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Wednesday, May 27, 2015

Redoing Redes: Strengthening Communication Procedures in the Illinois Medicaid Redetermination Project

The Illinois Medicaid Redetermination Project (IMRP) is erroneously suspending vital medical care for people who remain eligible. Since the rollout of the IMRP in early 2013, the program has been plagued by inadequate communication from the state that leaves consumers confused and ultimately without healthcare. Consumers report that they are not receiving the required notices by mail and when they call with questions, frontline state staff cannot provide answers. Because of the state’s ineffective communication protocols and inadequate employee training, rightful Medicaid beneficiaries are in the precarious situation of being unable to fill their prescriptions, go to the doctor or receive treatment. The purpose of the IMRP is to save state dollars by trimming the Medicaid program of those who are no longer eligible, not cut people who still deserve services.

Letters Lost in the Mail

Medicaid beneficiaries are cut simply because they never received their redetermination notices in the mail. For example, Health & Disability Advocates worked with a mother whose child had been dropped from Medicaid because IMRP sent the notice to a non-existent address. The fact that IRMP sent the letter to an incorrect address on the same street where the family lived suggests that it was a clerical error. In this situation, a young adult dealing with serious mental illness could not access medication and treatment, because the state, not the individual made an error. Sudden lapses in care can pose serious consequences for people who rely on these supports for their physical and mental health.

This is not an isolated instance. A survey of case managers working with older adults and people with disabilities found that the IMRP fails to adequately notify people of their redetermination responsibilities and inform them when they are bounced from the program. Many get the bad news when they attempt to fill prescription or go to the doctor and are told that they are no longer covered. People deserve clear communication from the state telling them they are no longer covered and the steps to get reinstated.

Confused and Not Covered

Even in cases where Medicaid recipients do receive notices, many consumers find the letters are hard to understand and filled with jargon. Given that the intended audience has never before been required to submit to annual redeterminations and may also have lower literacy levels, the letters must be crystal clear. Reports from case managers suggest the letters are confusing.  One case manager surveyed noted “clients do not understand what documents they need to submit with the form and whether they need to submit anything.” With the potential for people to lose their health coverage, the consequences of this confusion are severe.

IMRP’s own data reveal their communication shortcomings. According to May’s Medicaid redetermination numbers, 81% of cancellations are due to a lack of response. Being cancelled doesn’t mean a person is ineligible. In fact, a substantial portion of these clients should still be receiving services.  Of those dropped, 1/3 were reinstated within three months.  In FY 2015 alone, this translates into 238,025 people being incorrectly cut from Medicaid, and this number could be even higher. People who are less frequent healthcare users may learn of their cancellation when they attempt to schedule a doctor’s appointment. With people who deserve Medicaid cut from the program, the IMRP is not achieving its main objective of reducing state expenditures by eliminating those who no longer qualify. Cutting eligible people will actually result in higher costs. Without access to primary medical treatment, people will resort to more costly emergency room care for conditions that could have been managed or even prevented.

Matters get worse when consumers call state workers for clarification, because frontline staff members are often not fully informed themselves. In the above-mentioned case of the mother fighting for her son’s coverage to be reinstated, her interaction with the IMRP hotline was unhelpful and hurtful. The representative said there was nothing more she could do and blamed the family. Stateline workers should be fully trained to provide answers; anything less only increases confusion and frustration.

The Path Forward

The state must develop plain-language notices that explain redeterminations and their importance while outlining the specific steps to keeping coverage. This would not be a new undertaking. State officials have previously brainstormed ways to create simple, more consumer friendly forms. Unfortunately, the furor around budget deficits and service cut threats has drowned out the push for clear communication standards. Even worse, continuing to deemphasize this issue will leave many rightful Medicaid recipients suddenly without coverage. Communication protocols and state staff should support individuals in maintaining their vital connection to healthcare, not create hurdles that effectively jeopardize emotional and physical health. State officials must restart the discussions on clear notices and broaden the conversation to include improved training for frontline staff. These reforms will go a long way towards supporting the IMRP’s original objective of eliminating wasteful spending while also keeping those who still deserve coverage connected to care.

Bryce Marable MSW
Health Policy Analyst


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  3. Hi, I am a Navigator for the Marketplace working in a FQHC in Marion Il. I work with Medicaid patients everyday to submit redetermination paperwork or to help with the confusion of why they were cut off . There has to be a much simpler option to help these patients. I do find the majority of the time that some patients simply don't take the time to open and read their mail. We also find that new addresses have not been communicated with the local DHS office. While reading your article today, it occurred to me that a simple fix to get the attention of clients who don't open and read their mail is to simply add RED ink on all yearly redetermination envelopes that simply say" Yearly Redetermination Response Required"! I feel if a person receives the notice of their benefit being cut off, then they also received the notice of redetermination! Ultimately it is the clients responsibility to communicate with DHS of any changes in address or circumstances. It wouldn't hurt to have the case workers remind clients of an upcoming redetermination if they are speaking with them on the phone as well. Communication is the answer.

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  5. As a Medicaid recipient whose family Medicaid case was canceled due to the clerical procedures in place at Maximus, I appreciate your drawing attention to this situation, but the issues go beyond what you stated. After receiving my Medicaid renewal forms, I scanned and uploaded my forms to their server and received a confirmation email. A month later I recorded a notice that my case had been cancelled due to the not receiving my paperwork. I waited hours to see a caseworker who also made copies of my information and reassured me my case would be reinstated. It was, but only for my children. Frustrated, I called Maximus who informed me that my documents had been deleted because clients are required to verify that they uploaded documents and unless they call to verify, the documents are auto deleted from their servers. I find it sad that the only thing Maximus has managed to streamline in regards to the Medicaid process is the auto deletion of documents and cancelling cases. There was no mention of the need for verification in the redetermination paperwork. Generally, a confirmation email indicates that a submission is successful. After reuploading my documents, I phoned 2 days later to verify the status of those documents and was informed that they had not had a chance to review the documents and Inshould call back tomorrow.