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Temporary halt in copay requirements for individuals on state health plan without citizenship status


Sep 12, 2023

The state of Illinois has temporarily halted a new policy that requires certain noncitizens enrolled in a Medicaid-like health insurance plan to pay copayments for certain services. The Department of Healthcare and Family Services plans to reinstate the copay policy, but it currently lacks the systems to administer it properly. Omar Shaker, the interim chief of administrative rules, informed the Joint Committee on Administrative Rules about the programming issues during a legislative oversight committee meeting in Chicago. The state originally announced the copay requirement in June, stating it would take effect on July 1 for customers enrolled in the Health Benefits for Immigrant Adults program and the Health Benefits for Immigrant Seniors program.

The Health Benefits for Immigrant Adults and Health Benefits for Immigrant Seniors programs provide coverage similar to Medicaid for noncitizens over the age of 42 who would qualify for Medicaid if not for their immigration status. These programs are primarily funded by state dollars due to federal reimbursement limitations for this population. Initially estimated to cost $220 million for the current fiscal year, the programs’ enrollment growth caused cost estimates to surpass $1.1 billion. To control costs, the Pritzker administration introduced copays and enrollment caps through rule-making authority granted by legislation.

Under the rules that went into effect on July 1, enrollees were required to make copayments for inpatient hospital stays, emergency room visits, and outpatient ambulatory surgery. However, on September 5, the Department of Healthcare and Family Services advised providers to stop charging copays and refund any money collected. Shaker explained to the rules committee that the issue with charging copays for emergency room services arises from the federal government’s reimbursement for those services, which includes immigrants not lawfully present in the country. Until the state has a system in place that can fully function and draw in federal matching funds, they have suspended the copay requirement and instructed providers to repay any copays that were collected.

In addition to resolving programming issues, the Department of Healthcare and Family Services needs to reprogram its computer systems that manage reimbursements to accommodate the new copay requirements. They also need to publish official guidance for providers on when to charge copays and when not to. The agency has not yet established a timeline for reinstating copays, but they plan to issue provider notices and inform recipients of their responsibilities before implementation.

By Editor

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