Illinois on track to end health coverage program for immigrant adults

SPRINGFIELD — State officials are on track to shut down a program at the end of June that provides publicly funded health care coverage to more than 30,000 non-U.S. citizens in Illinois, including many who are in the country without legal authorization.

A legislative oversight committee took no action Tuesday on a set of administrative rules the Illinois Department of Healthcare and Family Services adopted in March that will end the program, effective July 1 — the first day of the next fiscal year.

Sen. Bill Cunningham, D-Chicago, co-chair of the Joint Committee on Administrative Rules, said the lack of action Tuesday means nothing has changed about the plans to bring the program to an end.

"It (the rule) is in place now. It's phasing out. JCAR hasn't taken any action on it," Cunningham said in an interview after Tuesday's meeting. "I don't think there's anything to read into it beyond that."

The Health Benefits for Immigrant Adults program, or HBIA, was launched in 2021. It covers qualifying individuals aged 42 to 64. The program came about as a companion to a program that began the year before, Health Benefits for Immigrant Seniors, or HBIS, which covers about 8,900 individuals aged 65 and over.

Both programs were intended to provide health coverage to a segment of the population that was ineligible for coverage under Medicaid solely because of their immigration status. The programs cover those who are not lawfully present in the United States as well as legal permanent residents who have not been in the country long enough to receive Medicaid benefits.

However, the two programs have far exceeded their original cost estimates. According to an auditor general's report released in February, the total cost of both programs from Fiscal Year 2021 through Fiscal Year 2024 was more than $1.6 billion.

And because the programs cover individuals who are not eligible for traditional Medicaid — the public health insurance program for low-income individuals that is jointly funded with state and federal funds — nearly all the cost of those programs came exclusively from state dollars.

With the state facing flattening revenues and a projected budget deficit in the coming fiscal year, Gov. JB Pritzker proposed ending the HBIA program effective July 1.

A notice on the program's web page reads: "Due to State Fiscal Year 2026 budgetary constraints, the state had to make the difficult decision to use the limited funding available to continue coverage for eligible noncitizens aged 65+ only."

In proposing to end the program, Pritzker noted the working-age adults that it covers can get jobs with employer-sponsored health benefits.

The General Assembly's revenue estimating group, the Commission on Government Forecasting and Accountability, recently increased its revenue estimate over its previous March projection by about $266 million. But COGFA's latest forecast is still $471 million below the governor's February projection for baseline revenues, and Pritzker has not backed down from his call for ending the HBIA program.

Andy Manar, his deputy governor for budget issues, was quoted in the Chicago Tribune as saying as recently as last week that Pritzker remains "firm" in his decision to cut the program, noting that cuts had to be made in many state programs to balance next year's budget.

But as lawmakers continue working to pass a final budget before the end of May, Congress is considering other changes to the Medicaid program that could have an even more profound impact on the state budget.

The U.S. House Energy and Commerce Committee, which has jurisdiction over Medicare and Medicaid, began hearings Tuesday on a package of spending recommendations that the Congressional Budget Office estimates would reduce the federal deficit by more than $880 billion over the next 10 years.

Much of that, according to a summary of the recommendations, would come from the Medicaid program and the Affordable Care Act, the 2010 health insurance reform package also known as "Obamacare."

Those recommendations include, among other things, requiring Medicaid recipients to verify their income every six months instead of 12 months. It also calls for withholding federal funds under Medicaid or the Children's Health Insurance Program for people who do not provide proof of U.S. citizenship or satisfactory immigration status.

The package also calls for cutting by 10% the federal matching rate, known as the Federal Medical Assistance Percentage, or FMAP, for states that provide health care coverage under Medicaid or any other state-based program for undocumented immigrants.

"It could have a dramatic effect, if it actually happens," Cunningham said of the total package of proposed cuts. "Obviously Medicaid is one of the largest tranches in our budget and we depend on a lot of reimbursement dollars from the federal government. If the federal government goes ahead with those cuts, it would cause hundreds of thousands of people in Illinois to lose their health insurance."