Illinois

Illinois' immigrant health programs enact copays as cost estimates decline

Published

2 years ago

February 5, 2024

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.

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.

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.

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.”

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.

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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Illinois

2 men shot, 1 fatally, outside bar in Morris, police say

Published

8 hours ago

March 2, 2026

Press Room

2 men shot, 1 fatally, outside bar in Morris, police say

MORRIS, Ill. (WLS) — A man was killed and another was injured in a shooting outside of a bar in Grundy County.

The shooting happened early Saturday outside of Clayton’s Tap in the 100 block of West Washington Street in Morris, Illinois, officials said.

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The Grundy County Sheriff’s Office responded to the scene, where they found two men with gunshot wounds. One was pronounced dead at the scene and the other was taken to a hospital in critical condition.

The victim who died was identified by the Grundy County Coroner’s Office as 35-year-old Julian Rosario of Channahon.

A suspect in the shooting, 22-year-old Marshall Szpara of Seneca, was arrested and “initially charged with two counts of aggravated battery with a firearm, pending further review from the Grundy County States Attorney’s office,” Morris police said.

No further information was available.

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Illinois

Firefighter faces arson charges after Illinois wildfire burns hundreds of acres

Published

20 hours ago

March 1, 2026

Press Room

Firefighter faces arson charges after Illinois wildfire burns hundreds of acres

A volunteer firefighter is facing arson charges after he allegedly set a fire in a Lee County wildlife preserve, scorching hundreds of acres.

According to authorities, 21-year-old Trent Schaefer, a volunteer firefighter in Ohio, Illinois, was charged with one count of arson in connection to a fire that occurred in the Green River State Wildlife Management Area Friday.

On that date, temperatures had soared into the 60s, winds were whipping at more than 30 miles per hour, and humidity plunged below 30%, leading the National Weather Service to issue warnings on the danger of wildfires in Illinois.

It is alleged that Schaefer was seen by witnesses getting out of a vehicle and igniting multiple small fires within the nature preserve, which then coalesced into a larger blaze.

Those witnesses were able to restrain the suspect until Lee County sheriff’s deputies arrested him.

Image taken by Lee County Sheriff’s Office

By the time firefighters arrived on scene the blaze had already spread, and multiple departments were called in to assist with the fire, including the Illinois Department of Natural Resources.

Firefighters were able to bring the blaze under control by the late afternoon, but not before it burned more than 700 acres, according to authorities.

Schaefer is also a suspect in several other arsons around Lee County, but he has not been charged in any other fires at this time.

Illinois State Police are assisting with the investigation, and no further information was immediately available.

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Illinois

Who is running for Illinois governor in 2026? What to know as primary Early Voting sites open

Published

1 day ago

March 1, 2026

Press Room

Who is running for Illinois governor in 2026? What to know as primary Early Voting sites open

With Election Day for the 2026 Primary quickly approaching, many voters are considering who to mark their support for when they cast their ballot.

There are several big races on the ballot, including the gubernatorial race that has the potential to make history.

Though rumors are swirling that sitting Governor J.B. Pritzker has his eyes on a potential run for president in 2028, he’s still in the running for re-election. If he retains his seat, he’ll be the first Democratic governor to secure a third term in office in Illinois history.

While Pritzker is the only Democrat aiming for governor on the ballot, there is a slew of Republican candidates vying for a face-off with the incumbent in November.

Voters with their mind made up on which candidate they support can head to their local early voting site to cast their ballot before Election Day.

Though downtown sites and some across the suburbs have been open since early February, early voting sites will open in all 50 of Chicago’s and in several suburb on Monday, March 2.

For those still deciding how to mark their ballot, here’s a look at the gubernatorial candidates.

Democrats:

Governor J.B. Pritzker and Christian Mitchell

Current Governor of Illinois J.B. Pritzker is taking aim at a third term, promising to continue building on the work of his first two terms. According to his campaign website, some of his intentions for a third term include “[tackling] the affordability crisis,” continuing to protect access to reproductive health care in Illinois, and investing in education.

Chrisitan Mitchell is running alongside Pritzker for lieutenant governor. After representing the 26th District in the Illinois House of Representatives from 2013 to 2019, Mitchell served as deputy governor to Pritzker from 2019 to 2023. Mitchell led efforts to ban assault weapons, make Illinois a leader in clean energy and create jobs through infrastructure projects as deputy governor, according to his campaign bio.

Republicans:

Ted Dabrowski and Dr. Carrie Mendoza

Ted Dabrowski is a Wilmette resident and former president of Wirepoints, a media outlet focused on conservative economic policies and financial data. From 2011 to 2017, Dabrowski worked as a spokesperson and Vice President of Policy at the Illinois Policy Institute, a right-leaning think tank.

Dabrowski, who has never previously held political office, aims to cut and cap property tax rates, veto any and all tax increases, and repeal both Illinois’ sanctuary laws and zero-emissions energy policy, according to his campaign website.

“We must return power to the people, remove barriers to prosperity, embrace educational freedom, push political power down to its lowest level and restore the rule of law,” his campaign website says.

Dr. Carrie Mendoza, a Chicago-native with more than 25 years of experience as a physician, is running to be Dabrowski’s lieutenant governor, according to her campaign biography. Like Dabrowski, Mendoza has never held political office. Her campaign biography says she is “driven by innovation and a passion for justice.”

James Mendrick and Dr. Robert Renteria

The first Republican candidate to enter the race, DuPage County Sheriff James Mendrick is campaigning on a push for public safety initiatives.

Sheriff since 2018, Mendrick has partnered with DuPage County Health Department to provide Medicated Assisted Treatment to inmates fighting opioid addiction and advocated for the use of a drug deactivation pouch system to protect people and the state’s waterways from dangerous medications, according to his campaign website.

“He is committed to ending soft-on-crime policies, defending parental rights, and delivering quality education to every child in the state,” his campaign website says.

Dr. Roberta Renteria veteran of the U.S. Army and is a prolific author and activist, according to his campaign biography.

“Dr. Renteria uses his personal story, business acumen and leadership skills to address bullying, gangs, violence, drugs, suicides and school dropout,” his campaign biography says. His books and curriculums are taught in 25 countries around the world, and he has given many Ted Talks.

Darren Bailey and Aaron Del Mar

Former state senator Darren Bailey, who unsuccessfully ran for governor of Illinois in 2022, is giving another go at assuming the political seat. A third-generation downstate farmer, Bailey’s campaign is focused on reducing government spending, cutting taxes, and cracking down on crime, according to his campaign website.

In addition to his farm work, Bailey founded a private Christian school with his wife Cindy.

He fought against spending, raising taxes and sanctuary state policies while in the Illinois House and later in the State Senate.

Aaron Del Mar is an entrepreneur who became the youngest-ever Councilman for the Village of Palatine at 29 years old in 2016. He oversees public safety and infrastructure and guides community organizations in the position, according to his campaign biography.

Rick Heidner and Christina Neitzke-Troike

Though businessman Rick Heidner has never held office, he has led several notable companies, including Gold Rush Gaming, Ricky Rocket’s Fuel Centers, Prairie State Energy, and Heidner Properties, according to his campaign website.

A lifelong Illinoisian, Heidner is “running to make Illinois safe again, affordable again, and full of opportunity again,” his website says.

Christina Neitzke-Troike is looking to step up into the lieutenant governor seat from her current role as Mayor of Homer Glen after nearly two decades in several elected positions.

Neitzke-Troike hopes to bring her “unparalleled understanding of how state mandates affect local budgets, property taxes, and public services” to Springfield, according to her campaign biography.

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