The decision to move into a long-term care facility is a difficult one for both individuals and their families. The last thing a family needs is government bureaucracy making the process even more difficult.
During the last 10 years, there has been a growing problem of delays in getting individuals approved for nursing home care. Those delays have led to a backlog of 14,000 cases waiting for approval; some cases taking up to a year to resolve.
The problem originates from having a complicated bureaucratic process of rules and regulations at the Federal and State levels. Those outdated rules have made the application process very difficult for families and for the facilities trying to help them. Additionally, Illinois had the most antiquated computer system in the nation. It was a system where applications had to be faxed or mailed in and then manually entered into the system. To compound these enrollment complications, the state also had a staffing shortage.
Faced with this problem, the Governor’s Office went to work on a number of fronts. The key first-step was a fundamental change in technology. While it took almost three years to get the new system in place, it is now up and running. Secondly, the Governor hired more staff and opened a third enrollment hub.
However, to fix the systemic problems in long-term care, legislative reforms were needed.
In January the Governor and the Department of Healthcare and Family Services (HFS) began working with a bipartisan team of legislators, led by Senator Dave Syverson and Senator John Mulroe. They worked with the long-term care industry and crafted sweeping reforms. These reforms resulted in the two bills the Governor signed today: Senate Bill 2385 and Senate Bill 2913
This legislation addresses a wide range of fixes:
- One of the major reasons for delays in care approval is obtaining financial information. This legislation sets up a simplified process for financial institutions to submit data.
- Under current law, each resident had to go through a new application process every year to prove they still financially qualified. 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
- This legislation 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.
- A number of smaller, technical fixes will lead to a simpler enrollment process and will save taxpayers dollars.
With these sweeping changes in place, new technology and additional staff, the 10-year struggle with delays in getting individuals approved for care will finally be resolved.