Illinois health advocates say changes to state’s program for immigrant adults and seniors will impact access to care


Boram Kim


Immigrant health advocates in Illinois have been critical of the state’s recent changes to the Health Benefits for Immigrant Adults (HBIA) and Seniors (HBIS) programs. 


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Illinois became the first state to ensure healthcare access for undocumented immigrants shut out of Medicaid and Medicare programs when the Healthy Illinois Campaign successfully pushed for the passage of legislation in 2020 that created HBIS, establishing healthcare coverage for low-income Illinois seniors ages 65 and over, regardless of immigration status. 

Coverage expanded to adults aged 42 and older through the creation of HBIA in 2022. A campaign to expand age eligibility to the program to 19 years and older failed during this year’s legislative session over concerns the HBIA program had grown too quickly and become too costly. 

Since their creation, HBIA and HBIS have both offered Medicaid-like health insurance with $0 premiums and $0 co-payments, covering primary and hospital care, dental and vision services, prescription drugs, lab tests, rehabilitative services, and mental health and substance use disorder services.

In July, the Illinois Department of Health and Family Services (HFS) initiated co-pays for inpatient hospitalization ($250) and emergency rooms visits ($100), co-insurance (10%) for hospital outpatient services, a reduction in hospital reimbursements, and an enrollment pause for new members to the HBIA program. 

The Illinois Coalition for Immigrant and Refugee Rights (ICIRR), which helped push for the passage of these programs, told State of Reform this week the HFS decision is impacting access to the basic human right of healthcare. 

“The changes to HBIA and HBIS have already prevented many community members from accessing this essential care. ICIRR members across Illinois saw great interest in the programs in their communities before the enrollment freeze, and have heard after the emergency rules went into effect from many community members who were unable to enroll or who are concerned about new copay requirements.”

— Luvia Quiñones, ICIRR’s senior director of health policy

The Healthy Illinois Campaign strongly condemned the decision in June and called on Gov. JB Pritzker to reverse the changes and reopen enrollment immediately. 

HFS released estimates in April that enrollment in the HBIA program, based on its growth trajectory so far, would cost $1.1 billion. The enrollment pause will be in effect until HFS can ensure the program does not exceed the $500 million in general funds available and appropriated for fiscal year 2024.  

Prior to determining cost-containment actions, HFS sought to maximize available funds for these programs by utilizing the following to enhance revenues:

  • Pursuing methodology to maximize federal reimbursement for emergency medical expenses.
  • Pursuing supplemental prescription drug rebates for the covered noncitizen population.
  • Transitioning HBIA and HBIS program enrollees to the Medicaid Managed Care program starting Jan. 1st, 2024, which will generate additional dollars to fund the programs through collected taxes HFS collects from the Medicaid Managed Care Organizations.
  • Addressing current overpayments to the Cook County Hospital System.

ICIRR and its member organizations have been making a concerted effort to ensure that those currently enrolled in state Medicaid programs, including HBIA and HBIS, are able to maintain healthcare coverage during the redetermination process.

Quiñones says community members who do not have healthcare coverage can still seek care from federally qualified health centers, free and charitable clinics, and emergency rooms if necessary. 

“We are continuing to organize our members and work with other stakeholders to find a solution that allows those currently enrolled in HBIA and HBIS to keep their coverage, and for the HBIA program to reopen to as many people as possible as soon as possible. In the long term, we are advocating for revenue solutions that will ensure universal access to healthcare for all Illinoisans, no matter their immigration status.”

— Quiñones