Illinois fixes procedural disenrollment issue during Medicaid redeterminations


Maddie McCarthy


Illinois is working to complete the remaining third of Medicaid redeterminations that are due in the state since the federal continuous coverage requirement ended on March 31st.

Of the redeterminations that have been completed so far, about 533,400 people—90%—had their Medicaid renewed, while approximately 57,700—10%—have been disenrolled, according to the Kaiser Family Foundation’s (KFF) Medicaid unwinding tracker. They are tied with Maine as having the lowest percentage of disenrollments.

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In August, the Centers for Medicare and Medicaid Services (CMS) sent a letter to all fifty states warning them of an issue causing high numbers of procedural disenrollments. In the letter, CMS said, “We understand that some states are conducting ex parte renewals at the household level, without regard to differing eligibility statuses and income thresholds for individuals within the household.”

In September, 30 states including Illinois were told to pause redeterminations because they were not conducting ex parte—otherwise known as automatic—renewals at the individual level. The issue with that, CMS said, is that children have a lower threshold to meet Medicaid eligibility than adults, so eligible children had been disenrolled because others in the household were ineligible. 

These states were required to fix the issue and begin ex parte renewals at the individual level.

The Illinois Department of Health and Family Services (HFS) provided a statement to State of Reform in which they addressed the issue and the change CMS required states to make.

“Illinois’ Integrated Eligibility System, like the majority of other states, was implemented and certified federally to look at cases holistically rather than individually. However, we immediately understood the benefit of this change, especially for potentially eligible children. HFS implemented a solution very quickly and as of September, ex parte redeterminations are being conducted at the individual level. HFS has also been working to reinstate the cases that were closed July 31st that would have been deemed eligible with this change. As a result, Illinois has not paused Medicaid disenrollments.”

— HFS statement, Nov. 30th, 2023

Sometimes procedural disenrollments can occur due to the beneficiary not responding to their Medicaid renewal. For those people, “the state is still able to reinstate their case if the necessary information is received within 90 days, essentially meaning they would have no gap in coverage if they are determined eligible,” HFS said.

HFS also said they have been conducting outreach efforts for the people who could not have their coverage renewed automatically in order to avoid procedural disenrollments due to no response.

Now, Illinois has the second lowest number of procedural disenrollments at 16%, behind Oregon. 84% of the 57,700 people who have been disenrolled were determined to be ineligible for renewal. 

In regards to those deemed ineligible for renewal, they are often able to find care elsewhere. HFS advised disenrolled people to visit the Affordable Care Act Marketplace, Get Covered Illinois.

“Anyone who is found ineligible for Medicaid coverage who finds that their circumstances change in the future, is strongly encouraged to reapply.”

— HFS, Nov. 30th, 2023

The remainder of those whose redeterminations have yet to happen can take steps to ensure their coverage will be renewed if they meet the requirements. 

First, HFS advised them to visit the Application for Benefits Eligibility (ABE) website and set up a profile. The agency said those up for renewal must update their information, especially their address, so their renewal materials can be properly delivered.

On the ABE website, people can also see the date of their renewal so they know when to expect materials to be sent to them. To check their renewal date, they can call the customer service response system at 855-828-4995. The number is available to call 24/7 in English and Spanish. To use this number, they will need their Recipient Identification Number (RIN).

“Customers can find their nine-digit RIN on their medical card from HFS, and customers enrolled in a managed care plan can also find their RIN on their [Managed Care Organization] (MCO) ID card. Customers on the client line can also transfer to the Health Benefits Hotline during business hours to obtain their RIN.”

— HFS, Nov. 30th, 2023