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State trying to reduce huge Medicaid backlog

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Illinois

Illinois is hiring hundreds of frontline workers to resolve major delays of its Medicaid application and renewal processes.

The Illinois Department of Healthcare and Family Services, which oversee Medicaid, and the Illinois Department of Human Services are working together to fill the vacancies, the departments said in a statement today. The first positions [were] expected to be filled [last] week.

The Medicaid redetermination process, which reviews eligibility for the state’s nearly 3 million Medicaid beneficiaries, can lead to lapses in coverage. Such gaps are hard on patients, especially those managing chronic conditions, and health systems that don’t get reimbursed for medical services when claims are denied by health plans.

Backlogs, which have increased in recent years, are considered delays of 45 days or more for initial applications and 60 days or more for renewals, the statement says.

* More from WUIS…

The state of Illinois is expected to hire more than 300 training and technical staff members in an attempt to bring down a backlog of unprocessed Medicaid applications.

The General Assembly also approved a bill this spring aimed at addressing problems with the Medicaid program. Those include a high denial rate cited by providers and the application processing backlog – which has reached over 100,000.

State Sen. Heather Steans, a Chicago Democrat, the bill’s sponsor, said, “The federal government actually has outstanding problems with the state, and the state’s at risk of losing some dollars from the federal government because of the long, long backlog,” she said.

Applications are going unprocessed now for long periods, which is now in violation of federal rules. Many who do have the insurance for lower income individuals lose it because of problems with the renewal process. That’s according to Dan Rabbitt, a health polucy expert with the the Heartland Alliance.

posted by Rich Miller
Wednesday, Jul 10, 19 @ 9:46 am

Comments

Great to see. Having a first world state requires that we do the best we can for those who need health insurance. We obviously have to improve and are now doing so. Leave austerity to the right wingers and the lower-income red states.

The new workers will be covered by a new contract that will benefit them and was won by AFSCME through a very tough ordeal. They will get step pay increases, COLA’s and all the other benefits and protections that come because of collective bargaining and a strong union.

Comment by Grandson of Man Wednesday, Jul 10, 19 @ 9:59 am
If Illinois ever got single payer, it might struggle to do better than this.

Comment by Steve Wednesday, Jul 10, 19 @ 10:02 am
Another step in the recovery process caused by the cruel and heartless policies of 1.4%.

Good on Pritzker.

Comment by Huh? Wednesday, Jul 10, 19 @ 10:03 am
Such excellent news. There’s a kind of joy in being surprised over and over again by Illinois doing something good (because we haven’t had that in so long, not used to it).

Comment by lakeside Wednesday, Jul 10, 19 @ 10:10 am
The excuses are over, the governing and accountability are here.

Comment by State of DenIL Wednesday, Jul 10, 19 @ 10:16 am
GOM @ 9:59 am, well stated. While this is good news, DHS caseworkers are still required to use the poorly designed, difficult to use integrated eligibility system. The use of task-based case work for long-term care and assisted living cases isn’t working, these cases need to be assigned to staff by facility.

Comment by kitty Wednesday, Jul 10, 19 @ 10:17 am
Good but it will take a while to get the new hires properly trained and up to speed on the process and procedures; you can bet a lot of it is not really clearly documented.

Comment by RNUG Wednesday, Jul 10, 19 @ 10:17 am
Couldn’t we outsource this task? What happens to all these employees once we catch up?

Comment by Groucho Wednesday, Jul 10, 19 @ 10:18 am
Groucho- not stated in the article, but 4 years of “austerity” likely means that many of these positions were left unfilled in the goal of, well , breaking the state for personal gain , the main goal of the last administration. They will still have plenty of “catching up” to do for some time.], and then actual doing the work for the people of the state after that

Comment by Roadiepig Wednesday, Jul 10, 19 @ 10:39 am
The ruinous rein of Rauner…left painful marks.

Comment by Dotnonymous Wednesday, Jul 10, 19 @ 10:44 am
Under Federal law and a court order,Illinois is allowed 90 days to determine eligibility, or they must pay ALL medical bills of the applicant.In 2013 it took DHS 5 months to approve my Medicaid coverage. It took over a year to get it back because they screwed up the cases so badly, and kept canceling my appeal hearings in error. Fast forward to 2019, and look how little it has changed.

Comment by revvedup Wednesday, Jul 10, 19 @ 10:48 am
If they want to speed processing up they need to get rid of the IES computer system that is full of flaws. Ask any caseworker.

Comment by jimbo26 Wednesday, Jul 10, 19 @ 10:48 am
Hey Steve, thanks for your morning dose of unrelated conservative talking points. What makes you think the state will have any role at all in single payer? Especially since it is more of a concept than a signed law.

To the post, this is just a small part of rebuilding the state government that has been hollowed out at all levels. I have no problem starting with people in need, as well areas where we can maximize federal dollars, but the rest will have to come.

Comment by Jibba Wednesday, Jul 10, 19 @ 10:50 am
jimbo26
While they’re at it, they can also get rid of the financial ERP.

Comment by Anyone Remember Wednesday, Jul 10, 19 @ 11:09 am
Part of the issue is what I refer to as the Rauner Robo-Denials. Three separate letters a year regarding benefits and if you do not respond in ten business days you are zonked and have to return to go. Given delays in placing envelopes in the mail and cuts to the postal service recipients often have less time. People who are in and out of hospitals and the blind are in a perpetual turnstyle for “redetermination.” If someone was born blind, at age 51 they not need “redetermined” three times a year. If someone is going in for 30 days for acute leukemia treatment they will be bounced and later when they are able to walk, be “redetermined” to get back payments and get the hospital paid properly.

The blind get Braille statements from their bank, their cable TV company and phone bills. But DHS spends a billion a month and can’t send them statements they can even read.

Comment by Al Wednesday, Jul 10, 19 @ 11:16 am
Well I hope all those who bash state employees will now get in line and get the gravy jobs they were all clammering about.

Comment by Generic Drone Wednesday, Jul 10, 19 @ 11:18 am
>Couldn’t we outsource this task?

I’d rather see our tax dollars go to people who to live in our communities and pay state and local taxes than see the money leave to an out of state corporation. And I don’t confuse the pension debt problem with the fact that Tier II state employees are cost-effective in terms of their pensions.

Comment by Earnest Wednesday, Jul 10, 19 @ 11:19 am
Fixing IES would solve a lot of problems. I mean it when down yesterday and nothing could be processed in the afternoon.

Comment by Ike Wednesday, Jul 10, 19 @ 11:41 am
new hires properly trained and up to speed on the process and procedures.

RNUG, yes and yet the new hires can get their feet wet on simpler tasks freeing up certified caseworkers to be retasked to smash that backlog. We’ve been pulling major overtime hours to attack it.

Comment by Honeybear Wednesday, Jul 10, 19 @ 4:10 pm
I’ve had to read and sort out the notices for a friend of mine; 3 sets of notices in a month’s time. Each is written in bureaucratic language so bad I get 3-4 pages in to find out what was said on pages 1-2 doesn’t actually apply to him anyway, and forget about calling to reach the Unnamed Caseworker; his Local Office wouldn’t answer the main phone number anyway despite trying on different days. Standard business practices, like answering the phone or giving clients the name of their caseworker or other point of contact in notices is a foreign country to DHS. No offense to Honeybear and the frontline troops; you can only do so much when senior management is asleep.

Comment by revvedup Wednesday, Jul 10, 19 @ 6:05 pm