Performance Audit of Medicaid Eligibility Determinations for Long-Term Care Reveals Systemic Issues in Illinois

Strategic Insights -

The Illinois Auditor General's performance audit of Medicaid eligibility determinations for long-term care services and supports has uncovered significant concerns regarding the Integrated Eligibility System (IES) and the Department of Healthcare and Family Services (HFS), the Department of Human Services (DHS), and the Department on Aging (DoA). The audit found that the IES continues to have internal control issues, resulting in incomplete data, and issues with the system's ability to accurately track extensions and determine eligibility in a timely manner. The audit also revealed that HFS has failed to post LTC reports on a monthly basis as required by the Illinois Public Aid Code.

Key Takeaways:

  • The Integrated Eligibility System (IES) continues to have internal control issues, resulting in incomplete data, and issues with the system's ability to accurately track extensions and determine eligibility in a timely manner.
  • During the audit, 11 out of 50 applications (22%) were pending past the required number of days, with an average delay of 41 days from receipt of application to decision.
  • The status of the prior recommendation on the timeliness of eligibility determinations was determined to be partially implemented.
  • Applications involving asset discovery investigations continued to be overdue, with 8 out of 17 applications not completed in a timely manner, ranging from 14 to 156 days overdue.
  • Multiple issues were identified for these HFS OIG cases during the review, including incorrect information in IES and a lack of controls in IES.
  • A system enhancement implemented in IES to address the prior audit recommendation regarding extension tracking was not fully effective, with 5 out of 10 extension cases reviewed having issues with inaccurate IES data.
  • HFS failed to post LTC reports on a monthly basis as required by the Illinois Public Aid Code, with documentation available for only 18% of the reports.

Statistics:

  • 11 out of 50 applications (22%) were pending past the required number of days.
  • The average delay was 41 days from receipt of application to decision.
  • 8 out of 17 applications (47%) involving asset discovery investigations were not completed in a timely manner.
  • 5 out of 10 extension cases (50%) had issues with inaccurate IES data.
  • HFS completed reports for 78% of the months during the audit period (28 out of 36 months).
  • HFS was only able to provide documentation for 18% of the reports completed during calendar years 2021 to 2023 (5 out of 28 reports).

Sources:

  • Illinois Auditor General's report on Medicaid Eligibility Determinations for Long-Term Care (2025).
  • Public Act 100-380, Section 11-5.4 of the Illinois Public Aid Code.