Stakeholders criticize Pritzker administration’s proposed changes to Medicaid-like program for undocumented individuals

Proposed changes by Gov. JB Pritzker’s administration to a program offering Medicaid-like coverage for undocumented individuals, including an enrollment pause starting next month for those who aren’t seniors, caught advocates off guard, according to speakers at a Health News Illinois panel Wednesday.

The Department of Healthcare and Family Services released proposed rules earlier this month to address rising costs for the program, which typically offers coverage to those 42 years and older who do not qualify for other medical assistance and have an income at or below 138 percent of the federal poverty level.

“We’ve had 14 days basically to scramble and let community members know what these will mean and try to assess them ourselves,” said Healthy Illinois Campaign Director Tovia Siegel. “People are really, really scared.”

The new changes include a pause on new enrollees between the age of 42 and 64 on July 1. Seniors can still join, unless their enrollment reaches 16,500. The rules also include copays for hospital services not eligible for a federal match, such as $250 for inpatient hospitalizations and $100 for emergency room visits.

Immigrant advocates, as well as members of the Illinois Legislative Latino Caucus, have criticized the proposals, saying they will limit healthcare access for thousands.

“These changes have been framed as sort of fiscally necessary, the responsible thing for the state to do,” Siegel said. “And while I understand the necessity of fiscal responsibility with our state budget, this would be unthinkable with another population.”

Pritzker defended the rules earlier this week as necessary cost-cutting measures that will allow the state to remain fiscally responsible. HFS officials estimated the program will cost the state $1.1 billion, though advocates have pushed back on those figures.

“We’ve called into question those numbers. We continue to call into question those numbers,” said Rep. Dagmara Avelar, D-Bolingbrook.

The recently signed budget package allocates $550 million for the program — more than $300 million over the initial budget proposal.

The administration has said enrollment will reopen “as soon as fiscally possible.”

Panelists said barriers remain, including upcoming Medicaid redeterminations in the year ahead, a continuous workforce shortage and an ongoing healthcare worker burnout crisis.

“The reason we’re here at this moment is because the program was wildly successful,” said Cook County Health CEO Israel Rocha Jr. “I want to make sure that there’s not a message lost in translation that by having so many people enrolled something bad happened. It’s a good thing.”