The Departments of Healthcare and Family Services (HFS) and Human Services (DHS) are initiating an enhanced eligibility verification project with the official name of the “Illinois Medicaid Redetermination Project” (IMRP) and the unofficial name of EEV (Enhanced Eligibility Verification). The purpose of this project is to process the backlog of cases that require immediate redeterminations and ensure that going forward, redeterminations will be processed in a timely manner, so that eligibility for Medicaid coverage is verified on an annual basis. This note will provide some background information on the project in case of inquiries from clients or to otherwise answer questions.
The Illinois Medicaid Redetermination Project arose from an emergency procurement authorized by the Save Medicaid Access and Resources Together (SMART) Act of May 2012, to secure services of a Vendor to assist in the verification of income, assets and residence for Medicaid eligibility through use of data matching resources.
On September 13, 2012, the State entered into a contract with MAXIMUS Health Services, Inc., who in turn subcontracted with HMS for the data matching component. This document summarizes the key program components, including:
- Scope of Work;
- Impacted Programs;
- Schedule; and
- Illinois Medicaid Redetermination Program Hotline Information.
Scope of Work
- MAXIMUS will review cases using a proprietary system, called Max-IL that assembles data from multiple data sources. Using business rules, the system indicates cases that are most likely eligible and those potentially ineligible for medical benefits.
- While some of the data can be verified entirely through electronic means, conflicting or missing data will require customer contact.
- Clients will return any information or supporting documents to the Illinois Medicaid Redetermination Project. The information will be uploaded to the new Max-IL so it can be viewed by the caseworker.
- Redeterminations for medical-only cases will be completed by State caseworkers in central hub offices that specialize in completing redetermination reviews.
- Where the case includes SNAP or cash assistance, the clients will be contacted by state Caseworkers using current procedures.
- A few smaller medical programs, such as Health Benefits for Persons with Breast or Cervical Cancer, Illinois Veterans Care, Health Benefits for Workers with Disabilities and Illinois Healthy Women will not be included in the IMRP process.
- State caseworkers will determine whether the Max-IL recommendation is correct, and complete the redetermination in the State’s eligibility system.
- MAXIMUS will provide clients with access to dedicated customer support and a variety of tools to confirm the status of their cases in the eligibility redetermination process and submit required documentation:
Illinois Medicaid Redetermination Program Hotline: a call center staffed with Customer Service Representatives specifically trained to handle questions and inquiries concerning the redetermination process. They will answer the phone as “Medicaid Redetermination Project”. These representatives will be able to address questions concerning the IMRP process. They will not explain policy nor address specific eligibility questions as those inquiries must be handled by state caseworkers.
There will be multiple channels for submitting documentation: mail and fax, and scanned material may be uploaded via the State’s secure file transfer portal (FTP).
Illinois Medicaid Redetermination Program Schedule
|January 2, 2013
||MAXIMUS-operated Illinois Medicaid Redetermination Program reviews and assesses initial test cases and addresses issues
|January 21, 2013
||Full hotline and recommendation processing for medical-only cases
|February 1, 2013
||MAXIMUS begins review of cases that also include SNAP or other benefits
|February 4, 2013
||State begins to receive medical-only case redetermination recommendations
||Long Term Care eligibility rdetermination forms are sent out by MAXIMUS
|February 1, 2014
||Maximus begins operation of Max-IL that will make automated recommendations based on current case information and electronic cross matches. A new pre-populated rede form is introduced for most medical only redes. Central state rede hub workers begin processing redes.
IMRP Hotline Information
A client who has been asked to submit information to the Illinois Medicaid Redetermination Project should submit the data as shown below. Data can also be taken to local DHS office (or sent to the HFS Bureau of All Kids) but responding directly to the Redetermination Project in the stated time frames will decrease likelihood of recommendations being made for case cancellation due to missing, conflicting or outdated information.
While the IMRP is very focused on maintaining business continuity, the situation of most concern is where a client is required to submit information within 10 business days. Failure to respond timely is cause for cancellation of eligibility. Clients will need to pay attention to any deadlines in correspondence and respond to the redetermination or requests for additional information promptly. A client should contact IMRP if their case is cancelled and they believe the cancellation is in error. Information that gets to the Call Center late will be routed to the correct in order to reduce the risk of process break-downs.
Illinois Medicaid Redetermination Program Hotline Information
Hours of Operation:
- Monday – Friday, 7 a.m. – 9 p.m., Central Time
- Saturday, 8 a.m. – 1 p.m., Central Time
Holidays: The IMRP Hotline will be closed on the following holidays:
- New Year’s Day
- Memorial Day
- Fourth of July
- Labor Day
- Thanksgiving Day
- Christmas Day
- 1-855-HLTHYIL (1-855-458-4945)
- TTY 1-855-694-5458
- FAX: 1-855-394-8066
- Illinois Medicaid Redetermination, PO Box 1242, Chicago, IL 60690-9992