Democratic Gov. JB Pritzker’s administration is lagging behind on a promised hiring spree to help tackle Illinois’ backlog of applications for the government-run Medicaid health insurance program.

Roughly 3 million low-income or disabled Illinoisans have health care coverage through Medicaid — about one in four people statewide.

In July, Pritzker outlined an aggressive months-long hiring initiative. The state would create around 240 jobs for caseworkers to process Medicaid applications. So far, around 170 people have been brought on.

Meanwhile, the backlog that once topped more than 100,000 applications is shrinking, but still hovers around 72,000 for applications that have been sitting around for at least 45 days.

The ripple effect not only leaves some people uninsured. But in Cook County, it also impacts the government budget – and taxpayers – because the county runs a health system that treats a large portion of Medicaid patients.

“This isn’t happening as fast as any of us would like,” said Theresa Eagleson, who leads the Illinois Department of Healthcare and Family Services, which runs Medicaid. “It’s not easy to solve long-standing embedded problems, but we are very much seeking to do this.”

She said the state has made “unprecedented progress” in hiring caseworkers. But there have been hurdles. The state brought on 500 caseworkers this year, but lost almost half of them when people retired, got promoted or left for other jobs in a relatively robust economy.

Grace Hou, who runs the Illinois Department of Human Services, said the state is on track to hire another 100 people this fiscal year, which ends on June 30.

The bulk of the nearly 3,000 employees who process Medicaid applications work for DHS. The rest work for HFS. Eagleson and Hou said they were significantly understaffed when Pritzker took office in January.

Persistent Medicaid backlog “strains credulity”

Still, the backlog of applications for people who want to join or keep Medicaid insurance persists. And it’s a constant source of frustration among leaders in Cook County government, who oversee one of the nation’s largest public health systems.

For one, the county-run health system has a Medicaid insurance plan called CountyCare, which has become a key money-maker for the county and is critical to its overall bottom line. CountyCare insures more than 300,000 people and is the largest Medicaid plan in Cook County. Growing CountyCare membership is vital because the health plan is paid by the state per enrollee. So any backlog in applications for CountyCare means less money to county government.

During budget season this year, County Board President Toni Preckwinkle blamed Pritzker’s predecessor, Republican Gov. Bruce Rauner, for declining enrollment in CountyCare. She alleged he purposely processed applications slowly.

Here’s another concern: The county health system, which has two hospitals and a network of clinics, is the regional medical safety net for the poor and uninsured in Cook County. Roughly one-third of patients were on Medicaid as of September, the health system’s most recent data shows.

If there’s a delay in Medicaid patients joining or keeping their coverage, patients still see the county’s doctors. But now they’re potentially uninsured. If the county treats them, it likely won’t get reimbursed for the care provided.

This has helped fuel a swelling financial problem at the county health system. The amount of medical care the health system estimates it will provide next year — without getting paid for it — is set to hit nearly $600 million.

During a November county health system board meeting, board members wondered aloud why the state wasn’t hiring caseworkers fast enough to process Medicaid applications.

“It strains credulity that anyone who has ever led a large organization cannot bring in the bodies necessary on a temp basis hire to resolve this issue, if that is the objective,” said board vice chairman Mary Richardson-Lowry.

Board Chairman Hill Hammock quipped: “Can we bring more pressure to bear on Springfield to process applications faster?”

It’s not clear how much of the backlog is for patients in Cook County, but county health system CEO Dr. Jay Shannon said during the meeting last month that thousands of county applications continued to languish. He said progress had stalled since Pritzker’s summertime announcements to process applications more quickly and streamline the application process.

“I think they’ve struggled both with the hands needed to do the cumbersome processing that they’re doing, and pretty old technology as well,” Shannon said.

Eagleson said the state is aware of how the backlog impacts the county as well as other medical providers and communities.

“That’s why we’re trying so hard … to make progress,” Eagleson said. “That and our customers deserve for this to work better.”

Advocate: State making “good faith effort” to reduce backlog

Carrie Chapman, senior director of litigation and advocacy at the Chicago-based Legal Council for Health Justice, which has sued the state over Medicaid application delays, said she thinks the Pritzker administration is “making a good faith effort” to hire caseworkers to process applications.

But chipping away at the heaping pile is more than just bringing on more workers, Chapman said.

She said the state still has technology issues, such as computers crashing during the application process. Letters sent to Medicaid enrollees to verify their eligibility get lost in the mail. And people might not know they can get temporary Medicaid cards while the state processes their applications.

Despite frustrations around eliminating the backlog, “we’re going in the right direction,” Chapman said.

Kristen Schorsch covers Cook County politics for WBEZ. Follow her @kschorsch.