 The Illinois Medicaid Redetermination Project will improve the integrity of the
state's Medicaid program by using advanced data-matching technology to verify
income and residency of the state's 2.7 million Medicaid clients on an annual
basis.
"It is vitally important for the sake of the integrity of the Medicaid
program that we have confidence that every person enrolled is actually eligible
for coverage," said HFS Director Julie Hamos. "This requires that we conduct an
annual redetermination to find out if the client's circumstances have changed in
such a way as to make them no longer eligible."
"This will help eliminate fraudulent and invalid use of Medicaid benefits,"
said IDHS Secretary Michelle R.B. Saddler. "Through tighter screening of
eligibility, the Enhanced Eligibility Verification system will optimize
resources available to those who are truly in need and eligible for Medicaid
services."
The background information and data verification work is being performed by
an outside vendor, MAXIMUS Inc. (NYSE: MMS). The company was hired in September
through an expedited procurement process authorized by the state's SMART Act,
the Medicaid reform law passed by the General Assembly in May and signed into
law by Gov. Pat Quinn in June. The company will make recommendations to
caseworkers housed in a new centralized eligibility redetermination unit being
created by IDHS. These IDHS caseworkers will make all final decisions on
redeterminations.
Among the major tasks being accomplished by the vendor are:
-
Processing the backlog of
cases that require immediate redeterminations and ensuring that going
forward, redeterminations will be processed in a timely manner, so that
eligibility for Medicaid coverage is verified on an annual basis.
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-
Beginning the
process of digitizing information flow, eliminating paperwork
and automating many of the manual processes involved in
collecting information for case processing.
-
Establishing an
online portal for state workers to easily manage cases,
collaborate and interface with databases needed to support the
verification process.
-
Providing beneficiaries with a more
accessible way to verify the status of their eligibility
redetermination.
MAXIMUS will provide clients with access to a dedicated call
center staffed with customer service representatives who are trained
to answer Medicaid eligibility questions and inquiries.
The two state agencies are also in the process of completely
replacing and modernizing the information system the state uses for
eligibility determinations. This $150 million project is being paid
for by enhanced funding from the federal government under the
Affordable Care Act to upgrade Medicaid data capabilities. This will
complete the process of digitizing information and automating manual
processes.
[Text from joint news release from
the Illinois departments of
Healthcare and Family Services
and Human Services, received from
the
Illinois Office of
Communication and Information]
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