Copay requirements for noncitizens enrolled in state health plans are suspended.

SPRINGFIELD — The state is suspending a new policy that requires some noncitizens enrolled in health insurance plans like Medicaid to pay out-of-pocket costs for certain services, forcing health care providers to They were instructed to refund the collected payments.

Omar Shaker, interim director of administrative regulations for the Department of Health and Family Services, told the Legislative Oversight Committee on Tuesday that the department plans to eventually reinstate the copay system, but does not have a system in place to properly manage it. He said it’s not ready yet. .

“We were recently made aware that there was a programming issue with this,” he said at the monthly meeting of the Joint Committee on Administrative Regulations in Chicago.

The Department of Health and Family Services initially announced in June that customers enrolled in the Immigrant Adult Health Benefits Program and Immigrant Elderly Health Benefits Program would be required to pay copays for certain services starting July 1. announced a notice.

These programs are aimed at noncitizens age 42 and older who would otherwise be eligible for Medicaid without immigration status.

These programs provide coverage similar to Medicaid. But unlike regular Medicaid, which is jointly funded by state and federal funds, the immigrant health care program is almost entirely state-funded due to federal reimbursement limits for its population.

The state first began targeting immigrants age 65 and older in 2021, but the program has since expanded to include adults ages 42 to 64.

The cost of this year’s program was originally estimated to be about $220 million, but rapid enrollment growth caused the cost estimate to jump to more than $1.1 billion. That prompted lawmakers to pass legislation giving the government rule-making authority to control these costs, and the Pritzker administration responded with co-pay mandates and caps on enrollment.


Under the rules that went into effect July 1, enrollees will pay a $250 copay for hospitalizations, a $100 copay for emergency department visits, and 10% of Medicaid reimbursement rates for outpatient outpatient surgeries. It was mandatory.

But on Sept. 5, the Department of Health and Family Services released another notice advising providers to stop charging co-pays and refund any money they’ve collected so far.

Shaker told the Rules Committee on Wednesday that emergency room services are one of the services that the federal government reimburses even for immigrants who are not legally in the country. He said there was a problem with charging a co-payment.

“Until the system is completely up and running, working properly, and allowing us to extract as much of the federal match as possible in these circumstances, we will suspend it and ask providers, if they have to pay out-of-pocket, “We decided that if there was an amount, we would direct it. We thought they would have to repay it,” he said.

Department of Health and Family Services spokesperson Jamie Manx told the Illinois Capitol in a separate email that the agency must reprogram the computer system that manages reimbursement to accommodate the new copay requirements. He said official guidance should be issued to health care providers telling them when to do so and when not to do so. to charge them.

Shaker said he could not estimate a timeline for resetting copays.

“The re-implementation process has not yet been fully fleshed out,” he told the committee. “We expect providers to notify in plenty of time that copays will resume on a specific date. We also notify actual recipients and advise them of their responsibilities.” I intend on doing it.”

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