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HFS cites programming issue for suspension of copays for undocumented individual healthcare program

13 Sep 2023 6:05 PM | Deborah Hodges (Administrator)

A “critical problem” related to receiving additional Medicaid matching dollars led to the recent decision to suspend copays in the program that provides Medicaid-like coverage to undocumented individuals, an official from the Department of Healthcare and Family Services said Tuesday. [Health News Illinois] 

Omar Shaker, an attorney for the department, told members of the Joint Committee on Administrative Rules that the existing system did not allow them to receive matching federal dollars when a non-citizen requires an emergency room visit.

He said the department chose to suspend the copay rule until it can “draw in as much federal matching as possible in these situations.”

HFS sent a notice last week to providers saying they should not charge cost-sharing for the population “until further notice.” Any cost-sharing that providers may have already collected must be returned.

Shaker told lawmakers he could not pinpoint when it was decided to suspend the rule, but added conversations began about two weeks ago on whether the department could implement the match into their system without the need for a suspension.

He added there is no timeline for when copays may be reinstated, nor is there an estimate for how much could be recouped through the federal match.

 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.


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