Political divisions over healthcare spending on undocumented population delayed passage of $50.6 billion Illinois state budget


Boram Kim


The political impasse over the proposed state budget ended Monday with the Illinois House of Representatives passing a $50.6 billion balanced state budget for FY 2024 along a strict 73-38 party-line vote.


Stay one step ahead. Join our email list for the latest news.



The total budget including both federal and state funds amounts to $118.9 billion with increased spending in areas of education, healthcare, and human services. 

The Departments of Healthcare and Family Services (HFS) and Human Services (DHS) combined consume more than 40% of the total budget, with allocations of $37.2 billion ($9 billion in general funds) and $13.4 billion ($6.3 billion in general funds), respectively. 

Meanwhile, the Departments of Public Health, Insurance, and Aging will receive $560 million, $87.3 million, and $1.5 billion in general and other state funds, respectively. 

“My thanks to Speaker Welch, Leader Jehan Gordon-Booth, and all the members of the House who voted today to advance our fifth balanced budget,” Gov. JB Pritzker said in a statement after the House vote.

“This budget reaffirms our shared commitment to fiscal responsibility while making transformative investments in the children and families of Illinois that will be felt for years to come. I look forward to signing this budget making childcare and education more accessible, healthcare more affordable, and our state’s business and economic position even stronger.”

General fund investments in health and human services include $22.8 million for the new Children’s Behavioral Health Transformation Initiative, $10 million for the childcare assistance program expansion, $18 million for reproductive health initiatives, and $85 million in additional funding for homelessness prevention

DHS will expand Home Illinois, its two-year, $350 million homeless initiative that provides support for homelessness prevention, permanent and affordable housing, and social services for the housing insecure. Investments will go into infrastructure projects, community-based services, and safety net systems. 

Meanwhile, the Division of Early Childhood Education will expand Smart Start Illinois, which will invest $250 million in preschool programs aimed at improving the educational workforce, access, and outcomes for early childhood development. 

The budget also includes increases of $500 million to support the overall healthcare system, $240 million to support developmental disability services, and $24 million to boost reimbursement rates for nursing home workers. 

Disagreements on the budget led to delays in its passage, with the final vote coming three days past the legislative session’s scheduled end date. 

HFS released estimates in April that enrollment in the Health Benefits for Immigrant Adults (HBIA) program would grow by 94% in FY 2024, adjusting its appropriation from $220 million to $1.1 billion. That projection, coupled with lower-than-projected state revenue estimates for the current fiscal year, had Republican lawmakers calling for an end to the program. 

Yet the approved budget maintains HBIA with an allocation of $500 million in general funds, $600 million short of cost projections for the program.

In an interview with State of Reform, Sen. Dave Syverson (R – Cherry Valley), minority spokesperson on the Senate Health and Human Services Committee, said that supporting the program meant less money in healthcare and social services for US citizens in Illinois.

“Illinois is the only state in the only country that covers any undocumented [individual] coming in [with] full medical coverage,” Syverson said. “California covers undocumented [individuals], but they only [provide coverage] for limited services. You have to go through federally qualified health clinics. They only cover generic drugs and mainly wellness-type benefits. So, that’s not an issue.

New York covers undocumented, but they only cover those over 65. So if you’re talking about covering people under 65, Illinois is the only state. So where would a person that had a significant health issue go? They’re coming to Illinois.”

The senator said because of the US open border policy, the federal government should be paying for HBIA, not Illinois taxpayers. He anticipates the burden of that half-a-billion-dollar gap in funding will fall on hospitals to absorb, which will raise costs for everyone. 

Syverson has received reports of hospitals being unable to discharge older undocumented patients because there is either no one to care for them at home or no home for them to return to. Instead, hospitals are resigned to utilizing their bed capacity to accommodate extended stays for these individuals. 

Along with these ancillary costs, Syverson said that the program fails to account for uncompensated care being delivered to non-citizens between the ages of 19 and 41 who are ineligible for coverage.

“Hospitals and doctors aren’t getting paid for them at all—it’s uncompensated care that the hospitals are losing money on,” Syverson said. “Then they have to pass that on to policy [holders]—private insurance has to pay more to make up for it … [The cost is] a huge problem, eating up the budget and growing at astronomical numbers.”

Two measures, House Bill 1570 and Senate Bill 122, proposed expanding HBIA to cover all low-income undocumented adults 19 years and older but failed to pass. State estimates put the cost of initiating the coverage expansion at $380 million in its first year. 

Bill advocates argued the majority of working undocumented adults are paying state taxes and that denying access to healthcare for these individuals raises the risk of this population developing advanced and chronic diseases, which would cost the state more in the long run to address. 

DHS received an appropriation of $38 million in FY 2024 to invest in immigrant integration services that support non-citizens with gaining legal residency, employment, and citizenship. In its report to the legislature in April, DHS recommended the state collect further data on the immigrant population, build capacity within state agencies for immigrants to serve, and advocate to expedite federal authorization of work visas to fill employment gaps. 

The Illinois Immigrant Impact Task Force reported that the state’s undocumented immigrant population has been falling over the past decade, estimated to currently stand at 400,000 individuals.