Prairie State Wire

The Department of Healthcare and Family Services (HFS) in Springfield has announced new rules for the Health Benefits for Immigrant Adults (HBIA) and Health Benefits for Immigrant Seniors (HBIS) programs. These changes are based on the authority granted by Senate Bill 1298, which was recently passed by the General Assembly and signed into law by the Governor.

The newly established rules outline how HFS will determine potential alterations to these programs and how they will notify the public about such changes. The FY24 State budget and Senate Bill 1298 mandate that the HBIA and HBIS programs must not exceed their allocated funds for FY24. As a result, HFS will temporarily pause new enrollments in the HBIA program for eligible residents aged 42 to 64 starting July 1. This decision does not affect current enrollees who remain eligible for coverage.

Enrollment in the HBIS program remains open, but it may be paused if enrollment reaches 16,500 individuals during FY24. Current enrollees in both programs who remain eligible will continue to receive coverage. HFS aims to resume new enrollments as soon as financially feasible.

These enrollment changes are intended to align program costs with the budgeted amount for State Fiscal Year 2024, beginning July 1. Enrollment growth among HBIA and HBIS populations has been higher than traditional Medicaid populations, with increased per-enrollee costs due to untreated chronic conditions and hospital expenses.

HFS recognizes the importance of these programs as essential resources for individuals who would otherwise qualify for Medicaid if not for their immigration status. The department is committed to maintaining this leading program.

To manage costs further, HFS will introduce co-pays for certain services when federal match eligibility is absent: $250 co-pay for inpatient hospitalization, $100 co-pay for emergency room visits, and a 10% co-insurance for outpatient services at hospitals or Ambulatory Surgical Treatment Centers.

Before deciding on cost-containment measures, HFS explored maximizing available funds through several strategies: seeking federal reimbursement methodologies for emergency medical expenses, pursuing supplemental prescription drug rebates, transitioning enrollees to Medicaid Managed Care starting January 1, 2024, which could generate additional funding through taxes collected from Managed Care Organizations, and addressing overpayments to Cook County Hospital System.