illinois. Available with Pro.
See them with Pro7 managed care contracts tracked for Illinois. Available with Pro.
See them with Pro239 bills tracked for Illinois. Available with Pro.
See them with ProGet the daily briefing.