More than 136,000 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 failed to...

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 nearly 276,000 individuals currently enrolled in Medicaid. That means that roughly 10 percent of the state’s Medicaid program has been audited by the vendor.

Of those, the vendor identified more than 136,000 who were ineligible for benefits. Another 31,000 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. Overall, the review has yielded an eligibility error rate of nearly 61 percent.

And things are actually getting worse. The overall error rate has increased for the fourth week in a row. Instead of finding fewer serious eligibility errors among those currently receiving benefits, the vendor is finding more. Of the 9,000 cases reviewed last week, nearly 5,000 were determined ineligible for the program. Another 1,000 had eligibility errors and were enrolled in the wrong program. With another 116,000 cases currently pending review, and thousands more on the way, this becomes all the more troubling.

Unfortunately, the American Federation of State, Municipal and County Employees has initiated a legal challenge which may slow or halt this progress. AFCME wants the state to terminate its contract with the expert vendor 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.

With the gubernatorial campaign season heating up, it will be interesting to see whether Gov. Pat Quinn will push back against AFSCME’s challenge. After all, AFSCME has donated more than $304,000 to Quinn since 2002 and AFSCME was one of Quinn’s largest backers in the last election. Could this become an issue in Bill Daley’s primary challenge to Quinn?

If Quinn won’t fight AFSCME on this issue, the General Assembly must have the good sense to amend the authorizing statute to make it explicitly clear that this project can move forward despite AFSCME’s protests.