Evidence record
Illinois Medicaid Managed Care Capitation Payments for Incarcerated Enrollees
- Jurisdiction
- Illinois
- Publication date
- December 2025
- Source record
- Original document linked
Findings
3
Recommendations
2
Overall conclusion
The audit determined that Illinois made unallowable managed care capitation payments for incarcerated enrollees during the audit period, totaling at least $9.5 million with $8.3 million Federal share, and identified failures to terminate enrollment as required. Recovered findings were not fully realized during the audit period, and recommendations were issued to refund unallowable payments and broaden data matching to prevent future occurrences.
Scope
Audit period October 1, 2020, through September 30, 2023, covering $22.5 million in Medicaid managed care capitation payments made on behalf of 11,722 incarcerated Illinois Medicaid enrollees; stratified random sample of 100 enrollees with capitation payments totaling $412,224.
Findings (3)
Each finding has a stable link.
- F-967
The State agency made unallowable capitation payments totaling $263,186 ($229,423 Federal share) on behalf of 48 incarcerated Medicaid enrollees.
- F-968
The State agency did not always terminate Medicaid managed care enrollment after receiving notification that an enrollee was incarcerated, with 29 cases where termination did not occur as required.
- F-969
The automated and county-initiated processes for terminating enrollment did not consistently include inmates in non-IDOC custody or other facility types, leading to unallowable payments.