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Illinois' immigrant health programs enact copays as cost estimates decline

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Illinois' immigrant health programs enact copays as cost estimates decline


SPRINGFIELD, Ill. — Cost estimates for a pair of state-funded health care programs serving certain low-income noncitizens have declined by tens of millions of dollars in recent months as the state rolled out new copay and co-insurance requirements this week.

The Health Benefits for Immigrant Adults and Health Benefits for Immigrant Seniors programs provide state-funded Medicaid-like benefits to individuals aged 42 and over who would otherwise be eligible for the federal low-income health care program if not for their immigration status.

That includes those in the U.S. without legal permission and those who have obtained a green card but not yet completed a five-year waiting period to earn federal benefits. Individuals who have applied for asylum or sanctuary in the U.S. – which includes many of the more than 34,000 migrants bused to Illinois from Texas in the last year-and-a-half – more likely qualify for other preexisting state or federal benefits.

Advocates for the programs contend they are not only lifesaving but also cost-saving in the long-run as they give individuals access to preventative care rather than making them reliant upon expensive emergency room visits to treat conditions that worsen due to lack of care. Opponents of the programs, namely Republican lawmakers, have criticized them as an expensive enticement for people illegally residing in the U.S. to relocate to Illinois.

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The programs, originally launched for those aged 65 and older in 2020 then expanded in waves, became a sticking point in state budget negotiations last year when Gov. JB Pritzker’s administration projected their single-year costs to exceed $1 billion.

But current estimates now project the programs will cost $773 million in the current fiscal year. Those estimates, however, have declined by $60 million since August, the month following the Pritzker administration’s initial announcement of certain cost-saving measures.

Cost-saving measures

Ultimately, the contentious budget negotiations ended last year with lawmakers allocating $500 million in funding to the program from the state’s General Revenue Fund and giving the Pritzker administration authority to limit program enrollment and costs.

The administration in turn paused enrollment in HBIA as of July 1 and in HBIS as of Nov. 6. The two programs now collectively serve about 69,000 people aged 42 and older, and enrollment remains paused.

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In January, the administration also began moving enrollees to the state’s Medicaid managed care program, which connects individuals with private insurers who contract with the state to oversee routine and follow-up health care.

The Department of Healthcare and Family Services, which administers the programs, expects the managed care transition to be complete in April.

After months of delays, the department announced that copays and co-insurance for certain services went live Thursday.

“Most services covered by the HBIA and HBIS programs … will continue to be free for customers, including primary care visits, prescription medications and vaccinations at a pharmacy or doctor’s office,” the department said in a news release. “The new copays and co-insurance will apply to the use of non-emergency hospital or surgical center services, like nonemergent elective surgeries, physical therapy and lab work.”

Enrollees may see a $250 copay per nonemergency inpatient hospitalization and a 10 percent charge for nonemergency outpatient services or care received from ambulatory surgical treatment centers. It’s a major difference from the federally funded Medicaid program, which does not require copays.

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Whether individuals are subject to those copays and co-insurance requirements will depend on if they have already been enrolled in managed care and which managed care organization is serving them, according to the department. The state reimburses managed care organizations at a specified rate, giving the MCOs authority to charge copays or co-insurance without requiring them to do so.

CountyCare in Cook County, where most program enrollees are located, is waiving all copays and coinsurance requirements, per the department.

The department announced it no longer plans to issue a copay for emergency room visits.

The Healthy Illinois Campaign, a statewide coalition of immigrant and health care advocates, has pushed for an expansion of the program and fought any efforts to limit it or install cost-sharing.

The group’s director, Tovia Siegel, praised the administration’s decision not to charge a copay for emergency room care but said the other copays “place a significant burden on both providers and patients, limiting access to healthcare for Illinois’ immigrant community.”

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The copays, advocates noted, are charged to medical providers by MCOs, but the providers are required to collect them from patients, creating an administrative burden. As well, they warned that individuals may choose to defer certain “elective” procedures, such as a colonoscopy, due to the copay requirement, potentially undermining the program’s preventative care goals.

“We urge the Department of Healthcare and Family Services and Managed Care Organizations to reconsider implementing these charges, which will generate a relatively small amount of money but can be the difference between life and death for low-income Illinoisans,” Siegel said in a statement.

Costs declining

The programs’ cost estimates, meanwhile, have been on the decline amid the administration’s savings measures. In September, an HFS analysis estimated the programs’ 12-month cost to be $832 million for the fiscal year that ends June 30. But the department’s latest estimate, published Jan. 9, now projects the programs will cost $773 million. In total, the state has spent nearly $330 million collectively on the programs in the first six months of the fiscal year, per the January estimate.

The department’s data shows average monthly costs for the programs decreased steadily between August and December, from $72.7 million to $45.3 million.

When the state announced its enrollment caps, it noted per-enrollee costs were higher among the HBIA and HBIS populations “due to more prevalent, untreated chronic conditions and higher hospital costs.” With the caps in place, the program is now populated with individuals who’ve been receiving routine care, rather than a steady stream of new enrollees who are more expensive to insure.

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Thus, the per-patient monthly costs have also declined. In August, per-patient costs reached $1,232 for enrolled individuals aged 65 and older, $1,295 for those aged 55-64, and $844 for those aged 42-54. In December, those numbers declined to $778, $805 and $541, respectively.

Advocates pointed to those declines as evidence that the programs are accomplishing their intended goal of replacing costly emergency care with more cost-efficient preventative services.

“While there are several potential explanations, cost decreases in the HBIA and HBIS programs can be an indication that enrollees are receiving more preventative care and therefore needing less intensive, expensive care,” Siegel said. “However, the implementation of copays could threaten these gains as enrollees are dissuaded from receiving this cost-saving preventative care.”

Capitol News Illinois is a nonprofit, nonpartisan news service covering state government. It is distributed to hundreds of newspapers, radio and TV stations 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.

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AIPAC faces test of its power in Illinois primary as Democrats debate future of Israel relationship

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AIPAC faces test of its power in Illinois primary as Democrats debate future of Israel relationship


WASHINGTON — A crowded primary season in Illinois is shaping up as the next test for the American Israel Public Affairs Committee, a powerful advocacy organization that’s generating fresh turmoil over the Democratic Party’s relationship to Israel and the role of undisclosed campaign cash in this year’s midterm elections.

AIPAC, which was founded decades ago to lobby for U.S. support for Israel, has reserved at least $1.9 million in advertisements through its super PAC in the race to replace Rep. Danny Davis, a veteran politician who is retiring. The organization hopes to boost Melissa Conyears-Ervin, the city treasurer in Chicago, to victory over a dozen other candidates in the March 17 primary.

Other organizations that critics believe are tied to AIPAC are also spending heavily in Illinois, a source of bitterness and recriminations in a state already known for its bare knuckled brand of politics.

The aggressive spending comes after AIPAC put almost $2 million into a recent Democratic primary for a special election in New Jersey, an effort that’s widely considered to have backfired. AIPAC targeted Tom Malinowski, a former congressman who narrowly lost to progressive candidate Analilia Mejia — who has been outspoken in criticism of Israel.

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But AIPAC appears undaunted by the experience, despite an outpouring of criticism from across the political spectrum.

“We expect to be involved in dozens of races both in primaries and general elections this cycle,” said Patrick Dorton, a spokesman for AIPAC’s affiliated super PAC, the United Democracy Project, or UDP.

AIPAC has more urgently pursued its mission as Democratic skepticism and even hostility toward the U.S.-Israel relationship increases because of the war in Gaza, jeopardizing traditional bipartisan support for military assistance to a historic ally. But the group’s assertive interventions in this year’s primaries, which are expected to expand in the months to come, also risk further fracturing the party and eroding any remaining goodwill.

AIPAC has been dividing line in Illinois primary

Campaign finance laws involving super PACs make it nearly impossible to ascertain who is behind much of the money being spent in Illinois. Although UDP is open about its affiliation, recently created groups like Elect Chicago Women and Affordable Chicago Now haven’t yet been required to disclose the sources of their money.

Neither group is obligated to disclose its funding until after the Illinois’ primary. Critics suspect they’re conduits for AIPAC money, and AIPAC has declined to say whether there’s any connection.

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UDP, Elect Chicago Women and Affordable Chicago Now are three of the top four spenders on advertisements in House races so far, with almost $11 million total, and the majority going to Illinois. Financial numbers are drawn from AdImpact, a nonpartisan ad-tracking service.

None of the organizations mention Israel in their campaign messaging, a strategy that AIPAC-affiliated groups have used in the past as well.

For example, the United Democracy Project assailed Malinowski in New Jersey as sympathetic to President Donald Trump’s deportation efforts, undermining him with liberal voters. In Illinois, it is promoting Conyears-Ervin to replace Davis in the 7th congressional district by saying she will fight to lower costs and protect healthcare.

The strategy has contributed to speculation and angst about AIPAC’s influence in politics. Supporters of Israel accuse critics of using antisemitic tropes about dual loyalty, and others say the focus on AIPAC is misplaced.

“I think the folks who are talking the most about AIPAC are seeking to demonize Israel and create a break in the U.S.-Israel relationship,” said Rep. Brad Schneider, a Democrat who represents Illinois’ 10th district.

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“The problem is Citizens United and the decision to allow dark money,” said Schneider, the co-chair of the Congressional Jewish Caucus. “The problem is the rules. Let’s fix the rules.”

Candidates have been criticizing each other for their perceived willingness to accept help from AIPAC. Four progressive candidates vying for different Illinois congressional seats jointly condemned the organization’s role in the state’s primaries during a press conference in February. Another candidate is selling shirts on her website with anti-AIPAC messaging.

AIPAC has increased its campaign spending in recent years

Malinowski is still raw over his experience as AIPAC’s target in New Jersey, and he said that he won’t support any candidates backed by the organization this year. He described himself as pro-Israel even though he opposed unconditional assistance for the country, a stance that drew AIPAC’s ire.

“Obviously, we were going to talk about Israel and Gaza in the campaign because many voters would be asking questions about it,” Malinowski said. “But I wanted those discussions to be about the substance, not colored by baggage of endorsements from groups that are controversial now.”

AIPAC said in a statement that Mejia’s success in the primary was “an anticipated possibility,” suggesting they had no regrets that their role could have helped pave the way for a candidate who has described Israel’s actions in Gaza as genocide.

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Although AIPAC has always been politically active, it began spending directly on campaigns during the 2022 midterms.

Since then, it has spent more than $221 million through its traditional PAC and its super PAC, according to Federal Election Commission filings between December 2021 and January 2026.

The super PAC has mostly focused on Democratic primaries. In the 2022 and 2024 cycles, UDP spent at least $1 million supporting or opposing 18 candidates, 16 of whom were Democrats. Many of those candidates were running in open races.

Traditional PACs are allowed to raise and donate up to $5,000 per candidate per election, and may coordinate directly with campaigns. Super PACs don’t have fundraising or spending limits but are not allowed to make direct or in-kind contributions to candidates nor coordinate communications.

In 2024, UDP’s biggest investments were made in support of centrist challengers to progressive incumbents. It spent more than $13 million in the 2024 Democratic primary in New York’s 16th District, in which current Rep. George Latimer defeated former Rep. Jamaal Bowman. It also spent $8.5 million opposing former Rep. Cori Bush, who lost her primary to Rep. Wesley Bell.

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Chicago Bears property tax incentives advance in Illinois House over city opposition

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Chicago Bears property tax incentives advance in Illinois House over city opposition


A tax incentive plan aimed at keeping the Bears in Illinois advanced in the state House Thursday amid opposition from City Hall and questions about whether Democrats can whip up enough votes to pass it.

The legislation, introduced by state Rep. Kam Buckner (D-Chicago), would allow the NFL team to negotiate a freeze on property tax assessments with local taxing districts — in this case, Arlington Heights, Cook County and local school districts.

This marks the latest development in the high-stakes bidding war between Illinois and Indiana over which state can lay claim to one of the NFL’s most storied franchises as the team looks for the exits from its long-time lease at Soldier Field.

On a roll call opposed by Republicans, the Democratic-led House Revenue & Finance Committee voted 13-7 to back Buckner’s legislation and position it for a vote by the full House. But that didn’t happen after the committee vote because the House adjourned for the week without taking action on the measure.

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Following the committee’s action, Buckner said it’s time to start putting a legislative plan into motion, and the property tax concessions are essential for anything going forward.

“I don’t feel pressured by the Bears,” Buckner said. “What is important to me, though, is that we are able to put these tools in play. I do want the team to stay in Illinois. That’s very important to me.”

The bill that advanced Thursday deals only with the issue of property tax certainty and saving the Bears hundreds of millions of dollars by freezing property taxes on the Arlington International Racecourse site, and allowing the team to negotiate reduced “payments in lieu of property taxes with suburban school districts.”

Still to be determined is the massive infusion of infrastructure funding required to bankroll the road, sewer and utility work needed to ready the site for development.

Ahead of the vote, Buckner appeared on “The Fran Spielman Show” podcast and said the infrastructure wish list that started at $855 million has been whittled down to $734 million and said, “We’re still talking through it.”

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But Buckner told the Chicago Sun-Times that whatever the final number turns out to be, the Chicago legislative delegation will demand similar help to renovate and refresh Soldier Field and ease the transportation bottleneck that makes it difficult to get in and out of the Museum Campus.

“We’ve still got some things to work on, including Chicago and what happens with Chicago and a Chicago package,” he said.

Buckner, whose district includes Soldier Field, has long spoken out against the state cutting a blank check to finance a new Bears’ stadium, particularly given that roughly half a billion dollars in debt remains from the 2003 renovation of Soldier Field. Buckner said the Bears should pick up that tab.

The Chicago Park District has made an ask for $630 million for infrastructure and renovation of the Soldier Field — an appeal that a representative of the mayor’s office renewed today despite formally registering as an opponent to Buckner’s legislation.

Steven Mahr, Chicago’s acting chief financial officer, told the House panel the relocation of the Bears would have “devastating consequences on the city,” and he re-upped the city’s previous $630 million infrastructure request.

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“Some of those consequences are unknowable,” Mahr said. “It is clear that Chicago is the economic engine of the state of Illinois. Engines require fuel to run, otherwise engines stall and grind to a halt. The city is requesting a fair and equitable opportunity and a level playing field.”

Labor unions, business groups and several northwest suburbs, including Arlington Heights, voiced support for the legislation.

This is a developing story.



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Bears, Illinois get do-over opportunity on new stadium, but will something finally get done?

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Bears, Illinois get do-over opportunity on new stadium, but will something finally get done?


INDIANAPOLIS — After last week’s breakdown in communication between the Chicago Bears and top Illinois lawmakers, the two sides are back to having constructive talks. The opportunity to do what they failed to do last week — advance legislation through the Illinois House – now seems possible.

While the language is still far from being finalized, there is renewed hope that PILOT legislation could pass in the Revenue and Finance Committee. An amended version of Illinois House Bill 910 was filed Wednesday evening in Springfield and added to the schedule for Thursday’s committee hearing at 10 a.m. Of significance, the filing of the bill came from Rep. Kam Buckner, who has been leading the City of Chicago’s interests during stadium negotiations with the Bears.

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What happens Thursday will be telling. One source close to the situation suggested there will be a push to not only pass the bill in the committee, but also push it to the House Floor for a vote by the end of the day. The same source expressed skepticism that a Floor vote would actually occur. The Illinois House is scheduled to adjourn until March 18 after Thursday’s proceedings, complicating the timing to advance significant stadium legislation.

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Pressure has mounted in Springfield this week, with the neighboring Indiana Senate scheduled to vote on their stadium legislation Thursday just steps away from the NFL Scouting Combine, which has brought Bears chairman George McCaskey and president Kevin Warren to town.

Multiple sources have insisted since last week that the Bears and Illinois are not far off in their negotiations. Gov. JB Pritzker told reporters at an event in Chicago on Tuesday that “there’s been really broad agreement” about changes the Bears have proposed in recent weeks.

But while Indiana stadium legislation remains at the one-yard line, the reality is that Illinois still needs more runway to finalize details, including what incentives the City of Chicago will receive from the Bears. The hope is that passing some form of PILOT legislation through a committee on Thursday will be a sign of good faith that Illinois is finally getting serious about keeping the Bears.

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The situation is essentially a do-over opportunity after similar legislation failed to make it to the same Revenue and Finance Committee last Thursday. Indiana, on the other hand, advanced their stadium legislation out of its Ways & Means House Committee with a 24-0 vote. The Bears later called it “the most meaningful step forward in our stadium planning efforts to date” in a statement.

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The events left Pritzker’s team stunned. The statement from the Bears lauding Indiana’s efforts caused the most frustration after what appeared to be a productive week of talks in Illinois. Those talks were put on hold until Warren released a statement to Crain’s Chicago Business that said: “We continue to work with Illinois’ leadership and appreciate the progress being made.”

Meanwhile, in Indianapolis, all signs point to Senate Bill 27 getting to Gov. Mike Braun’s desk before the Indiana legislative session ends Friday. The bill passed through the Indiana House with a 95-4 vote on Tuesday and is expected to pass in the Indiana Senate on Thursday. If all goes as expected, the Bears would be in a position to commit to building a stadium in Hammond, Ind. at any time.

That reality is accelerating movement amongst lawmakers in Springfield. And what happens Thursday could prove to be crucial.



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