Gov. Rauner enacts measures to streamline Medicaid long term care enrollment

Measures expedite Medicaid eligibility determination and eliminate backlo

ROCKFORD — Gov. Bruce Rauner today signed legislation (SB2385 and SB2913) to expedite enrollment in Medicaid long-term care (LTC). SB2385 makes it possible for banks to share financial information with the state to help determine LTC eligibility; SB 2913 eliminates the need for annual applications for qualified LTC beneficiaries if their financial situation is unchanged.

“We want to do everything possible in easing the bureaucratic burden on seniors and their loved ones as they enroll in Medicaid long-term care,” Rauner said. “It is not fair to residents that it can take up to year to get approved for essential services. Our families deserve better. These important reforms will reduce the wait time and help eliminate a backlog of applications.”

Beginning today, banks can send data directly to the state upon receipt of a standardized financial institution request form. The law alleviates concern about exploiting of seniors by releasing financial information to family members or LTC facilities. It should also hasten compliance with requests for eligibility information.

The change in re-enrollment eliminates a timely and expensive re-application process in situations where the financial situation of a beneficiary already in the program has not changed. As it stands, nearly 100% of applicants are re-approved, and the change eliminates backlog as well as costly paperwork and duplicative staff work. It also reduces unnecessary uncertainties experienced by needy LTC patients.

Other reforms contained in SB 2913 include:

• Allowance for the long-term care facility to provide missing application information, as opposed to waiting on a response from the resident or family member.
• Improving education for those enrolling residents so they avoid leaving out important information in the application. This will include training tools like webinars.
• Allowance for an electronic application process, reducing the costs of materials and mailings.
• Codification of the simplified enrollment process for individuals who have been on Medicaid for at least six months before applying to long-term care, a process the governor previously had enacted by executive order.

Beyond legislative measures, the Rauner administration also hired more staff assigned to processing applications, and is securing a procurement to further expand capacity to reduce the backlog. Additionally, the Departments of Human Services and Healthcare and Family Services have made changes to identify and eliminate application process bottlenecks, and undergone computer modernizations to more efficiently track the application processes. These steps have reduced the backlog of cases from 14,000 to just under 10,000, and the contract will remain in place until the backlog is eliminated.

This legislation is a bipartisan effort led by Sens. Dave Syverson and John Mulroe, together with the long-term care industry and members of the governor’s office. The bills received the support of banking and credit union associations, health care associations and the Department of Human Services.

“For over a decade, those going into long-term care in Illinois have struggled under an outdated and burdensome system that created long delays,” said Sen. Syverson, R-Rockford. “I want to thank the Governor for his leadership on making key reforms and his help on these bills which work to finally fix this broken system.”

“A major reason for the backlog of Medicaid long-term care eligibility determinations was the inability to expeditiously obtain an applicant’s financial documents from the banks,” said Sen. John Mulroe (D-Chicago). “Senate Bill 2385 creates a statutory form that aims to improve and expedite the eligibility determination process by allowing the banks to rely on the form to release an applicant’s financial documents directly to the departments, making the determination without exposing the banks to liability and at the same time protecting the applicant’s financial information. This part of the bipartisan solutions crafted this session will benefit our elderly and most vulnerable as well as the people that care for them.”