Lawmakers criticize Pritzker administration’s handling of noncitizen health care limits

[July 20, 2023]  By ANDREW ADAMS
Capitol News Illinois
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Members of a state rulemaking oversight committee voiced concerns Tuesday that Gov. JB Pritzker's administration didn’t sufficiently seek public input on its plan to cap enrollment in Medicaid-like health care programs for noncitizens.

The controversy centers on the Health Benefits for Immigrant Adults and Health Benefits for Immigrant Seniors programs, which provide health care benefits to low-income noncitizens who would qualify for Medicaid benefits if not for their citizenship status.

During May budget negotiations, lawmakers gave the Pritzker administration authority to cap program spending through emergency rulemaking, and his administration exercised that authority in late June.

Those emergency rules froze enrollment in HBIA, which serves noncitizens aged 42 to 64, and set a cap for enrollees in HBIS, which provides benefits to noncitizens age 65 and over. The changes also reduce reimbursement rates for two large public hospitals, institute copayments and coinsurance for some services and transition some enrollees into the state’s Medicaid managed care program in an effort to reduce costs.

The Joint Committee on Administrative Rules on Tuesday heard from representatives of the state’s Department of Healthcare and Family Services, who defended the rules.

The rules are designed, according to IDHFS officials, to limit costs for the program, which they say would be underfunded by hundreds of millions of dollars without the changes.

“We have projected liabilities of about $1.2 billion for the program if no changes are made,” IDHFS chief of staff Ben Winick said at JCAR’s Tuesday meeting in Chicago.

He noted the General Assembly allocated $550 million while giving the administration the authority to cap costs.

Pritzker’s administration proposed the changes in both “emergency” and “permanent” administrative rules. While emergency rules are generally valid for 150 days, the law authorizing the administration to limit program enrollment also allows it to refile emergency rules once they expire. That means that unless JCAR votes by a three-fifths majority to suspend the rules, they would remain in place as long as the department wants, at least for the next two years.

JCAR – which consists of six Democrats and six Republicans and is responsible for overseeing policy making within the state’s executive branch – didn’t take action on either the emergency or permanent rules Tuesday, although the committee can still take action at a future meeting.

Both Democratic and Republican members shared concerns with IDHFS officials that mostly focused on the process by which the rules were developed.

Sen. Cristina Castro, D-Elgin, and Rep. Eva-Dina Delgado, D-Chicago, question representatives of the Illinois Department of Healthcare and Family Services about proposed changes to programs that offer health care benefits to noncitizens in Illinois. (Capitol News Illinois photo by Andrew Adams)

Sen. Cristina Castro, an Elgin Democrat and member of the Illinois Legislative Latino Caucus, said that the department failed to consult stakeholders in the immigrant advocacy community when developing the rules.

“You quickly filed both the emergency rule and permanent rule. There’s obviously been no discussions with advocates on either, it seems,” Castro told IDHFS officials.

Rep. Eva-Dina Delgado, D-Chicago, also said she wanted to see “immediate action” to engage stakeholders and advocacy groups before moving forward with the process of implementing the department’s proposed permanent rules. She particularly criticized the department’s plan to issue a 14-day notice before freezing enrollment in HBIS.

“I’d like you all to engage with those that are impacted because I just don’t know if that’s going to be workable,” Delgado said. “If you change somebody’s health care every two weeks and expect them to follow along, even if they are fully language proficient, I think you’re just asking for problems.”

On the Republican side, Rep. Steven Reick, R-Woodstock, said that the rules represented an “abdication” of the General Assembly's responsibility and that they should have been considered in legislation, not in administrative policy.

“This is another instance of a governor that thinks he can legislate on his own,” Reick said. “First he did it with 47 disaster declarations and now he’s doing it with emergency rule.”

Sen. Bill Cunningham, a Chicago Democrat and co-chair of JCAR, said the committee was frustrated at the lack of stakeholder engagement from several agencies. JCAR also discussed a controversial emission rule change for heavy industries Tuesday, objecting to two state agencies’ hurried implementation process.

“I think you heard throughout this meeting a frustration from committee members about the lack of engagement between agencies and various stakeholders and that was true across the board,” he said in an interview after the hearing.

Cunningham said the committee will “likely” have another discussion about the health care rules next month.

“I am hopeful they will act in a good faith effort to collaborate more closely with the stakeholder groups,” Cunningham said.

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.