Thursday, December 19, 2013
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State agencies announce arbitrator's order to ease transition for Medicaid eligibility screening

Continues 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.

The 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 Medicaid services."

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:

[Text from Illinois Department of Healthcare and Family Services and Illinois Department of Human Services file received from the Illinois Office of Communication and Information]

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