Gov. Pritzker Announces Successful Medicaid Redetermination Effort

CHICAGO – Governor JB Pritzker joined Department of Healthcare and Family Services (HFS) Director Lizzy Whitehorn, Department of Human Services (DHS) Secretary Dulce Quintero, and other leaders today to celebrate the success of the campaign to keep eligible Medicaid customers enrolled in coverage during the yearlong unwinding from the federal Continuous Medicaid Coverage Requirement.

During this yearlong process, nearly 3.8 million individual Illinois Medicaid customers went through care redeterminations for the first time since March 2020. Redeterminations are an annual verification to ensure customers remain eligible for Medicaid benefits before their coverage is renewed for the next year.

Throughout this unwinding process, Illinois has consistently been among the leading states in its effort to keep eligible customers enrolled in Medicaid. Roughly 73% of Illinois Medicaid customers have retained their coverage throughout this process according to the latest data available from HFS, which administers the Illinois Medicaid program.

HFS implemented multiple flexibilities during the unwinding aimed at keeping Medicaid customers enrolled and will make some of those flexibilities permanent to make renewing coverage easier for customers on an ongoing basis.

“Medicaid is an essential service for millions of Illinoisans, and the priority of the state was ensuring as few customers as possible lost coverage because of lack of awareness or procedural support—a goal I’m proud to say we have achieved,” said Governor JB Pritzker. “I’m grateful to staff at HFS and DHS for their tireless work and creative approach to addressing this challenge and keeping the people of Illinois covered, healthy, and safe.” ​

“From the beginning of Illinois' unwinding from the Continuous Medicaid Coverage requirement, our top priority has been preserving coverage for eligible customers. We’ve conducted an aggressive outreach campaign and implemented multiple flexibilities to keep as many people covered as possible, and I’m excited to announce today that we’re making some of those flexibilities permanent,” HFS Director Elizabeth M. Whitehorn said. “I want to recognize and thank HFS’ dedicated staff for their deep commitment to the millions of Medicaid customers across the state.”

“Our IDHS caseworkers are on the front lines of this issue, connecting individuals and families with programs like Medicaid, which enhance their daily lives and well-being. We are proud to continue this work with our sister agency, HFS, as we meet people where they are at and address their most emergent needs, such as health care – which is a human right,” said IDHS Secretary Designate, Dulce M. Quintero.

The federal Centers for Medicare and Medicaid Services also announced last week that it is extending through June 2025 a flexibility that broadens states’ ability to conduct ex parte redeterminations for certain populations, including zero income customers. Ex parte redeterminations are automatic renewals that can be done in cases where there is enough state and federal data available to confirm a customer’s eligibility before they are asked to complete renewal paperwork.

At the beginning of the federal COVID-19 public health emergency, the federal government implemented the Continuous Medicaid Coverage Requirement, which directed states to cease conducting redeterminations. The federal government ended the Continuous Coverage Requirement on March 31, 2023, prompting state Medicaid programs to return to the standard practice of conducting annual redeterminations.

HFS will continue accepting customer attestation for income and insured status in instances where electronic verification is unavailable. HFS will also keep the reasonable compatibility threshold at 30%. Reasonable compatibility is a check to ensure that a customer is correctly reporting their income for Medicaid eligibility purposes, by comparing a customer’s self-reported income with information available from other sources, such as IRS data and quarterly wage reports. When the Department implemented this flexibility, it was an increase from 5% to 30%.

In order to address the challenge of raising customer awareness about redeterminations re-starting after three years, HFS launched the yearlong statewide multilingual ‘Ready to Renew’ outreach and advertising campaign in May 2023. The campaign was targeted to ​ reach Medicaid customers ​ to inform them about the steps they needed to take to renew their coverage, aiming to avoid any eligible customers losing their coverage for not submitting their paperwork in a timely and accurate fashion.

HFS and the Medicaid Managed Care Organizations (MCOs) also increased the direct outreach to customers reminding them that redetermination was coming due and encouraging them to respond before their due date.

During the unwinding period, HFS delayed procedural Medicaid disenrollments by one month for customers who did not return their redetermination by their due date or did not provide additional information needed to verify their eligibility. During this one-month grace period for customers, HFS conducted additional direct outreach, including a courtesy follow-up letter, to encourage customers to submit their redetermination to the state.

As of HFS’ most recent redetermination progress report, 3,274,184 redeterminations representing 87% of the total required to be conducted have been completed. An additional 85,675 redeterminations have been received and are pending processing by the state.

According to a Kaiser state redetermination data tracker, Illinois is among the 10 states with the lowest percentage of customers terminated for procedural reasons, such as unsubmitted redetermination forms or lack of a response to a request for more information to verify eligibility before the deadline. HFS is now returning to the regular practice of conducting redeterminations annually for all Medicaid customers in the state.

The Illinois Department of Human Services (IDHS), which assists Illinois Medicaid customers with their medical benefits, implemented text messaging capabilities and launched a redetermination texting campaign, reminding customers to update their address on file with the state and of their upcoming due dates.

IDHS also created a medical redetermination queue within the IDHS Help Line, which was among the improvements to enhance recognition of when a caller’s redetermination is due. This was coupled with guided questions targeted to help customers complete their redetermination over the phone. Since May 2023, IDHS has taken 78,403 medical redetermination phone calls.

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