IL Medicaid transitions

Session Description:

Over the last four years Illinois Medicaid has been moving from a fee-for-service system to a managed care system.  By March 2015 Illinois Medicaid expects to have 80% of its 3.3 million enrollees in mandatory managed care, most enrolled over the past year.  That’s in contrast to less than 10% of enrollees enrolled in voluntary managed care in March of 2011.  The mandatory managed care enrollment includes Medicaid’s 500K ACA Medicaid expansion adults.  Managed care entities are providing medical and long term support services via full risk and accountable care arrangements.  This session will discuss the various Illinois managed care arrangements, the actuarial considerations, and the operational challenges that managed care plans face in providing care to this unique population

Speaker(s):

Robert Mendonsa is the Deputy Administrator of Care Coordination Rate and Finance for the Illinois Department of Healthcare and Family Services. In this role, Robert is responsible for overseeing the hospital and managed care rate setting and managing the ACE and CCE initiatives.Robert has extensive experience in managed care having spent 23 years at Aetna. He was a regional president for over 8 years where we he oversaw all strategic and financial decisions including pricing and provider reimbursement for a 16 state region. After a brief retirement in 2010, Robert was asked to return to Aetna as Chief Executive Officer of Aetna Better Health where he lead the implementation of the Integrated Care Program which became effective May 1, 2011 for seniors and persons with disabilities in Suburban Cook and five collar counties. Robert has a BA from the University of California at Los Angeles and an MBA from the University of Southern California.