HFS Announces Next Steps for Health Benefits for Immigrant Adults and Seniors Programs

SPRINGFIELD - Utilizing the authority granted to the Department of Healthcare and Family Services (HFS) by Senate Bill 1298, recently passed by the General Assembly and signed into law by the Governor, the Department has filed emergency and regular rules for the Health Benefits for Immigrant Adults (HBIA) and Health Benefits for Immigrant Seniors (HBIS) programs.

These new rules establish the process the Department will use to determine if and when to alter the program, and how the Department will provide public notification of the alterations.

In passing the FY24 State budget and Senate Bill 1298, the General Assembly directed the Department to ensure the HBIA and HBIS programs do not exceed the funds available and appropriated by the General Assembly for FY24. To do this, HFS will follow the process laid out in the emergency rules to temporarily pause new enrollments in the Health Benefits for Immigrant Adults program, covering eligible residents between the ages of 42 to 64, beginning July 1. This pause does not impact current HBIA enrollees who remain eligible for healthcare coverage through the program.

At this time, enrollment in the Health Benefits for Immigrant Seniors program will remain open. However, HBIS enrollment will be temporarily paused for FY24 if the number of individuals enrolled in the program reaches 16,500.

Anyone who is already enrolled in and remains eligible for coverage through the HBIA and HBIS programs will continue to be covered. The Department will not be removing any current enrollees who remain eligible for this coverage, and hopes to resume new enrollments as soon as fiscally possible.

The enrollment changes are necessary to bring program costs within the budgeted amount for State Fiscal Year 2024, which begins July 1. Compared with the traditional Medicaid population, month-over-month enrollment has grown at a higher rate, and per-enrollee costs have tracked higher among the HBIA and HBIS-enrolled populations due to more prevalent, untreated chronic conditions and higher hospital costs.

HFS understands that this program is a vital resource for individuals who would otherwise be eligible for Medicaid but for their immigration status. The Department understands the importance of preserving this nation-leading program for the future.

In addition to program enrollment changes, HFS will implement several other changes to limit program costs, including putting in place co-pays for HBIA and HBIS enrollees for hospital services when they are not eligible for federal match:

• Inpatient hospitalization, $250 co-pay;

• Hospital emergency room visits, $100 co-pay;

• Hospital or Ambulatory Surgical Treatment Center outpatient services, 10% co-insurance.

Prior to determining cost-containment actions, HFS sought to maximize available funds for these programs, and will utilize 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 January 1, 2024, which will generate additional dollars to fund the programs through taxes the Department collects from the Medicaid Managed Care Organizations.

• Addressing current overpayments to the Cook County Hospital System.