NASL member firm Third Reading Consulting Group shares a legislative recap below:
Co-pays for the Illinois Department of Healthcare and Family Services (HFS) Health Benefits for Immigrant Adults (HBIA) and Health Benefits for Immigrant Seniors (HBIS) programs took effect on February 1. The two programs provide healthcare services to individuals who would otherwise qualify for Medicaid or Medicare if not for immigration status.
Co-pays were proposed as a way to stay within the $550M budgeted amount in FY 2024. However, HFS removed co-pays after receiving harsh criticism from stakeholders. The agency promised to return with a new co-pay proposal in January. Under the updated proposal, the co-pay amounts are $250 per inpatient hospital stay and 10% of the cost HFS would pay to the provider for outpatient hospital services and ambulatory surgical treatment. Some managed care organizations (MCOs) waived all co-payments, such as CountyCare, which only serves customers in Cook County, where the majority of program enrollees reside. HFS removed the $100 copay for non-emergency hospital ER services proposed in their original administrative rule after learning that the Centers for Medicare & Medicaid Services will allow them to seek reimbursement for those costs.
The new co-pays and enrollment pauses have helped decrease cost estimates for the HBIA and HBIS programs to $773M in FY 2024, down from an estimate of $832.7M in September. The state spent approximately $330M in the first half of the fiscal year on the two programs. While still above the budgeted amount of $550M, costs are declining on a monthly and per-patient basis. Monthly costs fell from $72.7M in August to $45.3M in December. Per patient costs stood at $1,234 for individuals over 65, $1,295 for individuals aged 55-64, and $844 for individuals aged 42-54 in August. Those figures declined to $778, $805, and $541, respectively, in December.
With rapidly increasing enrollment numbers, HBIA paused new enrollment on July 1 with around 63,000 enrollees, and HBIS paused new enrollment on November 6 with around 16,500 enrollees. The beginning of FY 2025 appears to be the most likely time for new enrollment to resume unless the General Assembly passes a supplemental budget with new funding for these two programs. Gov. J.B. Pritzker’s proposed $1B supplemental will provide approximately $250M for migrant services, with additional details coming in his annual budget address on Wednesday, February 21. It remains unclear if this funding will go to the HBIA or HBIS programs. Even if the budget does include additional funding for the two programs, it is unclear if that funding would be for new enrollments or to cover a potential budget shortfall of around $200M, based on current projections.
Important Upcoming Dates – Statewide
February 21 – Governor’s Budget and State of the State Address
March 15 – Senate Committee Deadline
March 19 – 2024 Primary Election
April 5 – House Committee Deadline
April 12 – Senate Third Reading Deadline
April 19 – House Third Reading Deadline
May 3 – Opposite Chamber Committee Deadline
May 17 – Opposite Chamber Third Reading Deadline
May 24 – Adjournment
May 25-31 – Contingent Session Days for Budget
November 5 – 2024 General Election