Hundreds of Thousands of Medicaid Recipients in Illinois at Risk of Losing Coverage

Hundreds of thousands of Illinoisans who currently get health care through Medicaid are at risk of losing their coverage.

That’s because emergency measures designed to ensure people didn’t lose their health care during the COVID-19 pandemic are now being phased out.

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Those measures suspended the requirement that people prove their eligibility for the government-backed insurance program each year.

But now those eligibility requirements are back.

Below is a Q&A with Samantha Olds Frey, CEO of the Illinois Association of Medicaid Health Plans, a membership organization of Medicaid providers in Illinois, explaining the changes.

(The interview has been edited for length and clarity.)

WTTW News: Explain how there could be as many as 700,000 Illinoisans who could lose their Medicaid coverage if they don’t act to prove their eligibility. Why is this happening now?

Samantha Olds Frey: Normally, in a non-pandemic world, everybody who’s on Medicaid has to renew their eligibility to demonstrate they’re still eligible for the program on an annual basis. Since the public health emergency went into effect, the federal government said we don’t want people losing health care coverage during a public health emergency. So no state within the country has been doing redetermination for Medicaid eligibility since March of 2020. Now we are coming out of the public health emergency, and we are going to begin that work here in Illinois. Because we’ve gone three years without doing it, there is this pent-up backlog and there are just more people and there are a lot of people who have never gone through this process. If you came on to the Medicaid program in March of 2020 you’ve never done this.

In terms of proving eligibility, is it essentially simply income eligibility that is the main criteria that has to be proven?

Frey: For the most part, the vast majority, it’s going to be income eligibility and proving that you still live in Illinois. … You have to provide a month’s worth of pay stubs in order to demonstrate eligibility.

What is being done to make sure recipients of Medicaid are aware of this change?

Frey: So we are trying everything we can think. We are texting members. We are sending letters. We’re using social media. We’re informing community-based organizations that are providers. … The state is actually going out with a multi-channel paid media campaign. We’re partnering with community-based organizations trying to get the word out everywhere we can because we do worry that the most vulnerable people, people who may be housing insecure or have moved a lot, those folks are most likely unfortunately to lose coverage, not because they’re not eligible, but simply because of paperwork.

Will every Medicaid recipient in the state have to prove their eligibility this year or is the state able to identify people who they think may no longer be eligible and focus on those people first?

Frey: So in Illinois everyone is going to go through what is called redetermination. There are about 30 to 40% of our current Medicaid enrollees where the state has enough electronic information that they can tell from payroll information and other things that those members and residents are still eligible. … They still go through the process, but the member themselves doesn’t have to submit anything. That’s 30 to 40%. Everyone else will go through the process and will have to send in paperwork in order to demonstrate that they’re still eligible.

What happens in the case of somebody who was a Medicaid recipient, but fails to prove their eligibility but then they get sick? At that point, is it possible for them to prove their eligibility at that time to get their Medicaid reinstated? What’s the situation for somebody in that position?

Frey: That’s exactly our biggest concern. So it will depend on when they realize they’ve lost coverage. There is in Illinois a 90-day reinstatement period. So if they realize they’ve lost coverage within the first 90 days, they can then submit their paperwork and once it’s processed, it will be retroactive back to the day that they lost coverage. But if it’s 91 days, 93 days … it’s a new application and they have a gap in coverage.

If you have to do a new application, how lengthy is that process?

Frey: Typically it is longer. You have to provide a lot more than just the redetermination paperwork.

How worried are you that tens of thousands of people or possibly even more may lose their coverage simply because they failed to complete the paperwork or online forms?

Frey: Historically 50% — half of members — who went through this process lost eligibility seemingly due to paperwork. So we’re worried. That keeps me up at night to be quite honest.

How many people in Illinois are recipients of Medicaid?

Frey: I believe the number right now is approximately 3.7 million people.

How can they ensure they don’t lose coverage? What’s the process?

Frey: There’s three ways — four really — but let’s walk through them.

First is online, which is the No. 1 recommended way to do it.    

The second way is to complete it and to actually have it faxed in. I don’t have a fax machine at home — I’m sure that most members don’t — but we do have providers that are trying to help members do that.

The third recommended way is to call the Department of Healthcare and Family Service call center and do it all over the phone at 877-805-5312.

The fourth is to complete the paperwork and mail it in.

Click here for more information on Illinois Medicaid renewals.

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