Dual Eligible Special Needs Plan (D-SNP)

The State of Illinois Department of Healthcare and Family Services (HFS) awarded a Dual-Eligible Special Needs Plan (D-SNP) contract to Aetna Better Health Premier Plan MMAI Inc. as a prime contractor. The contract, identified by BidBuy number 25-478HFS-DIREC-B-44525, is structured for an initial term from July 23, 2025, to December 26, 2029, with a total contract value of $2.989 billion. The procurement was conducted as an Open Market Competitive Sealed Proposal, with pricing determined through per member per month (PMPM) risk-based capitation payments developed by the state's actuarial firm in accordance with 42 CFR Part 438 rate development standards.

The contract's primary objective is to provide integrated healthcare services for dual-eligible populations in Illinois, combining Medicare and Medicaid benefits. Aetna will be responsible for care coordination, provider network management, quality assurance, and program integrity for participants. The contract includes a 1% Business Enterprise Program (BEP) vendor utilization requirement, mandating the integration of certified diverse businesses into the service delivery model. Future expansions are anticipated, including the potential addition of Managed Long-Term Services and Supports (MLTSS) population in 2027, with enrollment being voluntary for eligible members and mandatory for certain long-term service recipients.