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HFS processing backlog may have killed a nursing home

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Illinois

* Remember yesterday when I told you about the backlog at Illinois’ Medicaid long-term care (LTC) program? LTC covers 55,000 eligible residents in 738 nursing homes. The Illinois Department of Health and Family Services has to approve coverage, and they currently have a backlog of 14,572 pending admissions this month. So, the nursing homes are forced to pay for care out of their own pockets, and that amount has reportedly reached $300 million.

Why is this happening? A few reasons, according to the comptroller’s office (click here). Nursing home residence applications are rising as the population ages. The state has a shortage of case workers. And the snazzy data system launched late last year apparently isn’t performing as well as hoped.

* The delayed payments may have killed a nursing home…

Pleasant Hill Healthcare [in Girard] said they will have to almost immediately shut down due to the lack of state funding.

It’s part of the Pleasant Hill Village, which includes the Healthcare and Assisted Living department. The Healthcare department, which includes a Dementia unit and Skilled Care unit, will shut down.

The facility opened in 1905, about 113 years ago. Some residents describe the place as a serene and peaceful home. […]

[Executive director Paulette Buch Miller] said the state owes them over $2 million in pending and approved Medicaid payments.

Aside from the human factor, the worst part of all this is that it’s Medicaid, so there’s a federal match that the state isn’t tapping.

* From the comptroller’s office…

We haven’t had any hardship letters from this nursing home. But we don’t have any vouchers here in our system for them. So even if they did reach out for help through our hardship process, as it stands now, there’s really nothing we can do.

posted by Rich Miller
Friday, Jun 29, 18 @ 10:56 am

Comments

Someone in the BTIA would actually have to give a damn, to avoid things like this.

Comment by Langhorne Friday, Jun 29, 18 @ 11:01 am
Spell check: Pleasant Hill is in Girard, Macoupin County.

Comment by tomhail Friday, Jun 29, 18 @ 11:07 am
Care Center of Abington and Good Samaritan in Flannigan both closed earlier this year and the eligibility processing backlog played a role in their demise.

Comment by Hoping for Rational Thought Friday, Jun 29, 18 @ 11:11 am
If it’s a choice between “Pritzker Plumbing” and “Rauner Retirement Care”, I’ll take the “plumber” any day.

Comment by Anon221 Friday, Jun 29, 18 @ 11:16 am
=Pleasant Hill Healthcare [in Gerard] said they will have to almost immediately shut down due to the lack of state funding.=

This is a Rauner specialty. He has a long and documented history here. It makes me sick as my own parents are approaching the age where they may move to a care facility of some type.

Pritzker needs to pound Rauner mercilessly on this stuff. Rauner’s only response will be “but Madigan”.

Comment by JS Mill Friday, Jun 29, 18 @ 11:17 am
=Care Center of Abington and Good Samaritan in Flannigan both closed earlier this year and the eligibility processing backlog played a role in their demise.=

Both rural communities where people have few choices for services.

Nice job governor. Tell me more about growin’ jobs.

Comment by JS Mill Friday, Jun 29, 18 @ 11:20 am
I’m sure Rauner will “take the arrows” directed at James Dimas. /s

Comment by Jocko Friday, Jun 29, 18 @ 11:22 am
The reason the Comptroller can’t help with hardship is because there are no vouchers. This is because the backlog of poendsing applications means the NH can not bill HFS for the care. So a NH could be providing care for 9 month, a year, and in a few cases 2 years before being able to bill. Also banks won’t extend lines of credit for pendings. THis problem has been growing since 2013 but really exploded over the last year. Ironically the state hired more caseworkers last year and the problem got worse partly because of the new IES which slowed the process down.

Another aspect to this problem is DHS and HFS do not work together well. Caseworkers work for DHS processing Medicaid benefits but HFS runs Medicaid and sets policy. HFS is accountable for Medicaid but doesn’t direct the caseworkers. DHS has no accountability for Medicaid so is less motivated and focuses on the programs they are accountable for SNAP etc.

Comment by Hoping for Rational Thought Friday, Jun 29, 18 @ 11:29 am
Squeeze the beast by other means, or just BTIA(TM) FUBAR?

Misanthropy or incompetence appear to be the only choices.

Comment by wordslinger Friday, Jun 29, 18 @ 11:35 am
Between stuff like this and the WIU story yesterday, tell me again why us voters should care so much about Pritzker’s toilets?

Comment by Anonymous Friday, Jun 29, 18 @ 11:40 am
Hoping- true DHS and HSF caseworkers are compartmentalized but we don’t focus on SNAP to the detriment of Medicaid. We deal with both as the problems/cases arise. I’ve got this one little abuella in here just now who I can’t get the IES system to update that she left the nursing home 5/1. Round and round stuck in a loop. She needs the AABD coverage. So frustrating to know what has to be done but stymied in executing it. Meanwhile the lobby is filling up.
We’re working as fast as we can and doing overtime 6 days a week
EIS cancels cases faster than we can fix them.
It’s a firehose water fountain.
That’s why Rauners
Screwing with the workforce is so short sighted
People have been looking for other jobs
And leaving.

Comment by Honeybear Friday, Jun 29, 18 @ 11:46 am
Deloitte designed the new Integrated Eligibility System (IES) to work DHS caseworkers harder, not smarter. The idea was that frustrated caseworkers would retire or quit, allowing them to be replaced by minimum-wage private-sector workers.

The many IES bugs that slow (or stop) caseworker productivity actually speed up the caseworker replacement process.

Deloitte and DHS management were warned about this by (mostly union) MIS staff but were ignored or just plain told to “ shut up”.

Comment by Me Again Friday, Jun 29, 18 @ 11:53 am
HFS seems to have a leadership problem and they just lost a good director and now their child support director is leaving too (something that seems to be greatly underreported).

Comment by I Miss Bentohs Friday, Jun 29, 18 @ 2:03 pm