Public Accountability Report Public Accountability Report

Department of Healthcare and Family Services
(Appropriated Spending in Thousands)
  FY 2021 FY 2020
Reporting Programs Expenditures Headcount Expenditures Headcount
Medical Programs $ 27,689,146.5 976.7 $ 23,479,425.1 935.1
Child Support Services $ 182,073.3 732.8 $ 174,413.0 716.2
Totals $ 27,871,219.8 1,709.5 $ 23,653,838.1 1,651.3

Totals may not add due to rounding.

Agency Narrative

The Department of Healthcare and Family Services (HFS) is committed to empowering Illinois citizens to lead healthier and more independent lives through providing quality healthcare coverage for children, parents, seniors, and persons with disabilities and establishing and enforcing child support obligations.

Child Support Services

The Division of Child Support Services (DCSS) serves families composed of Temporary Assistance to Needy Families (TANF) clients, Medical Assistance No Grant (MANG) clients, and any other Illinois resident requesting child support services (Non-Assistance (N/A) clients). The division helps to establish paternity, locate noncustodial parents, establish child support through judicial or administrative processes, and enforce child support orders through income-withholding orders; unemployment benefit intercepts; federal and state tax intercepts; real and personal property liens; denial of passports; suspension of drivers', hunting, and fishing licenses; and other lump-sum intercepts. DCSS also assists other states to establish parentage and establish and enforce child support on behalf of their residents. Together, these TANF, MANG, and N/A cases receiving these services are known as Title IV-D cases. The division also processes non-Title IV-D cases through the State Disbursement Unit (SDU). For fiscal year 2021, DCSS collected and disbursed almost $1.2 billion in total child support. Total collections include both Title IV-D and non-Title IV-D collections made to the SDU.

Medical Programs

The Division of Medical Programs is responsible for administering the medical assistance programs under the Illinois Public Aid Code, the Children’s Health Insurance Program Act, the Covering All Kids Health Insurance Act, the Veterans Health Insurance Program Act, other provisions of state law, and Titles XIX and XXI of the federal Social Security Act.

Program Goal

The program goal is to improve the health status of individuals enrolling in the Medical Assistance program, while simultaneously containing costs and maintaining program integrity.

Evaluation of Performance/Activity Measures

The average monthly count of enrolled individuals for which HFS provided medical coverage was over 3.16 million, including pregnant women, infants, children, parents and caretaker relatives, adults with no minor children in the home, seniors, people with disabilities, persons with breast and cervical cancer, and employed people with disabilities. Licensed practitioners, hospital and nursing facilities, and other medical and dental professionals enrolled with the department provided these medical services. The Medicaid reform law, Public Act 96-1501, adopted by the Illinois General Assembly in 2011, mandated that 50% of all Illinois Medicaid clients be in coordinated care by January 1, 2015. HFS has completed the rollout of mandatory care coordination programs for most Medicaid-only clients statewide and for the dual-eligible (Medicaid and Medicare) population in the two demonstration areas for the MMAI program. Through these programs, HFS has surpassed the 50% goal required by this law, with an enrollment of over 2.2 million clients in care coordination programs.


Although providing access to quality healthcare is the overriding mission of the department, it is also critical to perform this function in the most cost-effective and efficient manner. Two performance indicators have been selected to measure one aspect of this effectiveness: Cost-avoidance is a strategy recognized by the Centers for Medicare and Medicaid Services and is devised to make Medicaid the payer of last resort. Cost-avoided dollars are Medicaid savings, realized through the discovery of a private payer responsible for medical bills of medical assistance participants. The department saved the taxpayers of Illinois $798 million in fiscal year 2020 and $870 million in fiscal year 2021.

Office of Inspector General

The mission of the Office of Inspector General (OIG) is to prevent, detect, and eliminate fraud, waste, abuse, misconduct, and mismanagement in the Medicaid programs administered by HFS, the Department of Human Services, and the Department on Aging. The OIG combats fraud, waste, and abuse by implementing innovative Medicaid fraud prevention and detection techniques, conducting client eligibility investigations, performing Medicaid client fraud investigations, restricting clients who abuse their benefits, conducting post-payment audits and Quality of Care reviews of Medicaid providers, and identifying assets that were not disclosed by applicants for long-term care. OIG also acts as the liaison with all law enforcement and prosecutorial agencies in the state. The OIG showed cost savings, cost-avoidance, and recoupments of $143 million in fiscal year 2020 and $31 million in fiscal year 2021. The OIG has averaged $309 million in savings for the taxpayers over the past four years, and over $1.64 billion since fiscal year 2012.

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