State agencies announce arbitrator's order to ease transition for
Medicaid eligibility screening
commitment to root out waste, fraud & abuse
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[December 19, 2013]
CHICAGO — The Illinois
Department of Healthcare and Family Services and the Illinois
Department of Human Services announced this week that an arbitrator
has issued a supplemental order that affects the state's largest
public employee union and allows for a contract with an outside
vendor that handles Medicaid eligibility screening to be amended
instead of abruptly canceled.
The arbitrator's supplemental order
allows the state to maintain the improved screening process put in
place this year to verify that Medicaid clients remain eligible for
benefits when they reapply annually to remain in the program.
state was faced with the abrupt termination of the eligibility
screening contract with Maximus at the end of this year, under an
arbitrator's initial ruling issued this summer in response to a
grievance by the American Federation of State, County and Municipal
Employees Council 31.
Under the supplemental order, the Maximus contract will be
amended, and the state will retain the ability to use Maximus to
make preliminary electronic determinations through the end of June.
In addition, the agencies will be able to retain the use of the
Maximus call center and mailroom operations through June 30, 2015.
The screening program, known as the Illinois Medicaid
Redetermination Project, was authorized by the General Assembly as
part of the "Save Medicaid Access and Resources Together" Act of
2012, known as the SMART Act.
The amended contract will comply with state and federal law and
the collective bargaining agreement.
"This ruling provides the best and most efficient way forward for
taxpayers at this time and continues our momentum in rooting out
waste, fraud and abuse," said HFS Director Julie Hamos said. "It's
important to ensure full compliance with the SMART Act, which this
ruling does. We are committed to preserving the Illinois Medicaid
program at a lower cost to the state while providing health care for
our neediest low-income children and families."
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"This ruling will allow us to move forward and build on the
success of this project," said IDHS Secretary Michelle R.B.
Saddler. "By strengthening our eligibility redetermination
process, we can ensure that we are maximizing the resources
available to those who are truly in need and eligible for
To date, since the beginning of 2013, Maximus has launched a
comprehensive review of 497,000 Medicaid cases. Of these, the state
has completed the comprehensive review for 315,000 cases, of which
40 percent have been canceled due to the state's efforts to root out
waste, fraud and abuse. The cancellation rate is expected to come
down because the reviews started with cases that had been flagged
for having a discrepancy. The vast majority were canceled because
the client did not respond to a request for verifying information
about their income or residency.
For more information about the Illinois Medicaid Redetermination
Project, go to:
Department of Healthcare and Family Services
Illinois Department of Human
file received from the
Illinois Office of Communication and Information]