Thousands more Illinoisans discovered ineligible for Medicaid

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. 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. 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.

Since January, the independent vendor has reviewed eligibility for more than 254,000 individuals currently enrolled in Medicaid. Of those, they identified more than 124,000 who were ineligible for benefits. Another 29,000 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 error rate of 60 percent.

And things are only getting worse. The independent vendor reviewed nearly 17,000 cases last week – of those cases, more than 9,000 individuals enrolled in Medicaid were ineligible and nearly 2,000 were in wrong program. That means last week’s review yielded an error rate of 65 percent.

The independent vendor is in the process of reviewing thousands more cases each week. Unfortunately, AFSCME’s legal challenge may slow or halt progress on this project. If Quinn won’t fight AFSCME, 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.