SPRINGFIELD – Illinois officials are so far behind on determining Medicaid eligibility for 15,000 nursing home residents that privately run facilities are fronting $300 million in care while state officials struggle with the backlog, according to interviews and documents obtained by The Associated Press.
Starting Thursday, the state must pay the Medicaid cost of care for those who have waited more than 45 days for a determination of their eligibility, according to conditions set by a federal judge.
The Illinois Department of Healthcare and Family Services responded by issuing a request for a private company to step in and help catch up at a cost of up to $14.4 million. It would utilize a computer system whose glitch-laden rollout last fall included improperly canceling federal food assistance for 40,000 needy families.
Numbers compiled by state Comptroller Susana Mendoza and obtained by the AP show the backlog of cases waiting for eligibility determination peaked at more than 16,000 in May before dropping this month to 14,572. The oldest cases – those still awaiting a decision after 90 days – jumped 143 percent, to more than 9,000, just from December 2017 to May, Mendoza found.
Nursing home administrators are perplexed by the holdup. Universal Health Care Management’s 49-bed nursing home in Stockton, a town of 1,900 in northwestern Illinois, has fronted about $500,000 for residents awaiting eligibility determination, according to company Vice President Michael Nudell.
“Some of these are slam dunks,” Nudell said. “There’s no property, no money, no outside source of income. You look at these and say, without question, they meet the criteria to get Medicaid coverage, yet these are taking a long time.”
A report Mendoza plans to publish, obtained in advance by the AP, says state agencies in the past have blamed staffing shortages along with unfamiliarity with the same computer system that caused the food assistance problems.
It’s unclear how the backlog grew so quickly or why its escalation began shortly after the deadline legislators imposed in a 2013 law that demanded elimination of a smaller backlog by summer 2014. Department of Healthcare and Family Services spokesman John Hoffman said Thursday that the lawsuit prevents him from commenting
The state’s Medicaid long-term care program focuses on those 65 or older or who are disabled and have assets less than the cost of private nursing care. It’s responsible for 55,000 nursing home residents in 738 Illinois nursing homes, according to Mendoza, a Democrat highly critical of Republican Gov. Bruce Rauner.
“For Illinois’ aging population, this is a massive health care and housing crisis and it again demonstrates an inability by Gov. Rauner to manage basic state functions and critical programs,” Mendoza said in a statement.
U.S. District Judge Joan Gottschall, in a lawsuit filed last year, ordered the state to clear the backlog by Thursday or, going forward, presume everyone who’s been awaiting an eligibility decision for at least 45 days is eligible and pay the state’s share of the federal-state Medicaid program. That rule would be enshrined in state law under legislation awaiting Rauner’s action.
Matt Werner, a Springfield consultant on the case, estimated the cost currently at $280 million to $320 million overall, with half reimbursed later by the federal government. He said payments will be spread out because HFS must create identifiers for the residents and then providers must bill the state for each.
Nursing homes find themselves in a situation not unlike the way others providing goods or services have fronted state government costs for years because of a historic budget stalemate, waiting months for payment, as evidenced by a $6.4 billion bill backlog.
“We function, essentially, as a state bank,” said Greg Wilson, vice president of Petersen Healthcare in East Peoria.
Some operations have begun refusing admission to residents whose Medicaid eligibility is not concluded, but most don’t consider that an option, Wilson said.
“We’re part of the communities we serve,” he said. “We don’t turn people away, but the state owes us millions.”
HFS sought a private company to help reduce the backlog, estimating in a procurement document that it would cost $14.4 million over two years. The solicitation closed Monday. There’s no indication of whether a contractor was selected.
The request indicated the successful bidder would use the Integrated Eligibility System.
The state first implemented it in 2013 for $144 million. By the time it became fully operational last fall, the cost was over $287 million and its rollout beset by bugs that improperly canceled Supplemental Nutrition Assistance Program benefits for 40,000 needy families. The benefits were restored late in the year.