Performance Audit of Medicaid Eligibility Determinations for Long-Term Care
Learn how the AI-generated research projects were createdOverall Conclusion
The audit identified significant delays, data inaccuracies, and reporting deficiencies in Illinois' Medicaid long-term care eligibility process. While some system enhancements have been implemented, issues remain with timeliness, data integrity, and reporting practices. The agencies have agreed with the recommendations, and further improvements are necessary to ensure compliance with federal and state requirements.
Source Document
Audit Scope
The audit covers Illinois' Medicaid long-term care eligibility determinations from calendar years 2021 to 2023, including the assessment of the Integrated Eligibility System (IES), reporting practices, and the transition from task-based to facility-based processes.
Key Findings Summary
Issues with the Integrated Eligibility System (IES) affecting internal controls and data completeness.
Timeliness issues with eligibility determinations, with 22% pending past required days, averaging 41 days for decision.
Overdue applications involving HFS OIG asset investigations, with delays ranging from 14 to 156 days.
View the Findings tab to see all 7 findings
AI-Assisted
AI Scope Summary
The audit aims to assess the performance, timeliness, accuracy, and reporting of Medicaid eligibility determinations for long-term care in Illinois, and to evaluate the effectiveness of the current eligibility determination processes.
AI-Generated Insight
This comprehensive audit highlights systemic challenges in Illinois' Medicaid long-term care eligibility process, emphasizing the need for robust controls, accurate reporting, and process re-evaluation to enhance efficiency and compliance.
Audit Objectives
Evaluate the performance and compliance of Illinois agencies in meeting Medicaid long-term care eligibility determination requirements.
Assess the timeliness, accuracy, and completeness of LTC eligibility determinations and reporting.
Review the efficacy and efficiency of the task-based process versus the facility-based process for eligibility determinations.
Audit Findings (7)
Issues with the Integrated Eligibility System (IES) affecting internal controls and data completeness.
Timeliness issues with eligibility determinations, with 22% pending past required days, averaging 41 days for decision.
Overdue applications involving HFS OIG asset investigations, with delays ranging from 14 to 156 days.
Inaccurate and incomplete LTC reports, with issues in data accuracy, missing elements, and posting delays.
Transition from task-based to facility-based eligibility process, with ongoing assessment needed.
No issues found with DHS staff conducting eligibility instead of HFS.
Delays in redeterminations due to COVID-19 emergency rules, with some redeterminations completed post-emergency.
Recommendations (6)
Improve controls to enhance timeliness of eligibility determinations.
Enhance referral and investigation processes with HFS OIG.
Implement better tracking of extensions and disability status in IES.
Ensure monthly LTC reports are completed, posted timely, and contain all required elements.
Develop controls to improve the accuracy of LTC monthly reports.
Reassess and improve the efficacy and efficiency of the facility-based eligibility process.