Illinois alerts more than 700,000 people they will or could lose public health insurance

The Pritzker administration is alerting more than 700,000 people across Illinois that they will lose, or are at risk of losing, their public health insurance due to unprecedented changes from the federal government.Officials estimate about half of these enrollees live in Cook County.The state has to people who have Medicaid public health insurance, a state-federal program for those who have low incomes or disabilities. About 3 million people have Medicaid coverage in Illinois, about 1 in 4 people.“It could be a huge step backward,” said Kathy Chan, director of policy at Cook County Health in Chicago, one of the largest public health systems in the U.S. “We and many other partners … are working toward a goal of trying to mitigate the harm as much as we can, and try to preserve coverage for as many people who are still eligible as possible.”The significant changes are coming due to H.R. 1, known as the One Big Beautiful Bill, that President Trump signed into law last year.They affect mostly two groups of people who have Medicaid statewide.Starting Oct. 1, about 8,500 people who are not U.S. citizens but have legal status, such as refugees and survivors of trafficking, will lose coverage. H.R. 1 narrows which immigrants qualify for Medicaid.Next year, about 700,000 people who have joined Medicaid since Illinois expanded eligibility under the Affordable Care Act more than a decade ago are at risk of losing coverage. That’s if they don’t meet work or volunteer requirements. And they will need to prove they are eligible every six months, instead of just once a year.This group is known as “ACA adults.” They are 19 to 64 years old. They don’t have children younger than 18 at home.These adults must work or volunteer at least 80 hours a month — about four hours a day Monday through Friday — or they could be in school at least part time, among other criteria. A person could also do a combination of work, volunteer and school to meet requirements, according to the state.ACA adults who are new to Medicaid as of Jan. 1 would need to comply immediately.For current enrollees who don’t comply, the earliest they would lose coverage is April 1, according to a spokesperson for the Illinois Department of Healthcare and Family Services, which oversees Medicaid. More people could lose their insurance on a rolling basis, depending on whether they meet the new work requirements when it’s time to renew their coverage.There are several exemptions for ACA adults, including if a Medicaid enrollee is pregnant or postpartum, if they’re a parent, guardian or caregiver of a child younger than 14 or if they are “medically frail.” That’s broadly defined as having a substance use or serious mental health condition, or a serious or complex medical condition that requires regular treatment, among other factors.One of the most daunting tasks: spreading the word to Medicaid recipients that big changes are coming and making sure they get paperwork to the state on time so they don’t become uninsured. That could have far-reaching ripple effects on hospitals, clinics and even for people who have commercial insurance, local leaders have warned.Healthcare and Family Services declined an interview request but responded to questions over email and shared letters the agency sent to Medicaid enrollees.Even for Medicaid enrollees who aren’t subject to the new rules, there will likely be more confusion heading into 2027, Chan said. Medicaid is a complicated program, and every month about 10 percent to 15 percent of enrollees lose coverage not because they aren’t eligible, but because of some hiccup with the paperwork getting to them, or getting back to the state, Chan said.For example, not everyone has a steady mailing address, and some might have trouble navigating the online system, Chan said. Cook County and other organizations have created an online tool kit to help Medicaid enrollees navigate these changes.Jessica Davenport-Williams, co-founder of Black Girls Break Bread, an advocacy organization that works to reduce barriers to medical care for women and children in particular, is especially worried that pregnant and postpartum mothers could fall through the cracks.She wonders who will tell the state that a woman with a Medicaid plan is pregnant to make sure she’s exempt from work requirements, when it can take months to get a doctor’s appointment, or she isn’t connected to a doctor and plans to give birth at home? Otherwise, she risks becoming uninsured.In Illinois, about one-third of pregnancy-related deaths happen more than 60 days after a woman has her baby, according to the state public health department.“Access to care is very important, especially with our maternal health deserts,” Davenport-Williams said.Kristen Schorsch is a senior reporter covering public health for WBEZ.

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