Illinois Lawmakers Criticize Pritzker Administrations Over Handling Limits on Health Care for Non-Citizens

Health Care Programs For Non-Citizens

Members of a state watchdog committee on Tuesday expressed concern that Governor JB Pritzkers’ administration did not seek enough government support on its plan to limit enrollment in Medicaid-like health care programs for non-citizens.

The controversy centers on the Health Benefits for Immigrant Adults and Health Benefits for Immigrant Seniors programs, which provide health benefits to low-income noncitizens who would qualify for Medicaid benefits if not for their citizenship status.

During budget negotiations in May, lawmakers gave the Pritzker administration the authority to limit program spending through emergency regulation, and his administration exercised that authority in late June.

Emergency Rules Froze Enrollment in HBIA

Those emergency rules froze enrollment in HBIA, which serves non-citizens ages 42 to 64, and capped enrollees in HBIS, which offers benefits to non-citizens 65 and older. The changes also reduce reimbursement rates for two large public hospitals, institute co-payments and co-insurance for some services, and transfer some enrollees to the state’s Medicaid managed care program in an effort to reduce costs.

• The Joint Committee on Administrative Rules Tuesday heard from representatives from the states’ Departments of Health and Family Services, who defended the rules.
• The rules are designed, according to IDHFS officials, to limit the costs of the program, which they say would be underfunded by hundreds of millions of dollars without the changes.
• We have projected liabilities of about $1.2 billion for the program if no changes are made, IDHFS chief of staff Ben Winick said at the JCAR meeting in Chicago on Tuesday.
• He noted that the General Assembly has earmarked $550 million giving the administration the authority to limit costs.

Emergency and Permanent Administrative Rule Changes

The Pritzker administration has proposed both emergency and permanent administrative rule changes. While emergency rules are generally valid for 150 days, the law that authorizes the administration to limit course enrollments also allows it to re-archive emergency rules once they expire. That means that unless JCAR votes by a three-fifths majority to suspend the rules, they would remain in effect as long as the department wants them to, at least for the next two years.

The JCAR, which is made up of six Democrats and six Republicans and is responsible for overseeing policymaking within the state’s executive branch, did not act on either the emergency or permanent rules on Tuesday, though the committee may still act at a future meeting.

Both Democratic and Republican members shared concerns with IDHFS officials who primarily focused on the process by which the rules were developed.

State Senator Cristina Castro, D-Elgin, and a member of the Illinois Latin Legislative Caucus, said the department failed to consult stakeholders in the immigrant advocacy community when developing the rules.

You quickly archived both the emergency rule and the permanent rule. Of course there were no discussions with supporters about either, apparently, Castro told IDHFS officials.

Engage Stakeholders and Advocacy Groups

State Representative Eva-Dina Delgado, D-Chicago, also said she wants to see immediate action to engage stakeholders and advocacy groups before moving forward with the process of implementing the departments’ proposed permanent rules. She specifically criticized the department’s plan to issue 14-day notice before freezing HBIS enrollment.

I would like you all to engage with those affected because I don’t know if it will be feasible, Delgado said. If you change someone’s healthcare every two weeks and expect them to follow up on you, even if they have good language skills, I think you are just asking for trouble.

State Representative Steven Reick R-Woodstock said

On the Republican side, State Representative Steven Reick R-Woodstock said the rules represent an abdication of General Assembly accountability and should have been considered in legislation, not administrative policy.

This is another example of a governor thinking he can legislate on his own, Reick said. Before he did it with 47 declarations of disaster and now he does it with the state of emergency.

Stakeholder Engagement From Several Agencies

State Senator Bill Cunningham, D-Chicago, co-chair of JCAR, said the committee was frustrated with the lack of stakeholder engagement from several agencies. JCAR also discussed a controversial change to emissions rules for heavy industries on Tuesday, opposing the rushed implementation process by two state agencies.

I think you heard during this meeting a frustration from committee members about the lack of engagement between agencies and various stakeholders and that was true across the board, he said in an interview after the hearing.

Cunningham said the committee will likely have another discussion on health rules next month. I hope they will act in good faith to work more closely with stakeholder groups, Cunningham said.

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