SPRINGFIELD Governor JB Pritzkers’ administration wasted no time last week in exercising the new authority granted by lawmakers to limit enrollment in a pair of state-funded health care programs for low-income noncitizens.
In a move that drew a sharp backlash from immigrant rights advocates, Pritzker signed House Bill 1298 on Friday, then immediately introduced emergency rules authorized by the law to temporarily suspend enrollment in the Health Benefits for Immigrant Adults program at starting July 1st. years who would be eligible for Medicaid benefits based on income levels but not their citizenship status.
A similar program for non-citizens 65 and older, known as Health Benefits for Immigrant Seniors, will remain open unless enrollment reaches 16,500, at which time it will also be suspended. As of June 7, there were 14,594 people enrolled in HBIS, according to the administration, which forecast in March that enrollment would increase to 21,000 in the next fiscal year.
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The Healthy Illinois Campaign, which advocates for health care equity for non-citizens, called the freeze unethical and short-sighted, saying it will force people to give up cancer treatment, diabetes treatment, mental health care and countless other types of necessary medical care.
By cutting life-saving health care coverage for Illinois’ immigrants, Governor Pritzker is turning his back on the communities he supports Illinois is welcoming and aligning himself with anti-immigrant Republicans across the country, the organization said in a statement.
Pritzker had previously defended and celebrated the programs when he signed them into law, agreeing with supporters that it is cheaper to provide preventive care to non-citizens than to have them rely on emergency room visits to treat conditions that have not been diagnosed at due to a lack of health care benefits.
But a press release Friday from the Department of Health and Family Services announced the changes as a necessary move to ensure that programs do not exceed funds available and allocated by the General Assembly in an amount set at about $550 million.
Compared to the traditional Medicaid population, month-over-month enrollments have grown at a higher rate and costs in enrollments have increased among HBIA and HBIS-enrolled populations due to more prevalent, untreated chronic conditions and higher hospital costs, IDHFS said in a press release.
The emergency rules will now be considered by the Joint Committee on Administrative Rules, a 12-member bipartisan group of lawmakers from both houses of the General Assembly. The rules will remain in effect for 150 days, although HB 1298 allows the administration to re-file an identical rule after that time.
JCAR could vote with a two-thirds majority to suspend the rules. It could also oppose them, leaving them in order to request a response from the administration. But nothing in the law requires JCAR to act on the rules, in which case they would remain in effect.
Advocates hailed the launch of the HBIS program in 2020 as a national precedent for providing health care to immigrant older adults regardless of their legal residence status.
But it far exceeded the initial estimate of $2 million a year cited by her House sponsor at the time, Rep. Delia Ramirez, D-Chicago, who has since moved on to Congress.
We must protect something as fundamental to our humanity as providing health care coverage to people, regardless of the status of records, Ramirez said in a statement after the governor announced the changes. It is extremely disappointing to hear that the state administration has decided to block immigrants from accessing life-saving health insurance on the grounds that it costs too much, especially since the alleged costs of the program are under discussion.
The Pritzker administration in March noted that the HBIS program had cost the state $187.5 million in the prior 12 months and projected that cost would rise to $285 million in the next fiscal year.
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Similarly, HBIA program expansions exceeded expectations, leading the administration to project a total price tag of $1.1 billion on noncitizen health care in the next fiscal year if enrollment was not capped. . That number was about 5 times what Pritzker had proposed spending in its February budget.
Supporters accused the governor of overestimating those numbers and caved in to calls from Republicans to cut spending on the program. GOP lawmakers held several press conferences in the waning days of the spring session of the General Assembly to call for a suspension of programs, which they said would cause new immigrants to come to the state and thus become increasingly expensive.
When he signed off on the state’s fiscal 2024 budget earlier this month, Pritzker said limiting enrollments in the program would help limit spending to about $550 million.
It’s more than we expected, but not as much as it would have cost if we didn’t have the necessary tools (to limit the growth of the program), Pritzker said.
The HBIA pause does not affect current enrollees, but the administration also announced that enrollees in both programs will soon be subject to copays and coinsurance if their health care is not otherwise eligible for federal reimbursement. This includes a $250 copay for hospital admissions and $100 for an emergency room visit. Enrollees receiving certain outpatient services at hospitals or surgical centers would be subject to 10% coinsurance.
IDHFS said in a statement that enrollee payments under the new coinsurance requirement could range from $3.70 to $202.95, depending on the service received.
Ramirez suggested those changes will drive higher costs for those already enrolled in the program and create additional financial pressure on our safety net hospitals.
Healthcare providers would be responsible for collecting such cost sharing payments and bear the cost of non-payment.
In January, enrollees will also be transferred to the state’s Medicaid managed care program, a system overseen by private insurers. This change aims to generate additional dollars through the state’s managed care organization tax.
IDHFS also noted in a press release that the department is seeking to maximize federal reimbursement for emergency medical expenses, as well as pursuing supplemental discounts on prescription drugs for those covered by the programs. It will also seek reimbursement from large public hospitals, especially the Cook County Hospital System, which has received payments in excess of the rates paid to non-large public hospitals under the program.
The Illinois Latin Legislative Caucus has urged eligible non-citizens to enroll in the program in June before it is suspended. Eligible individuals can register online atabe.illinois.gov/abe/access.
Because we are proud to be a welcoming state, we should not cut health benefits and create barriers to health care, the Latino Caucus said in a statement.
The caucus had backed an expansion of the program to people ages 19 to 41, which would cost just an estimated $380 million, according to the administration. That expansion would have ensured health coverage for low-income non-citizens of any age, as those 18 and younger are already covered by the state’s AllKids program.
Members of the Latino Caucus have not given up and will continue to close the gap in coverage until we achieve health care for all residents, the caucus said in a statement. The often disenfranchised communities we represent have sent us to Springfield to be their voice; we will never turn our backs on them.
Capitol News Illinois is a non-profit, non-partisan news service covering the state government. It is distributed to hundreds of print and broadcast outlets across the state. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation, along with major contributions from the Illinois Broadcasters Foundation and the Southern Illinois Editorial Association.
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