Pritzker quickly wields expanded authority to freeze noncitizen health care enrollment

[June 22, 2023]  SPRINGFIELD – Gov. JB Pritzker’s administration wasted no time last week in exercising new authority granted by lawmakers to limit the number of enrollees in a pair of state-funded health care programs for low-income noncitizens.

In a move that drew intense backlash from immigrant rights advocates, Pritzker on Friday signed House Bill 1298 then immediately filed emergency rules authorized by the law to “temporarily” pause enrollment in the Health Benefits for Immigrant Adults program as of July 1. That state-funded program serves individuals aged 42 to 64 years who would be eligible for Medicaid benefits based on income levels but not their citizenship status.

A similar program serving noncitizens age 65 and older, known as Health Benefits for Immigrant Seniors, will remain open unless enrollment reaches 16,500, at which time it will also be paused. As of June 7, there were 14,594 people enrolled in HBIS, according to the administration, which projected in March that enrollment would increase to 21,000 in the upcoming fiscal year.

The Healthy Illinois Campaign, which advocates for health care equity for noncitizens, called the freeze “immoral and shortsighted,” saying it will force people “to forgo cancer treatment, diabetes care, mental health care, and countless other kinds of necessary medical treatment.”

“By slashing live-saving health coverage for Illinois immigrants, Gov. Pritzker is turning his back on the communities he claims Illinois welcomes and aligning himself with anti-immigrant Republicans around the country,” the organization said in a statement.

Pritzker had previously defended and celebrated the programs when he signed them into law, agreeing with advocates that it is cheaper to provide preventative care to noncitizens rather than making them rely on emergency room visits to treat conditions that have gone undiagnosed due to a lack of health care benefits.

But a news release Friday from the Department of Healthcare and Family Services billed the changes as a necessary move to ensure “programs do not exceed the funds available and appropriated by the General Assembly” – an amount pegged at about $550 million.

“Compared with the traditional Medicaid population, month-over-month enrollment has grown at a higher rate, and per-enrollee costs have tracked higher among the HBIA and HBIS-enrolled populations due to more prevalent, untreated chronic conditions and higher hospital costs,” IDHFS said in a news release.

The emergency rules will now be considered by the Joint Committee on Administrative Rules, a bipartisan 12-member group of lawmakers from both chambers of the General Assembly. The rules will remain in place for 150 days, although HB 1298 allows the administration to refile an identical rule after that time.

JCAR could vote by a two-thirds majority to suspend the rules. It could also object to them, leaving them in place while requesting a response from the administration. But nothing in law requires JCAR to act on the rules, in which case they would remain in place.

Costs ‘in question’

Advocates hailed the 2020 launch of the HBIS program as setting a “national precedent” for providing health care for immigrant seniors regardless of their legal residency status.

But it far outpaced the initial estimate of $2 million annually that was cited by its House sponsor at the time, Rep. Delia Ramirez, D-Chicago, who has since moved on to Congress.

“We have to protect something so fundamental to our humanity as providing health care coverage to people, regardless of documentation status,” Ramirez said in a statement after the governor announced the changes. “It's extremely disappointing to hear that the state administration has decided to stop immigrants from accessing life-saving health insurance under the pretense that it costs too much, especially since the alleged costs of the program are in question.”

The Pritzker administration in March noted the HBIS program cost the state $187.5 million in the prior 12 months, and it projected that cost would increase to $285 million in the upcoming fiscal year.

Gov. JB Pritzker is pictured at a news conference in his Capitol office earlier this year. (Capitol News Illinois photo by Jerry Nowicki)

Expansions of the HBIA program have similarly outpaced expectations, leading the administration to project a total price tag of $1.1 billion for noncitizen health care in the upcoming fiscal year if enrollment wasn’t capped. That number was about 5 times what Pritzker had proposed spending in his February budget.

Advocates accused the governor of overestimating those numbers and caving to calls by Republicans to curtail the program’s spending. GOP lawmakers held several news conferences in the waning days of the General Assembly’s spring session to call for a suspension of the programs, which they said would entice new immigrants to come to the state and thus become increasingly expensive.

When he signed the state’s Fiscal Year 2024 budget earlier this month, Pritzker said capping program enrollment would help limit spending to “about $550 million.”

“That's more than we expected, but not nearly as much as it might have cost if we didn't have the tools necessary (to limit program growth),” Pritzker said.

The HBIA pause does not affect current enrollees, but the administration also announced enrollees of both programs will soon be subject to copays and coinsurance if their health care is not otherwise eligible for federal reimbursement. That includes a $250 copay for inpatient hospitalizations and $100 for an emergency room visit. Enrollees receiving certain outpatient services at hospitals or surgical centers would be subject to 10 percent coinsurance.

IDHFS said in a statement that enrollee payments under the new coinsurance requirement “could range from $3.70 to $202.95, depending on the service received.”

Ramirez suggested those changes would “result in higher costs for those already enrolled in the program and place additional financial strains on our safety net hospitals.”

Health care providers would be responsible for collecting those cost-sharing payments and would bear the cost of nonpayment.

In January, enrollees will also be transferred to the state’s Medicaid managed care program, a system overseen by private insurers. That change is aimed at generating additional dollars through the state’s tax on managed care organizations.

IDHFS also noted in a news release that the department is looking to maximize federal reimbursement for emergency medical expenses, as well as pursuing supplemental prescription drug rebates for those covered under the programs. It will also seek reimbursement from “large public hospitals” – namely the Cook County Hospital System – that received “payments in excess of the rates paid to non-large public hospitals” under the program.

The Illinois Legislative Latino Caucus urged eligible noncitizens to enroll in the program in June before it is paused. Eligible individuals can enroll online at abe.illinois.gov/abe/access.

“As we pride ourselves as being a welcoming state, we should not be cutting health benefits and creating barriers to health care,” the Latino Caucus said in a statement.

The caucus had advocated for an expansion of the program to individuals aged 19-41, which would have cost a projected $380 million alone, according to the administration. That expansion would have ensured health care coverage for low-income noncitizens of any age, as those aged 18 and under are already covered under the state’s AllKids program.

“Latino Caucus members have not given up – and will pursue closing the gap in coverage until we achieve health care for all residents,” the caucus said in a statement. “The often-disenfranchised communities we represent sent us to Springfield to be their voice; we will never turn our backs on them.”

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