Cross-Agency Efforts to Eliminate Medicaid Backlog

At the direction of Governor JB Pritzker, three State departments - the Illinois Department of Human Services, the Illinois Department of Healthcare & Family Services, and the Illinois Department of Innovation & Technology - are leading the most aggressive cross-agency effort in Illinois history to expand healthcare access by eliminating the Medicaid application backlog.

The current initial application backlog is above 100,000, down from over 141,000 at its high point.
The re-determination backlog is over 150,000. Here's the timeline to eliminate both in 2020:

Initial Applications 45+ Day Waits Re-determinations 60+ Days Behind
Feb. 2018 Actual 141,479 N/A
Jan. 2019 Actual 120,725 N/A
Mar. 2019 Actual 112,444 164,501
May 2019 Actual 106,504 N/A
June 2019 Goal 97,000 150,000
Sept. 2019 Goal 72,000 126,000
Dec. 2019 Goal 46,000 92,000
Mar. 2020 Goal 40,000 47,000
June 2020 Goal 0 0

A seven-part strategy to address the backlog is underway:

  1. Targeted Hiring: More than 350 new caseworkers at HFS and DHS, alongside new policy and technical experts.
  2. Enhanced Training: For caseworkers - new training content, staff and schedules are being developed.
  3. Process Simplification: Major process improvements to help remove barriers to coverage and improve operations.
  4. Policy Streamlining: An updated Medicaid policy manual and expanded use of ex parte redetermination.
  5. Infrastructure and Programming Changes: Updating technology and IES to perform better.
  6. System Enhancements: For example, electronically tracking undelivered mail and phone-based redeterminations.
  7. Improved Reporting: Clearer tracking of patterns, to shape future priorities using the best available data.

A related, bipartisan bill to improve the eligibility system is being negotiated. Key features include:

  • Grace Period - Allows HFS to extend the end of benefit coverage date by one month for redeterminations.
  • Simplifying Proof of Income - Amends three laws to allow verification of a month's income by a single paystub.
  • Co-Payments - Eliminates the requirement to charge copays to ensure compliance with federal rules.
  • Beyond Medical Necessity - Requires administrative day payment for hospital stays past medical necessity.
  • Prompt Pay/Expedited Payments - Sets MCO prompt pay requirements; automatic interest and expedited payments.
  • Ex Parte Redetermination - Requires a review of eligibility categories suited for automatic redeterminations.
  • Application/Redetermination Assistance - Explores outside stakeholder involvement in eligibility determinations.
  • Eligibility Reporting - HFS and DHS shall report quarterly on progress of implementing the Act.