Public Accountability Report

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 (CSS) 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. CSS 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 2024, CSS collected and disbursed almost $978 million 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 administers Illinois’ Medicaid program, Children’s Health Insurance Program, Veterans Health Insurance Program, and other state healthcare programs under the authority established under multiple state statutes (including the Public Aid Code) and Titles XIX and XXI of the federal Social Security Act. These programs offer comprehensive health benefits, including primary, specialty, hospital, dental, and long-term care to millions of Illinoisans each year.

State fiscal year 2024 was ushered in by the termination of a national Public Health Emergency (PHE) on May 11, 2023 that had been raised in response to the global pandemic caused by SARS-CoV-2019 (more commonly referred to as COVID-19). The “return to normal” in Medical Programs was most visible through the resumption of medical assistance eligibility redeterminations—a process that had been suspended during the PHE to maintain recipients’ care continuity through the pandemic’s duration. Through that exercise, medical assistance enrollment fell from 3.94 million in state fiscal year 2023 to 3.67 million in state fiscal year 2024.

The delivery of Medical Assistance is often characterized as being either “fee-for-service,” in which medical benefits are managed directly by HFS, or managed care, in which HFS oversees a vendor managed care organization (MCO) that in turn is managing the benefit. This distinction was established through a Medicaid reform law passed in 2011 (Public Act 96-1501), which required 50% of Medicaid recipients be enrolled in managed care. Today, managed care oversees care of 77% of Illinois Medicaid recipients. Managed care is organized into two distinct programs (often referred to as “contracts”):

• HealthChoice Illinois. This program represents the bulk of enrollment, providing care for all populations that rely on Medicaid as their primary payor for healthcare services: children; seniors and persons with disabilities without Medicare coverage; adults eligible under the Affordable Care Act (ACA) expansion; as well as some dual-eligibles who opted out of the MMAI program described below.
• Medicare-Medicaid Alignment Initiative. This program seeks to align Medicare and Medicaid benefits for dual-eligible enrollees. Set up as voluntary demonstration by the federal Centers for Medicare and Medicaid Services (federal CMS) and organized as a federal-state partnership, the federal government decided to transition this population into another Dual-Eligible Special Needs Plan (D-SNP) January 1, 2026.

Accountability

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, $874 million in fiscal year 2021, $1.008 billion in fiscal year 2022, $1.145 billion in fiscal year 2023, and $1.371 billion in fiscal year 2024.

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 provider fraud investigations, client eligibility investigations, post-payment audits, and quality-of-care provider reviews; 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.