Elizabeth M. Whitehorn Director at Illinois Department of Healthcare and Family Services | Official website
Elizabeth M. Whitehorn Director at Illinois Department of Healthcare and Family Services | Official website
New copayments and coinsurance for the Health Benefits for Immigrant Seniors (HBIS) and Health Benefits for Immigrant Adults (HBIA) programs will take effect on February 1, as announced by the Department of Healthcare and Family Services (HFS). These changes apply to non-emergency hospital or surgical center services, such as elective surgeries, physical therapy, and lab work. Primary care visits, prescription medications, and vaccinations will remain free.
The introduction of copays and coinsurance is part of cost-saving measures to align program expenses with the budget for State Fiscal Year 2024. Enrollees transitioning to Medicaid Managed Care may experience varying impacts based on their specific plans. Some Managed Care Organizations (MCOs) are waiving certain charges, while others may impose copayments or coinsurance.
Emergency services required to evaluate or stabilize a medical condition will not incur any out-of-pocket costs. For non-emergency inpatient hospitalizations, a $250 copayment per stay applies. Outpatient services at hospitals or ambulatory surgical centers will require enrollees to pay 10% of what HFS would pay the provider.
A previously planned $100 copay for non-emergency hospital ER services has been removed following consultations with the Centers for Medicare & Medicaid Services. CountyCare, serving Cook County residents, is waiving all copays and coinsurance for HBIA and HBIS customers.
As of January 1, many HBIA and HBIS customers have begun receiving services through HealthChoice Illinois under a managed care model rather than fee-for-service. This transition aims to enhance care coordination through care coordinators who assist in connecting customers with necessary medical care and social services.
Enrollment in MCOs is occurring in phases, concluding on April 1. Customers are receiving information about this transition via mail. Those with comprehensive private insurance or spenddown will continue with fee-for-service arrangements without enrolling in managed care plans.
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