Evidence record
Performance Audit of the Health Benefits for Immigrant Seniors and Adults
- Jurisdiction
- Illinois
- Publishing agency
- Illinois Office of the Auditor General
- Publication date
- February 26, 2025
- Source record
- Original document linked
Findings
6
Recommendations
2
Overall 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.
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.
Findings (6)
Each finding has a stable link.
- F-745
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.
- F-743
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).
- F-744
Enrollment increased notably over the years, peaking in FY23, then decreasing in FY24 due to redeterminations and eligibility changes.
- F-746
The largest costs by service category were outpatient, inpatient hospital, and pharmacy services, with capitation payments becoming the largest cost in FY24 after the transition to managed care.
- F-747
The audit identified issues with duplicate enrollees, enrollees with Social Security Numbers classified as undocumented, and enrollees who were ineligible due to age or length of residency.
- F-748
Redetermination processes led to the removal of over 21,000 enrollees for eligibility or procedural reasons, and some enrollees were incorrectly categorized or enrolled in error.
Recommendations (2)
- R-663
HFS should review and clean its eligibility data, removing duplicate and ineligible enrollees, and work with DHS to develop controls over eligibility determinations.
Related finding F-747 - R-664
HFS should also seek federal reimbursement for any lost federal match due to misclassification of enrollees.
Related finding F-747