Illinois Expands Medicaid Funding But Needs to Improve Oversight

Last week, the Illinois Senate and House voted to restore Medicaid cuts that were made in 2012. Although there is excitement about the expansion, an auditor’s report issued the same week served as a  strong reminder of the need for more careful oversight of  Medicaid operations also came out last week.

Restored Medicaid Services

On Thursday, May 29, Illinois senators voted 46-10 to expand Medicaid benefits to restore funding for adult dental, psychiatric medication, and podiatry services after the House approved the measure on Wednesday. This coverage was cut two years ago to save money. The vote passed despite Republicans’have expressed concerns about sustaining services during a difficult budget year.

Democratic Rep. Greg Harris sponsored the bill. According to Harris, the 2012 cuts didn’t save the state money because people wound up in the emergency room, which costs more. Adult dental services, for example, were limited to emergencies. Because routine check ups were not covered, people would wait until problems got really bad, and emergency care was the only option. But emergency care is significantly more expensive than preventive dental coverage. By using preventive services, Democratic Rep. Mary Flowers contends, people will be healthy and therefore able to work and not lose their wages.

Rep. Harris says the additional services will cost approximately $221 million this year. But he says federal money will cover some of the expenses, making the final cost to taxpayers about $125 million. Republican representatives like Patricia Bellock are concerned about tight budgets and making sure there’s enough money for those who need it.

Program Oversight Needed

One of the ways to be sure the money is there is to be sure that money is being spent in the right places. According to an audit of the Illinois Department of Healthcare and Family Services, workers at the agency did not match up death records with the lists of people receiving taxpayer-funded medical benefits. This break in the system resulted in millions of dollars being paid out for services supposedly provided to patients who had died months, or even years, before.

The audit indicated that 561 individuals were signed up for Medicaid managed care more than 90 days after their deaths. The state of Illinois then paid monthly premiums for those dead beneficiaries totaling nearly $7 million. Additionally, other payments were made for large fee-for-service expenditures after the beneficiaries’ deaths. The audit indicated that Medicaid made payments of nearly $30,000 for medical services from 2005 through 2013 for a patient who had died in 1989.

“We recommended the Department improve its system of controls to ensure death dates for current enrollees are entered into its eligibility system and ensure that deceased individuals are not enrolled in managed care,” Holland wrote.

The systems involved in this issue are being updated “to ensure any current enrollees who pass away are entered into our eligibility system by their date of death, and that deceased individuals are not enrolled in managed care,” according to the memo written by Healthcare and Family Services Director Julie Hamos and Human Services Secretary Michelle Saddler.

“While this represents less than one-tenth of one percent of our caseload, and an even smaller percentage of our Medicaid budget, overpayments are unacceptable,” the agency heads wrote in the memo. “It is imperative that our databases include only people who are eligible for Medicaid.”