More than 115,000 Medicaid enrollees in Illinois found ineligible for the program

In January, the Illinois Department of Healthcare and Family Services, or HFS, began a new project verifying eligibility for Illinois’ 2.7 million Medicaid enrollees. For years, state workers had failed to take adequate steps to ensure the people receiving Medicaid benefits were actually eligible for the program. As an auditor general report noted, state workers...

In January, the Illinois Department of Healthcare and Family Services, or HFS, began a new project verifying eligibility for Illinois’ 2.7 million Medicaid enrollees. For years, state workers had failed to take adequate steps to ensure the people receiving Medicaid benefits were actually eligible for the program. As an auditor general report noted, state workers failed to verify basic eligibility criteria, such as income, residency and citizenship status. Worse yet, some of the annual eligibility checks had been delayed for more than five years. So state lawmakers pushed HFS to hire an independent vendor who specializes in this kind of work to review Medicaid eligibility.

Since January, the independent vendor has reviewed eligibility for more than 237,000 individuals currently enrolled in Medicaid. Of those, they identified more than 115,000 who were ineligible for benefits. Another 27,000 cases reviewed so far this year were eligible for some benefits, but enrolled in the wrong program. For example, some individuals enrolled in Medicaid may only qualify for programs with greater cost-sharing. Altogether, 60 percent of the reviewed cases contained eligibility errors serious enough that the individual was no longer eligible for the program in which he or she was enrolled.

And based on the reviews conducted last week, it could be getting worse. Of the nearly 9,900 cases reviewed last week, nearly 5,800 were found ineligible for benefits and more than 1,300 were enrolled in the wrong program. Altogether, nearly 72 percent of the cases reviewed last week had a serious eligibility error.

A legal challenge by the American Federation of State, Municipal and County Employees may slow or halt the project’s progress in rooting out this type of waste, fraud and abuse. AFSCME wants the state to terminate its contract with the experts reviewing eligibility and instead hire new dues-paying state workers to do the job. Never mind the fact that state workers’ failure to do the job adequately prompted the state to hire an independent vendor in the first place.

The vendor is in the process of reviewing another 154,000 cases, with more cases to check added regularly. Gov. Pat Quinn hasn’t announced whether he plans to fight the challenge by AFSCME, which was one of his largest backers in the last gubernatorial election. If he won’t act, hopefully the General Assembly has the good sense to amend the authorizing statute to make it explicitly clear that this project can move forward despite AFSCME’s protests.