Nursing home reforms address backlog of applications

During the last 10 years, delays in getting individuals approved for nursing home care have led to a backlog of 15,000 cases, with some taking up to a year to resolve. The problems stemmed from a complicated bureaucratic process of rules and regulations at the Federal and State levels, an antiquated computer system, and a staffing shortage.

The Governor’s Office took steps to upgrade the computer system, hire more staff and open a third enrollment hub. And during the spring legislative session, a bipartisan team of legislators worked with the long-term care industry and crafted sweeping reforms, which were signed into law on Aug. 2.

Senate Bill 2385 and Senate Bill 2913 streamline and simplify the process of enrolling in Medicaid and address outdated and ongoing problems in Illinois’ long-term care industry.

Senate Bill 2385 provides a process and form for Medicaid long-term care applicants and beneficiaries to release their financial records directly to the state for the purpose of determining Medicaid long-term care eligibility.

One of the biggest challenges getting approval for Medicaid-funded long-term care is obtaining financial information, with financial institutions raising concerns about releasing data. Senate Bill 2385 recognizes the need to protect personal information while also considering the needs of family members or care providers to have access to that critical information by creating a standardized form to send financial data directly to the state.

Senate Bill 2913 implements a number of sweeping reforms to simplify the process of enrolling in Medicaid and in the annual redetermination of Medicaid status, including:

•           Each resident used to have to go through a new application process every year to prove they still qualified financially. This process cost the state immensely, in both money and manpower, and was a waste when it was determined that nearly 100 percent requalified anyway. Now, only those with changes in finances need to complete new forms.

•           Individuals who have been on Medicaid for six months or longer before going into long-term care will have a simplified enrollment process.

•           The new law allows for electronic filing of applications instead of paper applications.

•           The state will set up training sessions and webinars to help individuals and facilities better understand the application process.

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