More Information for Children & Adults Who Get Medicaid Services for Developmental Disabilities, In Addition to Medicaid/AllKids Health Benefits
Important Hints and Tips for Families and Consumers
Illinois Medicaid Redetermination Program (IMRP) February 2013 Update
In 2012, the Illinois Legislature passed the Saving Medicaid Access and Resources Together Act (called the SMART Act, for short), designed to save money by streamlining the operations and services of our state’s Medicaid program.
The goals of the Illinois Medicaid Redetermination Project (IMRP) include both catching up on the backlog of cases waiting for redetermination and ensuring that future redeterminations will be carried out in a timely manner. Each year, everyone enrolled in Medicaid must undergo a redetermination (sometimes called “rede”) to find out if they are still eligible.
The new IMRP is being carried out under contract with two private vendors, Maximus and HMS. They have developed a joint data matching system to expedite redeterminations. The IMRP, which is also called Enhanced Eligibility Verification (EEV), is being run under contracts between the Illinois Department of Healthcare and Family Services (HFS) and two private companies:
HMS will provide MAXIMUS with a data mining computer system that will review records electronically and select those people who are most likely to be eligible as well as those who are most likely to no longer be eligible. They will do this by matching data across agencies and programs. This is being done “behind the scenes”. HMS forwards the information to MAXIMUS. Consumers and providers do not interact with HMS, only with MAXIMUS.
How It Works
MAXIMUS will review cases for people who are selected for redetermination. They will verify all possible data electronically, and contact clients to complete the redetermination process as necessary. They will identify themselves to Medicaid enrollees as working for the Medicaid Redetermination Project, not as MAXIMUS employees.
Some Medicaid recipients will have their redeterminations completed electronically “in house” via the data matching system and will not get redetermination letters.
When the data system indicates that more information is needed in order to complete the redetermination, Maximus will send out a letter to the recipient with instructions on how to proceed.
People contacted by MAXIMUS will have only 10 business days to respond. People who do not provide information within this deadline will then need to work with their local DHS Family and Community Resource Center to complete their redetermination.
Medicaid enrollees can mail or fax their information to MAXIMUS IMRP. They can also take it to their local DHS office. Future plans include the option to scan and email documents to MAXIMUS. No start date has been given for this electronic submission. MAXIMUS will also operate a toll-free program hotline for consumers at 1-855-458-4945.
Contact Information for the IMRP:
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
Holidays: The IMRP Hotline will be closed on the following holidays:
New Year’s Day
Fourth of July
Phone Number: 1-855-HLTHYIL (1-855-458-4945)
Mailing Address: Illinois Medicaid Redetermination,
PO Box 1242
Chicago, IL 60690-9992
Special thanks to the Legal Assistance Foundation of Chicago and Prairie State Legal Services for this important information about customer appeal rights for Medicaid redeterminations.
What will Maximus or DHS do with the information that they receive frombeneficiaries?
Based on the information gathered, Maximus will recommend to DHS whether beneficiaries remain eligible, eligibility has changed, or to have their case terminated.
DHS will use these recommendations to complete each beneficiary’s Medicaid redetermination in the state’s eligibility system, but DHS makes the final decision. Caseworkers are allowed no more than 20 days to complete this process.
How can the beneficiary appeal the decision?
Beneficiaries can appeal unfavorable redeterminations through the same process that has always been available. If beneficiaries believe they are still eligible, they must appeal immediately—no later than 10 days after receiving notice of termination—and explicitly request continuing benefits. Clients can file an appeal by calling the Bureau of Assistance Hearings (BAH) at 312-793-2618 or 1-800-435-0774. They can also fill out a Notice of Appeal at their local DHS office.
You can fax this form to your local DHS Family Community Resource Center office, or mail it to them via Certified Mail. Be sure to keep a copy for your records.
Find the mailing address and fax number for your local DHS Family Community Resource Center by using the DHS Office Locator: http://www.dhs.state.il.us/page.aspx?module=12
If you have Questions about redetermination appeals, please contact: Carrie Chapman, Legal Assistance Foundation of Chicago: firstname.lastname@example.org 312-347-8388
More information for children and adults who get Medicaid Waiver services for developmental disabilities, in addition to Medicaid/AllKids health benefits:
Participating in a Medicaid Waiver means that you must also continue to be eligible for and enrolled in Medicaid (or All Kids), so you must complete your redetermination on time.
If you do not send in your redetermination information on time, you might lose both your medical benefits from Medicaid and your waiver services. Then you will need to reapply.
In addition to your Medicaid redetermination, enrollees in DD waiver services ALSO have an annual redetermination with DHS/DDD. This is completed by your case manager from your Independent Service Coordination Agency (ISC), also referred to as a PAS agency.