The state temporarily paused enrollment in a health care program for immigrant seniors because spending again far exceeded estimates

News of the Illinois capital

Gov. J.B. Pritzker’s administration will suspend enrollment in the state-sponsored health care program for some immigrants 65 and older starting November 6 – implementation of the plan has previously announced to limit spending on the program.

It’s an expected move the administration announced in June aimed at controlling the rising costs of a program that has proven more expensive than initially estimated since it became law in 2019. 2020. Although no new applicants will be accepted at this time, those who are already in this program will not be accepted. The plan will not see any changes to their current benefits.

The Immigrant Senior Health Benefits Program provides state-funded Medicaid-like benefits to individuals who otherwise qualify for the federal program based on their income level. their immigration status. That includes individuals in the United States without legal authorization and those who already have green cards but have not completed the five-year waiting period to qualify for federal benefits. A related state program – Immigrant Adult Health Benefits – offers similar benefits to noncitizens ages 42-64.

But unlike traditional Medicaid, which is funded jointly with state and federal dollars, immigrant health care programs are funded almost entirely with state dollars due to limitations. on federal reimbursement to non-citizens.

Together, lawmakers allocated $550 million to fund those programs in fiscal year 2024, which begins July 1. Lawmakers also empowered the Pritzker administration to take action through the state’s administrative rulemaking process to maintain spending at those levels.

Seizing that power shortly after signing the bill, Pritzker capped the number of HBIA enrollees as of July 1 and announced a cap of 16,500 HBIS enrollees — a threshold expected by the Department of Health and Family Services ​will be reached early next month.

Read more: Pritzker quickly seizes expanded authority to freeze non-citizen health care enrollment

But the latest cost estimates from HFS show that those limits — combined with administrative delays in issuing copay and coinsurance requirements to enrollees — have failed to control program expenses.

A September 2023 analysis from the HFS website showed the program is expected to cost $831 million in fiscal year 2024, exceeding the allocated amount by more than $280 million. That estimate is based on total program enrollment of nearly 69,000 individuals with cost estimates per patient per month provided by actuarial firm Milliman, which contracts with the Department.

Although the latest estimate exceeds the budget amount, it is still nearly $300 million less than a May estimate from the Pritzker administration that projected program costs could rise to $1.1 billion if There are no cost-saving measures.

Read more: Projected cost for Illinois noncitizen health care program rises to $1.1 billion

Advocates for promoting health care programs for noncitizens — most notably the Illinois Legislative Latino Caucus — have long argued that providing health care , especially preventative care, for immigrant populations would be cheaper than making them dependent on emergency room visits.

The Healthy Illinois Campaign – a major advocacy coalition for the programs – has also long considered health care a human right. Surname posted on social networks Thursday to encourage eligible applicants to apply for the program before the cap takes effect.

“While expected, today’s announcement is a disappointing step backward from the overall progress our state has made,” Healthy Illinois Campaign Director Tovia Siegel said in a statement. in accessing health care services”. “The HBIS program provides critical, life-saving health care services to thousands of vulnerable older adults across Illinois.”

She said the move would “significantly reduce the state’s ability to care for the elderly” and called on the administration to “continue working with advocates and community organizations to find responsible solutions.” financially responsible” while protecting access to health care for program enrollees.

However, the administration notes that costs will be higher for new enrollees in the program because they often go long periods without preventive care. While it is expected that individual patient costs will stabilize as they receive routine care, growing enrollment means expensive first-time costs also continue to rise.

“Compared to the traditional Medicaid population, monthly enrollment has grown at a higher rate and costs per enrollee have also been higher among HBIA and HBIS enrollees due to more common chronic conditions , untreated and higher hospital costs, pushing the limits of funds available for these programs in the current fiscal year,” HFS said in a statement.

Before the legislative rulemaking oversight committee earlier this week, HFS attorney Omar Shaker said the department is still in discussions with the federal government to implement co-pay and cost-sharing measures.

Initially scheduled to launch July 1, copays will cost $250 for inpatient hospitalizations and $100 for an emergency room visit. Those enrolled in certain outpatient services at a hospital or surgery center will be subject to a 10 percent coinsurance, which the Department said at the time “may range from $3.70 to $202.95, depending on services received.”

Read more: Copay requirements paused for noncitizens in state health plans

But early last month, the administration paused those requirements to ensure they did not jeopardize federal matching dollars for services that must be reimbursed, such as emergency room care. Providers who collected copays have been instructed to return them.

Shaker told the Joint Committee on Administrative Rules this week that the department wants to restore copays and coinsurance measures, possibly as early as Jan. 1. But he acknowledged that the rules The new rules allow that they may not be ready by that date.

However, as of Jan. 1, he said he does expect the department to begin a “concerted effort” to engage managed care organizations in providing the care program. health care. It’s a state system that involves private insurers participating in the Medicaid program, ensuring patients receive regular checkups and follow-up care.

Shaker said the department expects that move to further reduce program costs.

Capitol News Illinois is a nonprofit, nonpartisan news service covering state government. It was distributed to hundreds of newspapers, radio and television stations statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation, with major contributions from the Illinois Broadcasting Foundation and the Southern Illinois Editorial Association.

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