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HFS and DHS Launch Enhanced Eligibility Verification Project

CHICAGO – The Illinois Department of Healthcare and Family Services (HFS) and the Illinois Department of Human Services (IDHS) today announced the launch of a project authorized under the State’s recent Medicaid reform act to provide enhanced annual eligibility screening of clients’ income and residency to ensure that they remain eligible for services.

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,” HFS Director Julie Hamos said. “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,” IDHS Secretary Michelle R.B. Saddler said. “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 Governor Pat Quinn in June.  It 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:

  • Processing the 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.

  • Beginning the process of digitizing information flow, eliminating paperwork and automating many of the manual processes involved in collecting information for case processing.

  • Establishing an online portal for state workers to easily manage cases, collaborate, and interface with databases needed to support the verification process.

  • Providing beneficiaries with a more accessible way to verify the status of their eligibility redetermination.

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 processes.

Medicaid Redetermination

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Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director