Executive Report
By JANICE R. HERRIN

Public aid answers audit report

THE AUDITOR general's report on the Department of Public Aid (IDPA) for the two years ending in March 1979 was critical of how IDPA is managed. The department took issue with many of the findings, but Director Jeffrey C. Miller emphasized that IDPA takes being audited seriously. "We know we have lots of problems and we're working on solving them," he said.

One of the auditor's main criticisms is that IDPA does not have enough competent staff to administer its daily operations with as high a degree of accuracy or efficiency as desired by the state. Also, according to the audit, some of the department's personnel lack the educational qualifications specified by the Department of Personnel. Miller disagrees with this last point, noting that all of the positions in IDPA except the top-level management positions are filled by the Department of Personnel and that clerical and caseworkers have an additional set of requirements placed on them by a collective bargaining agreement with the American Federation of State, County and Municipal Employees.

Miller agrees, however, that improvements in training are needed. "Right now," he explains, "when someone [a caseworker] joins IDPA, they get what amounts to approximately 20 days of training spread over the first 12 months of employment, ranging from orientation to the department's organization and the statutes under which it operates — and also specific policy related to a specific program area. But this training isn't nearly enough," Miller says, "and next year's budget proposal plans to triple the present amount of training available by creating a training facility in Chicago. That training will involve pulling employees out of their local offices and allowing them to carry half caseloads for three months concurrent with intensive training." Miller thinks this will give caseworkers an understanding of what their job is and a fair chance to perform more efficiently. He also thinks training will help IDPA determine who is and who isn't capable of doing casework jobs and prevent further placement of those who are not.

Miller also points out that IDPA, when compared to other states, has a smaller number of employees doing the same work. For example, Michigan's caseload is almost identical to IDPA's, but Michigan has 14,000 employees compared to IDPA's 9,000.

Miller says that because of staff shortages IDPA changed the cycle for redetermining recipient eligibility from a four-month cycle to a six-month cycle: "We tried to adjust what we demanded of staff to what was realistically possible and at the same time hold them accountable for accomplishments."

Miller has high praise for IDPA's clerical staff. He says that in the Aid to Families with Dependent Children (AFDC) program, the staff routinely processes over 98 percent of the applications within the time required by federal guidelines. However, there was a backlog in the Medical Assistance program over the last eight or nine months, and applications were not processed within the guidelines. The backlog has now been reduced to zero, Miller says, and IDPA is maintaining the application processing at 98.5 percent on time. "That is not critical of the department," Miller says. "On the contrary, it is a success story. It is particularly a success story when you compare Illinois' performance to other states similiarly situated — large urban states. We do a very good job taking applications, getting them through the system and rendering a decision and informing the applicant about that decision."

Another criticism by the auditor general is that while IDPA continues to be faced with documented problems of fraud and abuse, ineligibility of recipients and fraudulent medical bills, its preventive measures and post-payment reviews have not been adequate.

Miller agrees there are errors in eligibility but points out that many of them are technical errors. "Although 13.8 cents of each dollar is going to someone ineligible, this does not mean correcting that problem saves the state that kind of money," he explains. For instance, if someone is not registered for the Work Incentive Program (WIN), they are not eligible for AFDC. But registering for WIN will not guarantee that person a job because there are more people receiving public aid than there are jobs, and WIN presently has as many applicants as it can handle. And an applicant without a social security number is ineligible for AFDC, but correcting that error will not take the person off the public aid rolls or save the state any money.

The Medical Assistance program is the single largest program administered by IDPA. Out of IDPA's $2.6 billion budget for fiscal 1981, $1.4 billion goes to the medical program.

The audit report was critical of IDPA's Medicaid reimbursement rates to physicians. IDPA reimburses physicians $8.00 for an office visit, compared to the usual and customary charge in private practice of $20.00. The audit report said the low reimbursement rates induce many practitioners to leave the public aid program, to submit fraudulent invoices, or to reduce the quality of care provided to public aid patients. IDPA did request a physician rate increase for fiscal 1980, but the increase was not recommended by the governor's Purchased Care Rate Review Board (composed of representatives from the state's social service agencies and the Bureau of the Budget).

Of the billions budgeted for IDPA, over $600 million is for hospitals, over $300 million for nursing homes, and over $120 million goes to physicians. That's a lot of money, and the auditor is concerned that it is not being adequately monitored.

Miller has high hopes that many of IDPA's operations problems in Medical Assistance will be solved by Medicaid Management Information System (MMIS), This sophisticated computer system should be installed by the end of fiscal year 1981.

Miller says MMIS "will pick up some of the problems that it now takes so long to analyze manually. He says the system will benefit the Medical Assistance providers and will result in prompter payment of bills and in payment that better describes what is being paid and what is not and why. But the auditor general cautions that computers will not work unless employees can operate them. Successfully operating the complex MMIS system will certainly be a test of IDPA management.

Another test is the handling of the increased caseload — caused by the recession — without an increase in caseworkers. Inadequate reimbursements to doctors and the failure of AFDC, General Assistance, and Aid to the Aged, Blind and Disabled to keep up with the cost of living are all mentioned in the audit report as problems which prevent IDPA from doing its job as well as it should. But keeping up with the cost of living is a problem the governor and the General Assembly have the power to deal with rather than IDPA. "... I feel we're doing a reasonable job with the resources we have and the constraints under which we operate," says Miller.

32/October 1980/Illinois Issues