Dale Righter

Illinois State Senator | 55th District


Administration to appeal arbitrator’s ruling to cancel state’s Maximus contract

Friday, September 20, 2013

During a joint House and Senate Appropriations Committee hearing Sept. 17, state officials said they plan to appeal a June arbitrator's ruling that would nullify the state’s contract with Maximus, the company hired to remove ineligible individuals from the state's Medicaid program.

Senator Righter, a member of the Senate Appropriations 1 Committee, explained the hearing was called in response to the arbitrator’s ruling, which found that using a third party vendor to review Medicaid eligibility violates the state’s contract with AFSCME. Righter emphasized the contract with Maximus to review Medicaid enrollee eligibility was a key component of the 2012 bipartisan Medicaid reform effort.

"Using a third party vendor to work on Medicaid redetermination cases is considered a crucial part of the reforms implemented in the SMART Act. I hope the Quinn administration is sincere about continuing the work that is being done to ensure the Medicaid program remains viable for the people who need it the most," said Righter.

At the hearing, Department of Healthcare and Family Services (HFS) Director Julie Hamos stated the administration would seek to appeal the arbitrator's ruling while working to develop a "hybrid" system of redetermination utilizing both Maximus and state resources. Hamos emphasized HFS does not have the technology and resources available to Maximus, which would make the determination process significantly more difficult, time-consuming and costly for the state to take on. She noted that Maximus has reviewed approximately 15 percent of the state’s Medicaid cases and has already saved taxpayers $44 million.

As of Sept. 17, approximately 75,707 of the Medicaid cases Maximus has recommended for cancellation have been accepted by DHS; this amounts to roughly 125,000 ineligible individuals removed from the program. The state has accepted 70 percent of the Maximus recommendations to cancel Medicaid for individuals who do not qualify for benefits.

Lawmakers approved a bipartisan Medicaid reform package in 2012 as the program’s skyrocketing growth rapidly approached unsustainable levels. An active redetermination process to review Medicaid enrollees’ eligibility is a critical component of that process. 

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