Medicare AdvantageAdministrativeHigh impact
Nursing Home Participation in the Medicare Medicaid Alignment Initiative (MMAI) and Medicaid Managed Long Term Services and Supports (MLTSS) Program
Illinois Medicaid - HFS·IL · Geriatrics·Provider Notice
Effective date
Jul 1, 2016
We identified it
Jun 20, 2026
Summary
Illinois nursing homes serving dual-eligible patients (Medicare/Medicaid) must now participate in managed care organizations (MCOs) through MMAI and MLTSS programs. Billing teams must negotiate rates directly with MCOs rather than billing traditional fee-for-service, and Medicare bad debt rules change under MMAI.
Action Required
Immediately: Illinois nursing home billing teams must establish contracts with MMAI/MLTSS MCOs (Aetna Better Health, BlueCross Blue Shield, IlliniCare, and Meridian) to continue receiving reimbursement for dual-eligible residents. Update billing workflows to submit claims to MCOs instead of traditional Medicare/Medicaid fee-for-service. Note that Medicare bad debt submissions are no longer allowed under MMAI - negotiate compensation for these amounts directly with MCOs.