Quick Hit Ellyn Fortino Thursday August 15th, 2013, 3:19pm

Activists Want An Immediate End To Illinois' Medicaid Privatization Contract

Activists with the Alliance for Community Services protested at the Illinois Department of Healthcare and Family Services’ (HFS) Chicago office Thursday morning demanding that the state immediately end its $76 million contract with a private, for-profit company hired to “scrub” the Medicaid rolls.

Following a grievance filed by AFSCME, an arbitrator ruled back in June that the state must end its two-year contract with Maximus Health Services Inc. by December 31 because it violates the state’s contract with the union. Arbitrator Edwin Benn ruled that state employees should be doing the work to investigate Medicaid fraud, not Maximus, the outside contractor.

The approximately 20 activists at today's protest say the Maximus contract causes unjust Medicaid disqualifications, violates workers’ rights and costs the state more than if the job were done in-house. They called on Gov. Pat Quinn and HFS Director Julie Hamos to end the contract now, asking that the officials not wait until December 31 to fire Maximus. Quinn's administration has not yet said if it would appeal the arbitrator's ruling in court, or bring on the 100 extra state workers needed to cover the job Maximus is doing. According to AFSCME, the state would save $18 million a year by having public employees do the work instead of shelling out $76 million for a two-year contract with Maximus.

Fran Tobin with the Alliance for Community Services called the Maximus contract "bad policy."

"It’s being done in a way that’s hurtful to the very people who are supposed to be helped,” he said.

The agreement with Maximus to “clean up” Illinois’ Medicaid rolls stems from the state’s 2012 Medicaid reform legislation, the SMART Act. State officials said that the verification system would save $350 million in the first year by removing recipients from the rolls who no longer live in the state, make too much income to qualify for Medicaid or can alternatively enroll in Medicare. Maximus started work in January to electronically scan data to find ineligible Medicaid recipients. State workers then review Maximus' recommendations and make a final decision on whether someone is removed from the program.

The protestors said Maximus is motivated by profit, and looks for any possible way to get people kicked off the program. So far this year, Maximus has recommended terminating medical cards for 60,000 people. 

“Even if (the contract) wasn't a violation of the workers’ positions, it still is harmful to the people that human services are supposed to be serving, because Maximus is pushing to cancel people’s medical cards for bogus reasons,” Tobin said.

The group said Maximus has recommended cancelling medical cards if people's phones had been disconnected or if notices sent in the mail to people bounced back or got lost. Maximus has also suggested dropping people from the rolls in instances where it lost Medicaid eligibility documents that people have turned in, Tobin said.

“People have their medical coverage cancelled even though Maximus screwed up, not the person,” Tobin stressed.

Tobin said there shouldn’t be a need to check Medicaid eligibility to begin with, but at a minimum, trained public caseworkers should be doing the work. Public workers "don’t have a profit motive to knock people off," he said.

"They have more care in discernment in trying to figure out if someone is actually eligible or not," he continued. "It would be causing a lot less harm."

Anne Scheetz with the Illinois Single-Payer Coalition said Maximus is engaged in an "immoral" practice of "taking away people’s health care."

"And besides that, to add insult to injury, it’s not even following the state’s rules," Scheetz said. "It does things like send a letter, and if people don’t get it, that’s tough. However they get kicked off, that is very disruptive to care.”

The protestors asked to meet with Hamos, who was reportedly not at the office. Instead, Tia Goss Sawhney, HFS’ director of research, data and analytics, talked with the group. She promised the group that the agency would have a confirmed date for them to meet with Hamos by Monday.

Steve Edwards, a retired caseworker, told Goss Sawhney that the people who have been disqualified due to Maximus' recommendations are flooding into state caseworkers’ offices.

“Because of the short staffing, their cases don’t get reinstated for months,” he said. “The people that come in are reporting that they did answer the phone call. They did send in the redetermination, and their cases still got cancelled.”

Goss Sawhney said the SMART Act called for a “large-scale redetermination effort” and required the agency to hire a contractor “to get through this, and do it very fast.”

“It for sure has not been perfect, and my heart goes out to people who have been unjustly cancelled,” she told the group. “... Unfortunately, it’s had human costs, and I’m recognizing that."

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