Copay requirements paused for noncitizens on state health plan

The state has paused a new policy requiring certain noncitizens enrolled in a Medicaid-like health insurance plan to pay copayments for certain services, instructing health care providers to refund any such payments they have already collected.

Omar Shaker, the interim chief of administrative rules at the Department of Healthcare and Family Services, told a legislative oversight committee Tuesday that the department ultimately plans to reinstate the copay policy, but it doesn’t yet have the systems in place to properly administer it.

"I was informed recently that there were some programming issues with regards to that," he told the Joint Committee on Administrative Rules, or JCAR, at its monthly meeting in Chicago.

IDHFS originally published notice in June that customers enrolled in the Health Benefits for Immigrant Adults program and the Health Benefits for Immigrant Seniors program would be required to pay co-pays for certain services, effective July 1.

Those programs are for noncitizens over age 42 who would otherwise qualify for Medicaid if not for their immigration status.

Those programs offer coverage similar to Medicaid. But unlike regular Medicaid, which is jointly funded with state and federal money, the immigrant health care programs are funded almost entirely with state dollars due to federal reimbursement limitations for that population.

The state first began covering immigrant seniors aged 65 and over in 2021. The program was later expanded to include adults aged 42-64.

The programs were originally estimated to cost about $220 million for the current fiscal year but because of rapid growth in enrollment, cost estimates soared to more than $1.1 billion. That prompted lawmakers to pass legislation giving the administration rulemaking authority to control those costs, and the Pritzker administration responded by requiring copays and capping enrollment.

The rules that went into effect July 1 required enrollees to make a $250 copay for inpatient hospital stays, $100 for emergency room visits and 10 percent of the Medicaid reimbursement rate for outpatient ambulatory surgery.

But on Sept. 5, IDHFS published another notice advising providers to stop charging copays and to refund any money collected so far.

Shaker told JCAR Wednesday that there was a problem with charging copays for emergency room services because that is one service for which the federal government does offer reimbursements, even for immigrants not lawfully present in the country.

"Until we had the ability to completely have the system work and function appropriately as it should, and to draw in as much federal matching as possible in these situations, we decided to suspend it and instruct the providers that if there were any copays that were taken, that they needed to repay them," he said.

IDHFS spokesperson Jamie Munks told Capitol News Illinois in a separate email that the agency also needs to reprogram its computer systems that manage reimbursements to account for the new copay requirements and it needs to publish official guidance telling providers when and when not to charge them.

Shaker said he could not estimate a timeline for reestablishing copays.

"We don’t have the reimplementation process completely fleshed out yet," he told the committee. "We are anticipating a provider notice with sufficient time notifying them that on a specific date the copays would reinitiate as well as we would be notifying the actual recipients and advising them what their responsibilities would be as well."

* Capitol News Illinois is a nonprofit, nonpartisan news service covering state government. It is distributed to hundreds of print and broadcast outlets statewide. 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 Southern Illinois Editorial Association.