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:
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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process of digitizing information flow, eliminating paperwork
and automating many of the manual processes involved in
collecting information for case processing.
online portal for state workers to easily manage cases,
collaborate and interface with databases needed to support the
Providing beneficiaries with a more
accessible way to verify the status of their eligibility
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
[Text from joint news release from
the Illinois departments of
Healthcare and Family Services
and Human Services, received from
Illinois Office of
Communication and Information]