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If the governor had fixed this problem, then the GA wouldn’t have stepped in

Friday, Nov 30, 2018

* Finke

Rauner also complained about a bill that says people entering medical facilities like nursing homes are presumed to be eligible for Medicaid benefits until the state determines otherwise.

“That has the likelihood of costing tens of millions and potentially hundreds of millions of dollars that cannot be recouped,” Rauner said. “It is a huge mistake on the part of the General Assembly.”

Rauner had proposed changes to the bill that he said would help control costs. However, the House and Senate voted to reject those changes without any dissenting votes.

Lawmakers passed the bill in the first place because the state is far behind in determining if someone is eligible for Medicaid assistance. They were concerned that nursing homes were assuming costs for patients who should have been covered by Medicaid but weren’t because the state was behind in its work.

* From a June 28th press release from Comptroller Susana Mendoza

Since taking office, Comptroller Mendoza, as the state’s chief fiscal officer, has prioritized payments to programs serving the state’s most vulnerable populations, including the roughly 55,000 Medicaid long-term care (LTC) program participants, many of whom reside in nursing homes and supportive living and hospice care facilities.

But now the failure to process millions of dollars in bills for critical services and a spike in enrollment delays is threatening care providers’ ability to cover basic costs like medicine, food, and payroll, Comptroller Mendoza said. […]

The Comptroller’s report, which uses Department of Healthcare and Family Services (HFS) data, found that the number of pending Medicaid eligibility determinations for LTC over 90-days-old rose 143 percent between December 2017 and May 2018. HFS has reported it can only process 60 percent of new, incoming applications in a timely manner and, as of the end of last month, there were 16,378 pending admissions. According to the Associated Press, the estimated cost of these pending admissions is up to $300 million.

These problems are occurring at the same time the Rauner Administration continues to dump tax dollars into a failed technology solution meant to streamline Medicaid eligibility processes. The state has committed $288 million to Deloitte, the global consulting firm, for an Integrated Eligibility System (IES) to modernize enrollment in benefit programs like LTC or the Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps.

* Also from the comptroller’s office

HB 4771 enshrines into law the decision made in Koss v. Norwood, which requires the State to grant “provisional eligibility status to any applicant whose application is more than 46 days old.” Additionally, the bill requires the Department of Healthcare and Family Services to submit a voucher to the Office of the Comptroller within 10 business days of being granted provisional eligibility.

As noted above, the bill unanimously passed both chambers and then the governor’s veto was overridden without dissent. It had bipartisan sponsors, including Republicans with experience dealing with Medicaid issues.

The GA stepped in to fix something because Rauner couldn’t or wouldn’t. Legislative fixes opposed by the executive are never optimal. But they become necessary in these sorts of situations. And the time to influence legislation is during the spring session, not with a long amendatory veto in August.

- Posted by Rich Miller        

17 Comments
  1. - Not a Superstar - Friday, Nov 30, 18 @ 11:58 am:

    This could be the title of nearly every post.


  2. - don the legend - Friday, Nov 30, 18 @ 12:07 pm:

    Blagojevich left office on January 29, 2009. On that day was there anybody that would have said that in just six years we would elect someone exponentially worse as a governor.

    Blago should have been a once in a hundred year catastrophe. Rauner took just six years to push that pile of corruption and incompetence out of the record book.

    Congratulations Bruce.


  3. - Honeybear - Friday, Nov 30, 18 @ 12:09 pm:

    God’s honest truth
    I struggle with IES
    every single day
    every single hour.
    The cost of the system is well over 350 million now.
    It’s an unmitigated, over technical, over engineered nightmare.
    In our 30yo legacy system
    I could approve Medicaid in 5 minutes
    10 minutes if something was screwed up or we had to fix something.

    Now, with one app, I can struggle with it for an hour trying to get it to certify and issue a benefit. One moment an app can take 5-10 minutes to do (too many pages to go through, too many drop downs, it’s designed for management to glean data, NOT for the frontline to process quickly.)
    The next app that might seem just like the last will eat your lunch, cause an hour call with tech support and result in sending it off to Springfield, or worse yet, left to rot in the queue as a “known error”, meaning we don’t know what the hell we have to do to solve it.
    The LTC apps are sent off to an overworked small unit.
    Why small? Ask Dimas
    Maybe they didn’t want it to work.
    Maybe they have a contractor lined up to do it.
    Another Maximus waiting in the wings.
    Instead of training up or retasking a platoon of especially trained HSC they continue to perpetuate the problem

    In order to offer their preferred solution
    privatize it
    Like Quinn tried to do incidentally

    Take note Pritzker crew
    You absolutely must cultivate and maintain
    quality workers
    Training for IES is minimal.
    Veteran caseworkers have to figure stuff out for themselves, if they don’t have an SDS in office.
    Even then I can’t tell you the number of times my amazing SDS has said “I have no idea how to fix it”, “Call it in”
    Learn the lesson
    Technology doesn’t fix it
    Outsourcing doesn’t fix it

    Only good/highly trained/competent crew
    with a decent ship
    can fight the ship


  4. - wordslinger - Friday, Nov 30, 18 @ 12:13 pm:

    Rauner wasn’t in it for “fixing problems.”

    It was just one long, navel-gazin’ ego trip. Even by politician standards, his self-reverence was extreme.


  5. - Fixer - Friday, Nov 30, 18 @ 12:14 pm:

    Honeybear, one HSC to another, preach.


  6. - Anon221 - Friday, Nov 30, 18 @ 12:20 pm:

    Care facilities that have to wait months and maybe over a year to be paid for patients and residents whose insurance has run out cannot always provide the care needed. They have to cut corners, reduce staff, pay less. Mom was in one nursing home that, at the end of the month, might only be able to serve something like beans and hot dogs… and I am not exaggerating. Before she died, her Medicaid case had already been pending for over 6 months. It’s hard on the family, the facility, the staff- all are stressed out not knowing what will be paid and when, and what the ultimate financial burden will be for the family.


  7. - RNUG - Friday, Nov 30, 18 @ 12:29 pm:

    Until they get the bugs out of the new system, maybe somebody should get Deloitte to pay for contractors to catch up the workload.


  8. - Honeybear - Friday, Nov 30, 18 @ 12:58 pm:

    RNUG- good luck with that. The Rauner gravy train stopped and so Deloitte no longer supports us. We’re on our own. They gave us a boxed, over engineered system and we’re stuck with it.

    The horror is that each one of these apps, changes, cases, is a person, or a family
    That’s getting screwed or neglected.

    It’s hard on the soul when you get a “known error” or someone needs care yesterday.
    And I have to tell them
    I’m sorry, we’re still trying to fix our problem
    Folks don’t know how emotionally strong you have to be.
    To look someone in the face, at least several times a week
    and say that.


  9. - NeverPoliticallyCorrect - Friday, Nov 30, 18 @ 1:28 pm:

    We work with these systems and I will say again, as I have on other issues, this problem goes beyond any single governor. The state of Illinois has somehow managed to institutionalize incompetence in it’s employees and systems. The employee issue is related to existing employees having the right to bid on job openings they are not qualified to hold. The systems issue is one of maintaining systems even when they don’t serve the people they exist to serve. SO now we have a new governor but his committees are made up of many of the same players. let’s hope he has the wisdom and courage to demand more than the same things in new wrapping.


  10. - Langhorne - Friday, Nov 30, 18 @ 1:35 pm:

    I had an experienced law firm do my wife’s Medicaid app. Prepped like an appeal, to avoid do overs. Zipped through in 10 months….9 months after she died. Her nursing home accepted her “Medicaid pending”. Not all do.


  11. - kitty - Friday, Nov 30, 18 @ 1:37 pm:

    Hopefully Gov Elect Pritzker’s new leadership will cut losses with IES ASAP. The former systems PACIS and IPACS weren’t perfect but they worked better than IES. The task based casework model is terrible for approving / maintaining LTC & SLF cases, individual HSCs need to be given facility -based case management again.


  12. - PublicServant - Friday, Nov 30, 18 @ 1:46 pm:

    My brother, Mike, got a degree in nuclear engineering from The University of Illinois - CU. He was snapped up by the Navy and given intensive training in submarine power plant and sonar. He was then deployed out of Groton, MA on a fast attack submarine. Smart guy, my younger brother. The best this country had. He just turned 58 and is now in a Skilled Nursing home. I’ve sold his house, and he’s got a decent pension. That and the SSD that he gets, would allow him to live on his own, but these skilled nursing facilities are double that. Around 8k per month. I’m now trying to protect his little bit of savings, and qualify him for Medicaid. He knows who I am, and that I’m trying to help him. He doesn’t know much more than that, but he’s my little brother, and I love him.

    It is what it is, but this bill looks like it might be able to help him. The paperwork burden for Medicaid is enormous. 5 years of taxes with supporting documents. 5 years of bank statements from all accounts. I’ve got an Elder Law attorney who’s helping me, and I’ve got a firm helping me get everything together for Medicaid. It’s a slow process. If I can’t get him on Medicaid soon, he’ll be bankrupt in about 18 months. I’m trying to protect his savings in a trust that the state can’t touch, so I can use it for a few extra medical things like an RN who specializes in caring for seniors in a nursing home. She makes sure staff doesn’t slip up, catching things I would never have thought of. She’s not cheap, but is indispensable.

    I hope this bill helps. He needs all the help he can get.


  13. - Honeybear - Friday, Nov 30, 18 @ 2:00 pm:

    Neverpoliticallycorrect- holy moose crap buddy-I’m bout to go Kifowit on you.
    There is no way you work with these systems.
    You obviously have no idea what you’re talking about.
    Bite me a billion times.
    This has absolutely nothing to do with bidding on positions.
    And IES phase II is a new system as of 10/24/17
    They pulled all the old systems offline.
    But you are right that they don’t serve the people they were designed for.
    They serve managements’ need for data.

    Pritzker folks- This is the type of putz you don’t want being anywhere in state government.
    Not that I think you have the courage, maturity, or intellgence to do what stateworkers do every day, you arrogant Raunerite.

    Go back to pleasuring yourself at IPI with your policy fantasies.


  14. - Fixer - Friday, Nov 30, 18 @ 2:44 pm:

    NPC, I’m guessing your employee issue is a thinly veiled reference to Upward Mobility. Also, if you’ve never worked side by side with front line staff, some of whom came up through that program and work to make the best of this system…


  15. - Anon221 - Friday, Nov 30, 18 @ 3:02 pm:

    PublicServant- My heart goes out to you, and I hope his application gets the efficient approval it deserves.
    Your statement, “If I can’t get him on Medicaid soon, he’ll be bankrupt in about 18 months,” hits home. All Mom and Dad had were small pensions and SS, plus their home. Her application was “lost” three times the last time Dad worked with the nursing home to get it submitted. Mom was there due to dementia that had intensified following a bad reaction to anesthesia (Post-operative cognitive disorder). She was in and out of homes for over 2 years before finally being able to stay in one that would work with her and the funding issues.
    There was a tweet in the Scribby the other day about a son who posted who his father (who had dementia) was- who he had been, what he had done in life, and who he was today. He posted this on his dad’s door, so the caregivers would know and could use those remembrances to try and relate to him, and even encourage him to talk about his past- something usually easier for people to remember than that present. Others who responded to the tweet added things like placing pictures with stories about the photos in his room to, again, given caregivers clues on how they might reach him. I wish you both peace. It’s a hard road to travel.


  16. - LTSW - Friday, Nov 30, 18 @ 3:12 pm:

    While the new system is a POS. The real problem is not enough caseworkers to do the work. Haven’t been since Blago. And the feds actually match these workers at 75% now so the real cost isn’t insurmountable.


  17. - Honeybear - Friday, Nov 30, 18 @ 3:14 pm:

    Anon221 and Publicservant, I was a hospice chaplain for 5 years. The best thing I found for quality of life for memory loss patients was, I kid you not, Hawaiian music. Seriously, it’s amazing how well that will improve mood, stabilize and stimulate any patient. Get you some Don Ho and you’re good to go. There was a paper that I posted on facebook just the other day about how the musical part of the brain is not affected by dementia or Alzheimer’s. You put on Hawaiian music and you’ll see. Takes them straight to the beaches of Waikiki.
    Hope this helps


Sorry, comments for this post are now closed.


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