HFSMedical ClientsMedicaid RedeterminationProject Details for Assisting Clients

Project Details for Assisting Clients

The Departments of Healthcare and Family Services (HFS) and Human Services (DHS) are initiating an enhanced eligibility verification project with the official name of the “Illinois Medicaid Redetermination Project” (IMRP) and the unofficial name of EEV (Enhanced Eligibility Verification). The purpose of this project is to process the backlog of cases that require immediate redeterminations and ensure that going forward, redeterminations will be processed in a timely manner, so that eligibility for Medicaid coverage is verified on an annual basis. This note will provide some background information on the project in case of inquiries from clients or to otherwise answer questions.

Background

The Illinois Medicaid Redetermination Project arose from an emergency procurement authorized by the Save Medicaid Access and Resources Together (SMART) Act of May 2012, to secure services of a Vendor to assist in the verification of income, assets and residence for Medicaid eligibility through use of data matching resources.
On September 13, 2012, the State entered into a contract with MAXIMUS Health Services, Inc., who in turn subcontracted with HMS for the data matching component. This document summarizes the key program components, including:

  • Scope of Work

  • Impacted Programs

  • Schedule

  • Illinois Medicaid Redetermination Program Hotline Information

Scope of Work

Impacted Programs

MAXIMUS will provide a redetermination recommendation for the following programs. Clients within these programs may contact the IMRP Hotline.

  • Aid to the Aged, Blind and Disabled (AABD), including Long Term Care (LTC)

  • Family Health Plans, including:

  • FamilyCare/All Kids Assist

  • All Kids Share

  • All Kids Premium Level 1

  • All Kids Premium Level 2

  • All Kids Rebate

  • Moms and Babies

 MAXIMUS will NOT provide a redetermination recommendation for the following medical programs.  Clients within these programs should continue to work with their respective caseworkers or local office.

  • Health Benefits for Workers with Disabilities

  • Veteran’s Care

  • Breast & Cervical Cancer Program

  • Illinois Healthy Women

Clients who have other benefits in addition to Medicaid (primarily Supplemental Nutritional Assistance Program, SNAP, the official name for “food stamps”) should continue to work with their local caseworker.

Schedule

The following schedule outlines key program implementation dates:

Illinois Medicaid Redetermination Program Schedule

Date Activity
January 2, 2013 MAXIMUS-operated Illinois Medicaid Redetermination Program reviews and assesses initial cases
January 21, 2013 Full hotline and recommendation processing for medical-only cases
February 1, 2013 MAXIMUS begins review of cases that also include SNAP or other benefits
February 4, 2013 State begins to receive medical-only case redetermination recommendations

Since the initial case efforts will be focused on cases that have higher probability of being ineligible, there may be a wave of clients losing eligibility, particularly in February through April.

IMRP Hotline Information

A client who has been asked to submit information to the Illinois Medicaid Redetermination Project should submit the data as shown below. Data can also be taken to local DHS office (or sent to the All Kids Unit) but returning directly to the Redetermination Project in the stated time frames will decrease likelihood of recommendations being made for discontinuation due to missing, conflicting or outdated information.

While the project is very focused on maintaining business continuity, the situation of most concern is where a client is required to submit information to the Redetermination Project within 10 business days. When that period has elapsed, the control of the case is returned to the local office (or the All Kids Unit if that’s where case was being maintained) for a final decision. Once the case recommendation has been returned to the local office, the client should submit information there—or contact their local office if they are cancelled and they believe the cancellation is in error. Our plan calls for any information that gets to the Call Center to be routed to the local office if they have re-assumed control of the case, but the more hand-offs, the greater the risk of process break-downs. Clients will need to pay attention to any deadlines in correspondence and direct responses accordingly.

Illinois Medicaid Redetermination Program Hotline Information

Hours of Operation:

  • Monday – Friday, 7 a.m. – 9 p.m., Central Time
  • Saturday, 8 a.m. – 1 p.m., Central Time

Holidays: The IMRP Hotline will be closed on the following holidays:

  • New Year’s Day
  • Memorial Day
  • Fourth of July
  • Labor Day
  • Thanksgiving Day
  • Christmas Day

Phone Number:

  • 1-855-HLTHYIL (1-855-458-4945)
  • TTY 1-855-694-5458
  • FAX: 1-855-394-8066

Mailing Address:


Medicaid Redetermination

 

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