“The administration has negotiated a backroom deal with AFSCME that would halt the state’s redetermination efforts using an outside vendor by April 30, effectively eliminating the cornerstone of the Medicaid reform,” Righter said. “The redetermination process goes to the heart of fraud and abuse in the Medicaid program, and without it there is no doubt that the state’s limited resources will again be directed to people receiving taxpayer-paid benefits fraudulently.”
Bellock explained, “We were notified this morning that the union grievance will be dropped and the Administration will extend the Maximus contract, but as always the devil is in the details. The fact of the matter is, this decision by the Administration to strip Maximus of its ability to make the case review recommendations as required by law is nothing more than a four month continuation of the status quo.”
The lawmakers noted that the Administration is also seeking to hire twice as many Dept. of Human Services (DHS) caseworkers than they had previously requested. A supplemental order issued on December 17 noted DHS has plans to hire an additional 520 new caseworkers, while simultaneously limiting the number of Maximus employees that can work on the redetermination process. This is despite the fact the fact that there is a 40 percent cancellation rate for the first 315,728 cases reviewed by state caseworkers. To date 316,000 cases have been reviewed by both Maximus and the state, resulting in the removal of 127,000 cases from the Medicaid rolls. At an average of 1.7 persons per case, the Maximus review process has removed approximately 216,000 people from the rolls.
“Instead of vigorously appealing the initial ruling and defending state law, the administration struck a secret deal that not only undermines, but threatens to destroy Medicaid reform and blow a huge hole in the state budget heading into a year when the so-called temporary tax increase is set to expire,” said Righter. “This is politics at its worst.”
The 2013 SMART Act—Saving Medicaid and Resources Together—was heralded as bipartisan package of Medicaid reforms designed to trim costs, improve efficiency in the state’s $10 billion Medicaid program. In the negotiations, the General Assembly and Quinn Administration agreed to use a private vendor to review all Medicaid cases to determine whether those enrolled in the program were actually eligible for taxpayer-paid healthcare.
“Medicaid reform is only as good as its implementation and the Administration’s willingness to implement it. Both the Governor and the General Assembly embraced the independent contractor provision as a centerpiece of the new law; now the administration is doing everything it can to get out from underneath that requirement due to political pressure from their largest donor—the state employee union,” Bellock said.