 Instead of being asked once for a pay stub, Medicaid participants as
of July 1 will have to provide proof of a month's worth of income,
as well as proof of Illinois residency. Additionally, participants
will have to provide verification for continued eligibility as of
Oct. 1.Michelle Saddler, secretary of the Illinois Department of
Human Services, said the new requirements are in line with those
required for the federal food stamps program. The agency determines
eligibility for Medicaid, although the program is administered by
the Illinois Department of Healthcare and Family Services.
"This will help us confirm that we are fulfilling Medicaid's
purpose of serving low-income families in greatest need," Saddler
said.
The reforms will also crack down on the practice of "doctor
shopping," as Medicaid participants often hop from doctor to doctor,
said state Rep. Patti Bellock, R-Westmont. But moving half of the
state's current 2.8 million Medicaid participants into managed care
with a primary physician during the next four years should stop that
practice.
"We're trying to reform the system so that person now will go
back to their regular doctor every month," Bellock said. "If they
try to go to another doctor, it will be called an 'edit.' That will
go back and that bill will not be paid -- that's what an edit is as
far as I understand."
The new law for the first time gives the state some teeth in
going after fraud offenders and recouping any losses, with interest.
If an administrative hearing finds individuals guilty, they can be
fined up to $2,000. More serious cases could be kicked to local
state's attorneys for prosecution.
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John Allen, inspector general for the Department of Healthcare
and Family Services, told lawmakers in December that his office
either recovered money or stopped payments for a total of nearly
$100 million in 2009. Additionally, 161 cases of fraud were referred
to law enforcement, he said.
However, he said he has no control over whether a local state's
attorney will take on the cases.
"We present them to the prosecutor, and we have to take their
judgment as to what they're going to pursue or not going to pursue,"
Allen said.
The tightening of eligibility standards and cracking down on
fraud is new to the program, said Julie Hamos, director of the
Illinois Department of Healthcare and Family Services. Change is
always hard, she said, but it had to be done.
"None of this will be easy," Hamos said. "I will become probably
the most unpopular person in Illinois because everybody will protest
it."
[Illinois
Statehouse News; By MARY MASSINGALE]
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