What to Know About Illinois’s Pause on Health Insurance Programs for Undocumented Immigrants

BY JADE-RUYU YAN

People in Chicago have demonstrated in recent weeks after Governor J.B. Pritzker’s decision to limit enrollment to two state-funded health insurance programs—some of the only health insurance options for lowincome undocumented people in Illinois.

“There are people who may forgo cancer treatment, diabetes care, mental health care, and countless other kinds of necessary medical treatment because of the cost,” said Tovia Siegel, director of the Healthy Illinois Campaign, which aims to create state-wide equitable healthcare, in an email to the Weekly.

“These policy changes will have real world devastating effects on families who have lived, worked, and paid taxes in Illinois for many years.”

The health insurance plans, Health Benefits for Immigrant Adults (HBIA) and Health Benefits for Immigrant Seniors (HBIS), which are Medicaidstyle programs created in 2020, cater to people who are low-income, and who are undocumented or who have green cards but haven’t completed the five-year waiting period. Those eligible include people aged forty-two to sixty-four, and sixty-five and above, respectively.

The program for adults, HBIA, stopped taking applications as of July 1, while the program for seniors, HBIS, will also stop enrollments when it reaches 16,500 people, according to this change. There were 63,255 residents enrolled in both programs as of June 7, according to the Illinois Answers Project.

The move was framed as a temporary “pause” to enrollments in an announcement on June 16 by Illinois’ Department of Healthcare and Family Services (HFS). As of this article’s publication, it has not been made clear when this “pause” will be lifted.

Why did this happen?

The pause on these programs has been identified as a compromise by Pritzker in order to finalize Illinois’ budget.

According to Pritzker’s administration, the program was more costly than expected. Although it was estimated that the first year would cost $2 million, it was actually closer to $50 million, Pritzker spokesperson Jordan Abudayyeh told the Illinois Answers Project.

The decision drew backlash from healthcare organizers and Latinx lawmakers such as U.S. Rep. Delia Ramirez, who called the argument that the program is too expensive a “pretense” and said that the “alleged costs of the program are in question” in a statement.

“A lot of Americans (don’t) understand that having uninsured people is bad for all of us,” said Mark Kuczewski, professor of medical ethics at the Loyola University School of Medicine who has focused on health equity for immigrant patients.

Although it can be “difficult to run a health insurance program strictly at the state level… the fact is that we can’t really save money for Illinoisans by not doing it,” he said. “This is one of the things that I think a lot of people don’t understand: [people who are insured] pay for the uninsured, whether it’s through taxes" or an increase in premiums, he said. There is "a cost shifting all the time for the uninsured.”

When people who are uninsured come in for emergency care–“when they're really sick, because they don't come in a minute sooner than that: they don't want to come if they're uninsured,” said Kuczewski–hospitals “pass that along to the people who come with paid policies.”

But “that’s kind of hidden” whereas “state budget is transparent,” so it seems like we’re saving money even though we’re not, he said.

Illinois is one of few states to have had this type of state-funded health insurance for undocumented immigrants. California extended its state-funded Medicaid in 2020 to cover young adults and later expanded it to cover adults aged fifty and older, while Oregon similarly provided state-funded insurance with its “Cover All People” act in 2021, according to the Kaiser Family Foundation.

If I’m not enrolled in these programs, how will I be affected?

The program for adults, HBIA, is now closed to enrollment without a date as to when it will reopen. The program for seniors, HBIS, is technically open but will close when it reaches the 16,500 cap. People over sixty-five who are eligible for HBIS should “apply right away,” said Andrea Kovach, senior healthcare attorney with the Shriver Center on Poverty Law. “Even if you are unsure whether you’re eligible, just get that application in.” As of June 26, there were already nearly 15,000 people enrolled in HBIS, according to the Illinois Answers Project.

People can find instructions to apply for both programs here and here (for brochures in English or other languages, go here and here.) There are also organizations that help people apply for programs in several languages, including Spanish here: https://widget. getcoveredamerica.org/.

If I’m already enrolled for one of these plans, how will I be affected?

People already enrolled in both programs will continue to be covered, according to HFS, but they will incur new costs if they have services that are not deemed eligible to be reimbursed by the federal government.

Costs would include a $250 copay for inpatient hospitalization and a $100 copay for emergency room visits.

“In order to be eligible for these two programs (to begin with), you have to be very very low income,” said Kovach, so “a $100 copay or a $250 copay could be a significant portion of your monthly income. These copayments are exceptionally high.”

It’s also often “very unclear” to the patient going into treatment whether the services are federally reimbursable, she said.

There is also a ten percent coinsurance—which is the percentage of costs that patients will still have to continue pay themselves, even after they’ve met their deductible —for hospital outpatient services or ambulatory surgery centers. The deductible is a fixed amount they have to pay initially before their insurance will begin to pay anything.

If you’re confused about when you’ll need to pay the copay or coinsurance, it’s because it’s confusing. People will have to “navigate a world of uncertainty” because it’s unclear which services will incur these costs, said Kovach, specifically because it’s unclear what is considered reimbursable by the federal government.

As of July 5, HSF hadn’t informed healthcare providers what would be considered federally reimbursable services, said Kovach. “Until we see such a notice, we are also unable to provide information to enrollment assisters and others who work with immigrants enrolled in HBIA and HBIS,” she said.

It’s also unclear whether hospitals will charge the copay to begin with, because they have the choice to take on the cost themself—“but they don’t have to,” said Kovach.

What does the future of this program look like?

For impacted people who are wondering what their options are in the short-term: although you’re not eligible for federal programs such as Medicaid or the Affordable Care Act (ACA) marketplace if you’re undocumented, there are still federally qualified health centers, free clinics and community health centers that you can turn to, according to Siegel.

You can also qualify for financial assistance programs from hospitals such as CareLink (you can find information by scrolling down on this webpage: https://cookcountyhealth.org/patientsvisitors/billing-insurance/), which is Cook County Health system’s financial aid program, or Emergency Medicaid for some emergency medical services that qualify, she said.

And some people—including those who have had their green card for less than five years, those who are on temporary protected status or those who were granted parole for less than one year—are eligible for the ACA marketplace. If you’re in one of those groups, you can sign up for those plans starting November 1 this year, although check that you don’t qualify for a special enrollment period that would let you sign up sooner, said Siegel.

And in the long term, “I would be very surprised if this program doesn’t continue its march forward over time,” said Kuczewski. “It may be in fits and starts for a little while [and] there may be a need to find new revenue source for it” but “I’d be surprised if regressive politics does this in in the long run,” he said.

What can I do in the meantime?

“It’s important to call attention to the issue and pressure (politicians) to call attention to these kinds of programs,” said Kuczewski, referencing the work that Latinx politicians and immigrant rights advocacy organizations have done in recent weeks to protest the change.

While “we don’t want to suddenly say our politicians are evil—they’re talking about a pause—we want to make sure it’s just a pause,” he said.

Siegel urged people to contact Pritzker’s office as well as state legislators. You can find contact information on government websites by Googling “contact state legislators” or “contact Illinois governor” and “tell them to rescind these policy changes.”

People can also get involved with one of the organizations under the Healthy Illinois campaign and join efforts to advocate against the change, she said, and if you are among those who are affected by the change, you can contact Healthy Illinois to share stories of how they and their family are being impacted.

Kovach also advised that applicants stay connected with organizations such as the Immigrant Family Resource programs and Illinois Welcoming Centers that serve people who are immigrants. ¬

Jade-Ruyu Yan reports on how your access to healthcare is affected by business and politics.