Dual Eligible Special Needs Plan (D-SNP)

The Illinois Department of Healthcare and Family Services (HFS) has awarded a Dual-Eligible Special Needs Plan (D-SNP) contract to Humana Benefit Plan of Illinois, Inc. through a competitive sealed proposal procurement. The contract, identified as 25-478HFS-DIREC-P-81594, will provide integrated Medicare and Medicaid services to dual-eligible populations in Illinois, with a focus on comprehensive care coordination and managed care organization (MCO) service delivery. The contract is structured with an initial term from July 28, 2025, to December 31, 2029, representing a total contract value of $2.989 billion.

The contract's service delivery model involves per member per month (PMPM) risk-based capitation payments, developed in accordance with 42 CFR Part 438 rate development standards. Humana will be responsible for providing integrated healthcare services, including health risk assessments, care coordination, and comprehensive service management for dual-eligible beneficiaries. The contract includes provisions for potential Managed Long-Term Services and Supports (MLTSS) integration by 2027 and mandates a 1% Business Enterprise Program (BEP) goal for subcontracting with businesses owned by women, minorities, or persons with disabilities. Capitation rates will be finalized and available no later than January 1, 2026, with payment mechanisms tied to actuarial rate development requirements.