The reversal comes after the Illinois Department of Healthcare and Family Services ceased BCBSIL’s managed Medicaid enrollment April 11 due to noncompliance. At the time, the department also sanctioned the insurer $150,000 for having too-narrow provider networks and failing to keep up with members’ grievances and appeals.
In a letter to BCBSIL, Teresa Hursey, acting administrator of the department’s Division of Medical Programs, stated the health insurer proved it was back in compliance. However, the agency will still hold automatic enrollments for now. The department scheduled a follow-up with BCBSIL in December. Should BCBSIL show noncompliance, the state could reinstate the enrollment sanctions and fine the insurer $50,000 per month.
As of September, BCBSIL’s Medicaid enrollment was down more than 11 percent to 415,887 members, when compared to April. The plans are part of Illinois’ managed care Medicaid program, called HealthChoice Illinois, which Republican Illinois Gov. Bruce Rauner’s administration rolled out Jan. 1, 2018.
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