Health News
In 2012, the Illinois Legislature passed the Save Medicaid and Resources Together (SMART) Act. One portion of this Act aimed to address the backlog of Medicaid redeterminations that has accumulated over the years. From this Act came the 'Illinois Medicaid Redetermination Project' (ILRP), more informally known as "Enhanced Eligibility Verification" (EEV).
The goal of EEV is to determine the eligibility status of current Medicaid recipients and adjust or eliminate benefits accordingly. This will be the system that redetermines Medicaid eligibility annually for current and newly enrolled recipients. The circumstances under which individuals may be removed from Medicaid include death, relocation out of state, or excess income, amongst many others.
The State has contracted with MAXIMUS Health Services Inc. and developed a case review system that categorizes Medicaid cases as those most likely eligible and those potentially ineligible for medical services. To this end, MAXIMUS has begun its operation and as early as this week will be reaching out to current Medicaid recipients who they believe are no longer eligible for Medicaid benefits.
As early as this week, these enrollees will receive a letter in the mail from the Illinois Medicaid Redetermination Project requesting they submit the appropriate eligibility verification documents.
PLEASE NOTE:
If Medicaid enrollees fail to provide the proper documentation after receiving a letter of notice in the mail, their file will also be sent back to a case manager and their benefits likely eliminated. Although the state has implemented a new system to redetermine Medicaid eligibility, the appeal rights of applicants remains intact.
As Medicaid enrollees will only have 10 business days to submit the required verifying documentation, it's extremely important that advocates and providers provide support to their participants who receive Medicaid benefits that may need to submit such additional documents. With such a short turn-around time and in order to ensure continuity of care, it's imperative that Medicaid enrollees understand what they must provide and submit that information within the allotted time frame.
Contact information for the Illinois Medicaid Redetermination Project can be found below and summary of the program can be found here.
Illinois Medicaid Redetermination Program Hotline Information
Hours of Operation: Monday - Friday, 7:00 am - 9:00 pm, Central Time
Saturday, 8:00 am - 1:00 pm, Central Time
Phone Number: 1-855-HLTHYIL (1-855-458-4945)
TTY: 1-855-694-5458
Mailing Address: Illinois Medicaid Redetermination, PO Box 1242, Chicago, IL 60690-9992
FAX: 1-855-394-8066
Nadeen Israel & Molly McAndrew
Heartland Alliance for Human Needs & Human Rights
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Health News
Illinois Medicaid Redetermination -- What It is & What To Tell Your Clients
In 2012, the Illinois Legislature passed the Save Medicaid and Resources Together (SMART) Act. One portion of this Act aimed to address the backlog of Medicaid redeterminations that has accumulated over the years. From this Act came the 'Illinois Medicaid Redetermination Project' (ILRP), more informally known as "Enhanced Eligibility Verification" (EEV).
The goal of EEV is to determine the eligibility status of current Medicaid recipients and adjust or eliminate benefits accordingly. This will be the system that redetermines Medicaid eligibility annually for current and newly enrolled recipients. The circumstances under which individuals may be removed from Medicaid include death, relocation out of state, or excess income, amongst many others.
The State has contracted with MAXIMUS Health Services Inc. and developed a case review system that categorizes Medicaid cases as those most likely eligible and those potentially ineligible for medical services. To this end, MAXIMUS has begun its operation and as early as this week will be reaching out to current Medicaid recipients who they believe are no longer eligible for Medicaid benefits.
As early as this week, these enrollees will receive a letter in the mail from the Illinois Medicaid Redetermination Project requesting they submit the appropriate eligibility verification documents.
PLEASE NOTE:
- The envelope that the redetermination letter will arrive in is non-descript with nothing distinguishing it from junk mail. Advocates have made HFS aware of this issue and they have said they will be changing it.
- Current Medicaid enrollees will have only 10 business days to submit the proper eligibility verifying documents.
If Medicaid enrollees fail to provide the proper documentation after receiving a letter of notice in the mail, their file will also be sent back to a case manager and their benefits likely eliminated. Although the state has implemented a new system to redetermine Medicaid eligibility, the appeal rights of applicants remains intact.
As Medicaid enrollees will only have 10 business days to submit the required verifying documentation, it's extremely important that advocates and providers provide support to their participants who receive Medicaid benefits that may need to submit such additional documents. With such a short turn-around time and in order to ensure continuity of care, it's imperative that Medicaid enrollees understand what they must provide and submit that information within the allotted time frame.
Contact information for the Illinois Medicaid Redetermination Project can be found below and summary of the program can be found here.
Illinois Medicaid Redetermination Program Hotline Information
Hours of Operation: Monday - Friday, 7:00 am - 9:00 pm, Central Time
Saturday, 8:00 am - 1:00 pm, Central Time
Phone Number: 1-855-HLTHYIL (1-855-458-4945)
TTY: 1-855-694-5458
Mailing Address: Illinois Medicaid Redetermination, PO Box 1242, Chicago, IL 60690-9992
FAX: 1-855-394-8066
Nadeen Israel & Molly McAndrew
Heartland Alliance for Human Needs & Human Rights
- What Really Happens After Enrolling In Medicaid Managed Care?
Health & Disability Advocates (HDA) is monitoring the rollout of the Medicare-Medicaid Alignment Initiative (MMAI) and has heard from frustrated case managers working with consumers who are confused about the enrollment process and their rights. In...
- Aca, Medicaid And Unintended Consequences For People With Disabilities
People with disabilities who are eligible for healthcare through Medicaid may experience painful gaps in coverage during transitions. There are groups of people with disabilities that are particularly vulnerable: those who need long-term care services,...
- Medicaid Expansion Passes Both Houses Of The Illinois General Assembly
Earlier this week, the Illinois Legislature passed a bill (SB 26) to implement the Medicaid expansion option for adults without minor children on January 1, 2014. This expansion is a cornerstone of the Affordable Care Act and has the potential to cover...
- Dual Eligibles Next To Move Into Managed Care In Illinois
On February 22, the U.S. Department of Health and Human Services announced a Memorandum of Understanding (MOU) with the state of Illinois for a demonstration project that will enroll approximately 136,000 dual eligibles in northeastern and central Illinois...
- Recent "medicaid Reforms" In Illinois: How Do They Impact State Implementation Of The Aca?
The Affordable Care Act (ACA) offers states financial and health care coverage opportunities but also imposes administrative and structural requirements for states to meet in a very short timetable. There is, however, substantial federal money available...