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Thursday, January 24, 2013

Illinois Medicaid Redetermination -- What It is & What To Tell Your Clients

In 2012, the Illinois Legislature passed the Save Medicaid and Resources Together (SMART) Act. One portion of this Act aimed to address the backlog of Medicaid redeterminations that has accumulated over the years. From this Act came the 'Illinois Medicaid Redetermination Project' (ILRP), more informally known as "Enhanced Eligibility Verification" (EEV).

The goal of EEV is to determine the eligibility status of current Medicaid recipients and adjust or eliminate benefits accordingly. This will be the system that redetermines Medicaid eligibility annually for current and newly enrolled recipients. The circumstances under which individuals may be removed from Medicaid include death, relocation out of state, or excess income, amongst many others.

The State has contracted with MAXIMUS Health Services Inc. and developed a case review system that categorizes Medicaid cases as those most likely eligible and those potentially ineligible for medical services. To this end, MAXIMUS has begun its operation and as early as this week will be reaching out to current Medicaid recipients who they believe are no longer eligible for Medicaid benefits.

As early as this week, these enrollees will receive a letter in the mail from the Illinois Medicaid Redetermination Project requesting they submit the appropriate eligibility verification documents.


  • The envelope that the redetermination letter will arrive in is non-descript with nothing distinguishing it from junk mail. Advocates have made HFS aware of this issue and they have said they will be changing it.
  • Current Medicaid enrollees will have only 10 business days to submit the proper eligibility verifying documents.
Once Medicaid enrollees submit the necessary verifying information, the file will be sent back to their case manager in the local office. At this time, the case manager will have 20 days to review the information provided and make a determination of eligibility. To be clear, MAXIMUS will not make final decisions related to Medicaid eligibility, but will collect all necessary and relevant information for the Department of Human Services who will use that to make a final decision.

If Medicaid enrollees fail to provide the proper documentation after receiving a letter of notice in the mail, their file will also be sent back to a case manager and their benefits likely eliminated. Although the state has implemented a new system to redetermine Medicaid eligibility, the appeal rights of applicants remains intact.

As Medicaid enrollees will only have 10 business days to submit the required verifying documentation, it's extremely important that advocates and providers provide support to their participants who receive Medicaid benefits that may need to submit such additional documents. With such a short turn-around time and in order to ensure continuity of care, it's imperative that Medicaid enrollees understand what they must provide and submit that information within the allotted time frame.

Contact information for the Illinois Medicaid Redetermination Project can be found below and summary of the program can be found here.

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
Phone Number: 1-855-HLTHYIL (1-855-458-4945)
TTY: 1-855-694-5458

Mailing Address: Illinois Medicaid Redetermination, PO Box 1242, Chicago, IL 60690-9992
FAX: 1-855-394-8066

Nadeen Israel & Molly McAndrew
Heartland Alliance for Human Needs & Human Rights


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    Eligibility Verification method involves to ascertain patients eligibility level and supply range of reliable services like cut denial claims, lower account assets, temporary work flow etc.

    Eligibility Verification Services

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