REPORT HIGHLIGHTS

PROGRAM AUDIT OF THE COVERING ALL KIDS
HEALTH INSURANCE PROGRAM

PROGRAM AUDIT
Release Date:  June 21, 2023

State of Illinois, Office of the
Auditor General
FRANK J. MAUTINO, AUDITOR GENERAL

To obtain a copy of the Report contact:
Office of the Auditor General, Iles
Park Plaza, 740 E. Ash Street,
Springfield, IL 62703
(217) 782-6046 or TTY (888) 261-2887

This Report Digest and Full Report are
also available on the worldwide web at
www.auditor.illinois.gov

REPORT HIGHLIGHTS

Background:

The Covering ALL KIDS Health Insurance
Act (Act) (215 ILCS 170/63) directs the
Auditor General to audit the EXPANDED
ALL KIDS program every three years
beginning on or before June 30, 2022
(prior to this date, audits were
required annually).  The Act requires
that the audit include: payments for
health services covered by the program;
and contracts entered into by the
Department of Healthcare and Family
Services (HFS) in relation to the
program.

The ALL KIDS program is administered by
both HFS and the Department of Human
Services (DHS).  We have released
audits annually as required from the
first audit covering FY09 to the tenth
and last audit covering FY18.

Four of the five recommendations from
our FY18 audit are being repeated
during this audit period.  These four
recommendations have been repeated
since the first EXPANDED ALL KIDS
audit, which covered FY09. (digest iv)

Key Findings:

• Redeterminations of eligibility were
completed late or not completed during
July 2018 through March 2020.  During
FY19, 12,315 of the 25,907 (48%) annual
redeterminations due were completed
timely, and 6,466 of 25,907 (25%)
annual redeterminations due were not
completed.  During FY20, 14,783 of the
18,841 (78%) annual redeterminations
due were completed timely, and 3,559 of
18,841 (19%) annual redeterminations
due were not completed.
Redeterminations were suspended
beginning in March 2020 due to
COVID-19.  (digest vii)

• Auditors identified 1,328 enrollees
that were over the allowable age for
enrollment in the ALL KIDS program from
July 2018 through March 2020.  These
enrollees received 11,011 services
totaling $1,192,008 after the month of
their 19th birthday.  Beginning in
March 2020, enrollees that were over
the allowable age were allowed to
maintain coverage because of COVID-19.
Auditors also identified duplicate
enrollees during FY19 through FY22.
(digest viii)
• Auditors determined that there were
enrollees that were potentially
misclassified as undocumented during
FY19 through FY22.  For this four year
audit period, we identified a total of
5,513 of 111,722 (5%) undocumented
enrollees that are potentially
misclassified.  If these enrollees were
classified as undocumented in error,
the State did not receive the eligible
matching federal rate funds for FY19
through FY22.  At a minimum, the State
did not collect $8.2 million in federal
reimbursement for this time period.
(digest viii)

• Supporting documentation for
determinations of eligibility has been
an issue identified by auditors in each
of the previous 10 EXPANDED ALL KIDS
audits, going back to FY09.  However,
during this audit period we were unable
to conduct fieldwork testing in order
to follow up on this recommendation
because of the allowances made to
address COVID-19.  This recommendation
will be followed up on as part of
future State Compliance Examinations.
(digest ix)

Key Recommendations:

The audit report contains four
recommendations; one is directed at the
Department of Healthcare and Family
Services, and three are directed to
both the Department of Human Services
and the Department of Healthcare and
Family Services:

• The Department of Healthcare and
Family Services and the Department of
Human Services should annually
redetermine ALL KIDS eligibility as
required by the Covering ALL KIDS
Health Insurance Act.  (report p. 22)

• The Department of Healthcare and
Family Services should have controls in
place to ensure that its ALL KIDS
eligibility data is accurate and
reliable.  This includes ensuring that
enrollees over 18 years of age are
identified as no longer eligible and
ensuring that enrollees are not
enrolled in ALL KIDS more than once.
(report p.24)

• The Department of Healthcare and
Family Services and the Department of
Human Services should:
— ensure policies and procedures used
to classify enrollees as a documented
immigrant or undocumented immigrant
contain specific instructions for
caseworkers to make accurate
eligibility decisions;
— consider implementing an electronic
edit within the Integrated Eligibility
System (IES) that prevents enrollees
with citizenship or immigration
documentation from being classified as
undocumented;
— ensure documented immigrants are
classified correctly in its database;
and
— ensure the State receives federal
matching funds for all eligible
enrollees and ensure that federal
matching funds are not received for
ineligible enrollees.  (report p. 27)

• The Department of Healthcare and
Family Services and the Department of
Human Services should:
— ensure all necessary eligibility
documentation to support residency and
birth/age is received in order to
ensure eligibility is determined
accurately; and
— ensure one month’s worth of income
verification is reviewed for
determining eligibility. (report p.29)

This performance audit was conducted by
the staff of the Office of the Auditor
General.