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HFS delays copays for Medicaid-like program for undocumented individuals

6 Sep 2023 9:58 AM | Deborah Hodges (Administrator)

The Department of Healthcare and Family Services said Tuesday it will delay implementation of copays for healthcare services provided to those in the state program that provides Medicaid-like coverage for undocumented individuals. [Health News Illinois] 

Medicaid Administrator Kelly Cunningham said in a notice that providers should not charge cost-sharing for the population “until further notice.” Any cost-sharing that providers may have already collected must be returned.

“HFS will issue a provider notice with implementation guidance when the necessary provider reimbursement programming is in place,” she said.

The department did not return a request for additional comment.

The rules, unveiled earlier this summer, include a pause on new enrollees between 42 and 64 and copays for hospital services not eligible for a federal match. Seniors can still join the program until their enrollment reaches 16,500, a threshold that officials recently said has yet to be reached.

Tovia Seigel, director of the Healthy Illinois Campaign, said in a statement they are relieved by Tuesday’s decision as copays significantly burden individuals seeking care.

“We stand ready to work with (the department) to find fiscally responsible ways to make this delay a permanent policy and protect the … programs that thousands of immigrants rely on for critically important healthcare services,” she said.

HFS’ announcement comes as advocates for the program renewed their call for the Pritzker administration to reverse its decision to place restrictions on the program.

Nadeen Israel, senior vice president of policy and advocacy at AIDS Foundation Chicago, said at a public hearing that they understand the state faces financial challenges, but ensuring access to healthcare services is a necessity for the undocumented population.

“Investing in this care now will help save the state money in the long run,” she said, noting her organization is also part of the Healthy Illinois Campaign that has advocated for the expansion of the program. “We are ready to work with you to calculate and identify those cost savings.”

Advocates said Tuesday that the copays for hospital services not eligible for a federal match, such as $250 for inpatient hospitalizations and $100 for emergency room visits, could drive immigrants away from receiving healthcare.

“Therefore, immigrants will be less likely to even seek preventive care, which ultimately drives up the cost of emergency room visits,” said Edith Avila Olea, policy manager at the Illinois Coalition for Immigrant and Refugee Rights.

Additionally, she said several questions remain unanswered, such as whether enrollment will reopen after the planned transfer of members to Medicaid managed care occurs next year.

Others remain concerned that the agency has yet to provide a customer notice for individuals enrolled in the program as well as a provider notice to better clarify the copay process, specifically to aid individuals for whom English may not be a first language.

Andrea Kovach, an attorney at the Shriver Center for Poverty Law, said the current language does not ensure enrollees are informed if they will incur cost-sharing before receiving services, nor which services will be covered.

If the department will not pull the language related to cost-sharing, Kovach suggested they amend it to include an annual cap on the amount incurred by an enrollee.

 HFS Chief of Staff Ben Winick said the goal of Tuesday’s hearing is to take public feedback before the filing of a second notice of the rules to the Joint Committee on Administrative Rules.


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