When it comes to health care across the country, the term “back log” has been an unfortunately common part of our lexicon. Backlogs have been famous for years with the U.S. Department of Veterans Affairs, for example, as news throughout this year has revealed serious fraud in the cover-ups of these backlogs by management at VA health care facilities. Other medical facilities and health care providers experience backlogs, and this has unfortunately happened in assessing eligibility of Illinois residents for Medicaid, including those in need of nursing home care.
In the last year or so, the state of Illinois created and has implemented a new system in order to make the process of determining eligibility for state residents who seek state-funded care at nursing homes. The state has hired more employees in order to accomplish this. However, as recently reported in the Chicago Tribune, the NWI Times and multiple other news outlets, an audit report of the situation detailed that as of July 1, 2014, more than 51% of submitted cases for consideration were not resolved within 90 days. Federal regulations mandate a turnaround time of 45 days. Out of 4,226 pending applications, 2,141 languished past the 90 day mark. An additional source of delay has been the federal government’s slow pace of transferring applications to the state.
Eligibility determinations are largely based on financial means testing of applicants. The state considers an applicant’s financial situation to determine whether they have no other resources with which to pay for health care before going on state-funded and administered Medicaid. The backlog has adversely affected so many who desperately need care, as some have waited for an astounding six months in some situations. The Tribune has reported on many different individuals who are still waiting for their paperwork to be processed. For example, one man with lupus and high blood pressure is still waiting for approval so he can purchase the prescription medications he needs for his ailments. Another woman cannot see a doctor over concerns that she may be at high risk for skin cancer. Both of these individuals lost insurance through their employers, and make under $15,000 per year, which would presumably qualify them for Medicaid coverage.
This situation has complicated things for those in need of Medicaid care because not only do they claim to not have any other financial resources to pay for healthcare, but many of these people do not meet the minimum financial requirements for eligibility for Obamacare subsidies on the state’s healthcare exchange. Those under the financial cutoff for Obamacare are really only eligible for Medicaid, and when they cannot have that processed, they are stuck with nothing as they cannot afford private plans or to pay for the care directly. Since this tiered structure came into effect and Obamacare expanded the scope of Medicaid, hundreds of thousands of applications started coming in since last October 2013 when the exchanges started up and the Medicaid reforms took hold.
Illinois has the second largest backlog in the country behind California. While this issue affects so many across the healthcare spectrum, those in need of care at nursing homes and long-term care facilities are part of that population. Medicaid funds can go to pay for such care, and with a backlog in eligibility approvals, there too can be a delay for those in need of care and attention at nursing homes.
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