Nearly 106,000 Medicaid enrollees in Illinois found ineligible for the program

For years, the Illinois Department of Healthcare and Family Services, or HFS, has failed to take adequate steps to ensure the people actually receiving Medicaid benefits are eligible for the program. In 2012, for example, somewhere between 15 percent and 20 percent of Medicaid files were overdue for their annual eligibility checks. The auditor general noted that...

For years, the Illinois Department of Healthcare and Family Services, or HFS, has failed to take adequate steps to ensure the people actually receiving Medicaid benefits are eligible for the program. In 2012, for example, somewhere between 15 percent and 20 percent of Medicaid files were overdue for their annual eligibility checks. The auditor general noted that some of the files that were supposed to be checked every year were more than five years past due.

Even when HFS workers bothered to check eligibility, they often failed to adequately verify information. In some cases, state workers “verified” income verbally, through handwritten notes or by comparing it to previous applications, rather than collecting paystubs. In other cases, state workers didn’t bother to verify Social Security numbers, citizenship status or even residency. Some cases were missing the redetermination application altogether.

That’s largely why state lawmakers pushed HFS to hire an independent vendor who specializes in this kind of work to review Medicaid eligibility. We’ve been keeping regular tabs on their progress, though a legal challenge by the American Federation of State, Municipal and County Employees may slow or halt that progress if Gov. Pat Quinn and the General Assembly don’t act quickly to address it.

Since January, the independent vendor has reviewed eligibility for more than 210,000 individuals currently enrolled in Medicaid. Of those, they identified nearly 106,000 who were ineligible for benefits. Of the cases reviewed last week alone, the independent vendor found another 5,000 people currently on Medicaid who aren’t even eligible.

Another 25,000 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. That means that of the 210,000 case files reviewed so far, more than 62 percent had eligibility errors.

If Quinn won’t fight the outrageous legal challenge brought by AFSCME, one of his largest backers in the last gubernatorial election, the General Assembly must amend the authorizing statute to make it explicitly clear that this contract and this project can move forward.