Expansion of Medicaid for noncitizens sent to governor
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[April 23, 2022]
By PETER HANCOCK
Capitol News Illinois
phancock@capitolnewsillinois.com
SPRINGFIELD – A bill that would expand
Medicaid coverage to otherwise ineligible noncitizens is now awaiting
Gov. JB Pritzker’s approval.
That provision was part of an “omnibus” Medicaid bill, House Bill 4343,
that passed through the General Assembly on the final day of the
session.
And while Medicaid bills are traditionally worked out in a bipartisan
“working group,” this one drew strong opposition from Republicans
because the language about noncitizens had never been discussed in any
public hearing or working group meeting.
“We had a bipartisan group for the last three months, getting up at 7
o'clock in the morning for these meetings with the agreement that all
Medicaid expansions and increases were going to be working through this
group,” Sen. Dave Syverson, R-Rockford, said during floor debate in the
Senate. “And then you turn around a couple hours after this agreement
and you change the bill.”
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Sen. Ann Gillespie, D-Arlington Heights, who chairs a Medicaid
subcommittee, defended the process and said there were other provisions
of the bill that were negotiated outside the working group.
“We used this bill to add on the Medicaid omnibus, but it was never
exclusively the Medicaid omnibus,” she said.
She said the bill clarifies statutory language to help providers and
meets a goal of expanding health care coverage amid the pandemic to
“make sure that we're taking care of as many people as we can.”
In 2020, Illinois became the first state to offer coverage for
undocumented noncitizens by extending it to those 65 and older who would
otherwise qualify for Medicaid if not for their immigration status. In
2021, lawmakers lowered the age limit to 55. This year’s bill lowers the
age limit even further to 42.
In addition, Illinois does not apply a citizenship requirement for
children under age 18 or pregnant women, including up to 60 days
postpartum.
Medicaid is a government-funded health care program for low-income
individuals and families. It is jointly funded with state and federal
dollars and is administered by the state under federal guidelines.
Under federal rules, certain categories of noncitizens can qualify for
Medicaid if they are lawfully present in the country. Among those are
green card holders, asylees, refugees and members of federally
recognized Native American tribes who were born in Canada. Those
individuals typically must be U.S. residents for five years before they
become eligible.
But federal rules do not allow for coverage of those who are not
lawfully present in the U.S., which means the federal government will
not reimburse for their care and all costs of covering those individuals
must be paid solely with state dollars, estimated at $68 million a year
for the latest expansion.
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Covering noncitizens
Supporters of covering noncitizens regardless of their immigration
status argue that it’s actually cheaper than the alternative, which is
forcing them to get all of their care in emergency rooms.
“These are people that would have otherwise ended up in the emergency
room because of their diabetes, or because of high cholesterol in the
midst of a pandemic,” said Rep. Delia Ramirez, D-Chicago, who sponsored
a separate bill, House Bill 4437, that would have extended coverage to
all noncitizens age 19 and over. “And the cost of not insuring them was
3-to-1 to insuring them right now.”
But Syverson rejected that argument and said there is a bigger danger in
providing an inducement for people to come into the country illegally
with the offer of taxpayer-funded free health care.
“If the word’s out that Illinois is the place to go, they're going to
come here, and like I said before, we can't adequately take care of our
disabled and our seniors,” he said in an interview. “And yet, we're
going to provide better care for undocumenteds than we do for our own
families. And it's going to drive up the cost of health care for working
families, because again, the more people that are on government health
care that reimburses at a much lower rate to hospitals and doctors, the
more that gets shifted over to private-pay people.”
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The Illinois State Capitol is pictured in
Springfield. (Capitol News Illinois file photo)
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Gillespie said during a separate interview that the idea of expanding
coverage for more noncitizens grew out of a feasibility study directed
by the governor’s office through the Departments of Healthcare and
Family Services and Insurance.
That study examined several options for reducing the number of uninsured
people in Illinois and making coverage more affordable.
The report, released in April 2021, led to the formation of another
working group focusing on health care expansion, Gillespie said, and
that was the group that came up with the language to expand coverage to
more noncitizens.
“So the base of House Bill 4343 was the results coming out of that
group,” she said. “And then we added the Medicaid working group
provisions, agreed provisions, onto that bill. So the bill itself had
two separate geneses, if you will.”
Expanding Medicaid coverage to more noncitizens was also a top priority
of the Legislative Latino Caucus.
Speaking at an April 5 news conference to promote her own bill, Ramirez
argued that providing universal coverage was the morally right thing to
do.
“This would finally ensure that every single low-income person in our
state has access to health care coverage, regardless of their
immigration status,” she said. “Health care must be a human right.
Everyone should be able to access a doctor to treat their diabetes or
manage a chronic condition regardless of their immigration status.”
Ramirez’s bill was never voted on by a committee, but discussions about
expanding coverage for more noncitizens continued until the cutoff age
of 42 was agreed upon.
“And that's where the budget discussions came in. It really came down to
what was it that we could afford to do this year,” Gillespie said.
![](http://archives.lincolndailynews.com/2022/Apr/23/images/ads/current/culligan_sda_SFARM_2022.png)
Working groups
The process by which the bill passed the General Assembly highlights a
little-known and often obscure aspect of the General Assembly, informal
“working groups.”
Under the Illinois Constitution, all meetings of committees, joint
committees and legislative commissions must be open to the public.
Committee meetings may be closed if two-thirds of the members of that
chamber determine that it’s in the public interest to do so. Closing
joint committee and legislative commission meetings requires a
two-thirds vote in both chambers.
In recent years, however, lawmakers have gotten around that by forming
informal “working groups” that operate much like committees in that they
study issues, hear testimony and recommend the passage of legislation.
But their meetings are not open to the public and even their membership
is not publicly known.
Lawmakers on both sides of the aisle have defended the working group
process, saying it allows for more free discussions and that ultimately
it leads to bipartisan legislation.
“Over the past several years, the Medicaid work group has been a really
productive and collaborative experience for members of all four caucuses
and the administration, no matter which party was in control the
governor's office, to work through complicated issues in the Medicaid
space, and to evaluate a wide range of options that were brought before
the House,” Rep. Tom Demmer, R-Dixon, said during debate in the House.
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Demmer said bills crafted through that process have often received
unanimous support.
“Unfortunately, the bill that we see before us today has many items we
did talk about and reach consensus on, but others that were simply added
at the last minute and for that reason, I urge a no vote,” he said
during debate.
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Foundation and the Robert R. McCormick Foundation. |