Paused Copay Requirements for Non-Citizens on State Health Plan

SPRINGFIELD — The state has suspended a new policy that requires certain noncitizens enrolled in a Medicaid-like health insurance plan to pay copays for certain services, instructing health care providers to refund any payments they have already received.

Omar Shaker, acting chief of administrative rules for the Department of Health and Family Services, told a legislative oversight committee Tuesday that the department plans to reinstate the copay policy but does not yet have the systems in place to properly administer it. .

“I was recently informed that there were some scheduling issues regarding this,” he told the Joint Committee on Administrative Rules at its monthly meeting in Chicago.

The Department of Health and Family Services originally published a notice in June that customers enrolled in the Immigrant Adult Health Benefits program and the Immigrant Elderly Health Benefits program would be required to pay copays for certain services, starting July 1 .

These programs are intended for non-citizens over the age of 42 who would otherwise qualify for Medicaid if not for their immigration status.

These programs offer coverage similar to Medicaid. But unlike regular Medicaid, which is jointly funded with state and federal money, immigrant health care programs are funded almost entirely with state dollars due to federal reimbursement limitations for this population.

The state began covering immigrants ages 65 and older in 2021. The program was later expanded to include adults ages 42 to 64.

The programs were initially estimated to cost about $220 million for the current fiscal year, but due to rapid enrollment growth, cost estimates have risen to more than $1.1 billion. That led lawmakers to pass legislation giving the administration authority to set rules to control those costs, and the Pritzker administration responded by requiring copays and limiting enrollment.


The rules that took effect July 1 required enrollees to make a $250 copay for hospital stays, $100 for emergency room visits and 10% of the Medicaid reimbursement rate for outpatient outpatient surgeries.

But on Sept. 5, the Department of Health and Family Services published another notice advising providers to stop charging copays and to refund any money collected to date.

Shaker told the rules committee on Wednesday that there was a problem with charging copays for emergency room services because that is a service for which the federal government offers reimbursements, even to immigrants who are not legally present in the country.

“Until we had the ability to get the system fully functioning and functioning properly as it should, and to get as much federal matching as possible in these situations, we decided to suspend it and instruct providers that if there were any copays that were taken, that they needed to pay them back,” he said.

Department of Health and Family Services spokesperson Jamie Munks told Capitol News Illinois in a separate email that the agency also needs to reprogram its computer systems that manage reimbursements to meet the new copay requirements and needs to publish guidance officials telling providers when and when not to bill them.

Shaker said he could not estimate a timeline for reinstating copays.

“We don’t have the reimplementation process completely fleshed out yet,” he told the committee. “We are providing advance notice to providers with sufficient time, notifying them that on a specific date co-payments would restart, as well as notifying the actual recipients and letting them know what their responsibilities would be as well.”

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