Audit Knocks Illinois' $7.11bn Medicaid Privitization

Jan 23, 2017

An audit issued Tuesday shows Illinois government could not properly account for more than $7 billion paid to private medical insurance companies running parts of the Medicaid program.

It comes as Gov. Bruce Rauner¹s administration is planning to expand the role of private insurance.

Medicaid is Illinois' health care program for the elderly, poor and disabled, and the Rauner administration wants more of it run by private insurance.

But Democratic Rep. Fred Crespo, from Hoffman Estates, says these Managed Care Organizations, or MCOs, are squeezing patients.

"There is no doubt that the department has been very MCO-friendly at the expense of the people who use the services,” Crespo says.

The audit suggests that is a real possibility. It shows the Illinois Department of Healthcare and Family Services could not come up with basic information on the MCOs — like what they spent on administrative costs, how many claims had been denied, or whether the state had overpaid.

The administration mostly agreed with the audit’s findings and says it's working to meet the recommendations.

"The department rebooted Medicaid managed care to ensure program integrity and accountability, protecting taxpayer dollars while providing quality care for those with limited resources," Healthcare and Family Services spokesman John Hoffman said in a statement.