Medicaid not getting the scrutiny it needs

As a result of legislation passed last year by the Illinois General Assembly, a private company is analyzing Illinois’ Medicaid program to make sure it is running efficiently and that those who are receiving benefits are legally eligible to receive these services.

Maximus, the company hired to review the program, has reviewed 65,995 cases this year and made recommendations. Of those, the state made final determination on 51,587 cases, which has resulted in a conclusion that 26,871 do not qualify under current state law. The reasons are primarily because these individuals either don’t live in Illinois or they don’t meet the income guidelines.

With this first snapshot, it is clear the Medicaid program is failing miserably to serve the people who need these services the most. Unfortunately, the review process by Maximus has reviewed less than 5 percent of the 2.8 million people in Illinois enrolled in Medicaid.

According to the most recent summary report released by the Department of Human Services, the agency has reviewed the recommendations by Maximus and has verified more than 50,000 individuals are no longer eligible for Medicaid, and as far as we know, have been scrubbed from the rolls.

There is no debate about the importance of Medicaid. It serves as a vital program to help those Illinoisan’s who are in poverty. But, it also needs to be protected and sustained so that we can help those who most need it. We must protect the program by making sure that the benefits go to those who truly need them and not to those who are scamming the system by collecting benefits they are not entitled to.

The example above was part of last years’ bipartisan reform package that was designed to address the $2.7 billion shortfall in the Medicaid program. These reforms were long overdue to a program that has seen years of mismanagement and unsustainable growth. The General Assembly stepped up to the plate and made some difficult but necessary choices.

Unfortunately, the administration and the Illinois Department of Healthcare and Family Services (HFS) have bungled the implementation of these reforms. We now expect the cost savings to be hundreds of millions of dollars short of expectations. This is a huge step backward. Sadly, this isn’t the first time we have failed to deal with this issue.

As far back as 2004, the Medicaid Managed Care Task Force warned that the liability growth of our Medicaid program was unsustainable and needed to be reformed. A number of legislative initiatives were offered by the House Republicans and were blocked by the Democrat majority and HFS. Five years later, we succeeded in passing into law reforms to increase transparency and track provider fraud in the Medicaid program. Another law authorized the use of a third party to detect and recapture Medicaid payments made in error as the result of fraud or abuse. Gov. Pat Quinn signed these reforms into law, but then failed to implement them.

The result of this failure to implement these common sense proposals has brought us to the brink of disaster in the Medicaid program.

Illinois still faces a $494 million shortfall in Medicaid. This shortfall adds to our already challenging budget situation in which there are approximately more than $1 billion in unresolved and spending pressures in last year’s budget. House Republicans are deeply concerned that Democrats will continue to ignore this shortfall and simply add them to the already massive pile of unpaid bills. Our schools, caregivers and small businesses can’t continue to wait months for reimbursement and need to be paid.

We need to be aggressive in both enacting and implementing reforms to our Medicaid program. Being lax has led our state to massive shortfalls and raises serious questions about the fiscal stability of the program.

Ÿ State Rep. Tom Cross of Oswego is the Illinois House Republican leader.

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