Performance Audit of the Health Benefits for Immigrant Seniors and Adults
Learn how the AI-generated research projects were createdOverall Conclusion
The audit revealed significant discrepancies between estimated and actual enrollment and costs, issues with data accuracy and eligibility verification, and the need for improved controls to prevent ineligible or duplicate enrollments. These findings highlight the importance of robust oversight and data management to ensure program integrity and maximize federal funding.
Source Document
Audit Scope
The audit covers the Illinois Department of Healthcare and Family Services’ administration of Medicaid services and coverage for undocumented immigrants, focusing on the HBIS and HBIA programs from their inception in December 2020 through FY24, including enrollment, costs, eligibility, redeterminations, and program controls.
Key Findings Summary
Actual enrollment and costs exceeded initial estimates for both HBIS and HBIA programs. In FY23, enrollment was significantly higher than estimated, with costs also substantially exceeding initial projections—84% higher for HBIS (65+), 282% higher for HBIA (55-64), and 286% higher for HBIA (42-54).
Enrollment increased notably over the years, peaking in FY23, then decreasing in FY24 due to redeterminations and eligibility changes.
From FY21 to FY23, the programs cost just under $898 million, with the highest costs in FY23 for the HBIA (42-54) level at $244 million, and in FY24, the costs increased further.
View the Findings tab to see all 6 findings
AI-Assisted
AI Scope Summary
To evaluate the accuracy of enrollment data, the actual costs incurred, and the compliance with eligibility rules in the Medicaid programs for immigrant seniors and adults, and to recommend improvements in data management and eligibility verification processes.
AI-Generated Insight
This report underscores the challenges in managing Medicaid expansion programs for noncitizen immigrants, emphasizing the importance of accurate data, strict eligibility controls, and effective redetermination processes to prevent fraud, optimize costs, and secure federal reimbursements. The transition to managed care appears to be a pivotal step in controlling expenditures, but ongoing oversight is crucial to maintain program integrity.