Evidence record
Performance Audit of Medicaid Eligibility Determinations for Long-Term Care
- Jurisdiction
- Illinois
- Publishing agency
- Illinois Office of the Auditor General
- Publication date
- July 16, 2025
- Source record
- Original document linked
Findings
7
Recommendations
6
Overall 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.
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.
Findings (7)
Each finding has a stable link.
- F-736
Issues with the Integrated Eligibility System (IES) affecting internal controls and data completeness.
- F-737
Timeliness issues with eligibility determinations, with 22% pending past required days, averaging 41 days for decision.
- F-738
Overdue applications involving HFS OIG asset investigations, with delays ranging from 14 to 156 days.
- F-739
Inaccurate and incomplete LTC reports, with issues in data accuracy, missing elements, and posting delays.
- F-740
Transition from task-based to facility-based eligibility process, with ongoing assessment needed.
- F-741
No issues found with DHS staff conducting eligibility instead of HFS.
- F-742
Delays in redeterminations due to COVID-19 emergency rules, with some redeterminations completed post-emergency.
Recommendations (6)
- R-657
Improve controls to enhance timeliness of eligibility determinations.
Related finding F-737 - R-658
Enhance referral and investigation processes with HFS OIG.
Related finding F-738 - R-659
Implement better tracking of extensions and disability status in IES.
Related finding F-736 - R-660
Ensure monthly LTC reports are completed, posted timely, and contain all required elements.
Related finding F-739 - R-661
Develop controls to improve the accuracy of LTC monthly reports.
Related finding F-739 - R-662
Reassess and improve the efficacy and efficiency of the facility-based eligibility process.
Related finding F-740