Open Enrollment SBM Insurance for the State of Illinois

CCM Consulting Group

| Case Studies

Client: GetInsured in partnership with the State of Illinois
Industry: Healthcare / Government
Service Lines: Inbound & Outbound Call Center Operations | Workforce Management (WFM)
Location: Chicago, Illinois

The Challenge

As Illinois transitions from the Federally Facilitated Marketplace (FFM) to a State-Based Marketplace (SBM) for Plan Year 2026, the State required a dedicated, highly scalable consumer assistance center capable of supporting increased enrollment activity, Medicaid coordination, and Affordable Care Act (ACA) plan transitions.

The initiative also supports a long-term vision to shift to a “single door” model by 2028 — integrating State-Based Marketplaces (SBM) and Medicaid operations into one streamlined consumer experience. This transformation required:

  • Licensed, certified ACA exchange agents
  • Multilingual support
  • High-volume inbound and outbound call handling
  • Compliance with ACA and Centers for Medicare and Medicaid Services (CMS) certification requirements
  • Workforce flexibility to accommodate enrollment surges

The Environment

State-based marketplaces provide Illinois with enhanced flexibility and oversight, including:

  • Reduced auto-renewal risk compared to HealthCare.gov
  • Improved management of churn between Medicaid, Medicaid buy-in, and Qualified Health Plans (QHPs)
  • County- and city-level outreach data targeting
  • Multilingual assistance for diverse communities
  • Streamlined workflows to ensure timely insurance card delivery
  • Advocacy support to optimize use of wellness benefits

To support these objectives, Illinois partnered with GetInsured to operate a proven, fully built consumer support center with the ability to scale dedicated resources as needed.

The Solution

With over 10 years of experience managing public- and private-sector contact centers, CCM Consulting Group delivers licensed ACA Marketplace Exchange Agents certified to assist consumers with:

  • Comparing and selecting ACA-compliant health plans
  • Determining eligibility for premium tax credits and subsidies
  • Completing applications and document verification
  • Managing renewals and enrollment transitions
  • Supporting SHOP Marketplace coverage for small businesses
  • Ensuring full regulatory compliance

Our agents are state-licensed professionals who complete annual FFM or state-based marketplace certification and maintain CMS system access through the Enterprise Portal and MLMS platforms.

Through structured Workforce Management (WFM), CCM ensures optimal staffing alignment during peak open enrollment periods while maintaining service levels year-round.

Results & Impact

  • Fully operational, dedicated consumer assistance center in Chicago
  • Licensed and certified agents delivering compliant, high-quality service
  • Scalable staffing model to support enrollment surges
  • Multilingual, multi-channel customer engagement
  • Strong alignment with Illinois’ long-term single door integration strategy

By combining operational discipline, regulatory expertise, and proven contact center infrastructure, CCM Consulting Group helps expand access to healthcare coverage while supporting Illinois’ strategic transition to a state-based marketplace model.

Advancing Public Health Access Through Operational Excellence

Our partnership supports not just enrollment — but equitable access, informed decision-making, and a more resilient healthcare marketplace for Illinois residents.