Copay requirements paused for noncitizens on state health plan

Copay requirements paused for noncitizens on state health plan

By PETER HANCOCK
Capitol News Illinois
phancock@capitolnewsillinois.com

SPRINGFIELD – The state has paused a new policy requiring certain noncitizens enrolled in a Medicaid-like health insurance plan to pay copayments for certain services, instructing health care providers to refund any such payments they have already collected.

Omar Shaker, the interim chief of administrative rules at the Department of Healthcare and Family Services, told a legislative oversight committee Tuesday that the department ultimately plans to reinstate the copay policy, but it doesn’t yet have the systems in place to properly administer it.

“I was informed recently that there were some programming issues with regards to that,” he told the Joint Committee on Administrative Rules, or JCAR, at its monthly meeting in Chicago.

IDHFS originally published notice in June that customers enrolled in the Health Benefits for Immigrant Adults program and the Health Benefits for Immigrant Seniors program would be required to pay co-pays for certain services, effective July 1.

Those programs are for noncitizens over age 42 who would otherwise qualify for Medicaid if not for their immigration status.

Those programs offer coverage similar to Medicaid. But unlike regular Medicaid, which is jointly funded with state and federal money, the immigrant health care programs are funded almost entirely with state dollars due to federal reimbursement limitations for that population.

The state first began covering immigrant seniors aged 65 and over in 2021. The program was later expanded to include adults aged 42-64.

The programs were originally estimated to cost about $220 million for the current fiscal year but because of rapid growth in enrollment, cost estimates soared to more than $1.1 billion. That prompted lawmakers to pass legislation giving the administration rulemaking authority to control those costs, and the Pritzker administration responded by requiring copays and capping enrollment.

The rules that went into effect July 1 required enrollees to make a $250 copay for inpatient hospital stays, $100 for emergency room visits and 10 percent of the Medicaid reimbursement rate for outpatient ambulatory surgery.

But on Sept. 5, IDHFS published another notice advising providers to stop charging copays and to refund any money collected so far.

Shaker told JCAR Wednesday that there was a problem with charging copays for emergency room services because that is one service for which the federal government does offer reimbursements, even for immigrants not lawfully present in the country.

“Until we had the ability to completely have the system work and function appropriately as it should, and to draw in as much federal matching as possible in these situations, we decided to suspend it and instruct the providers that if there were any copays that were taken, that they needed to repay them,” he said.

IDHFS spokesperson Jamie Munks told Capitol News Illinois in a separate email that the agency also needs to reprogram its computer systems that manage reimbursements to account for the new copay requirements and it needs to publish official guidance telling providers when and when not to charge them.

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

“We don’t have the reimplementation process completely fleshed out yet,” he told the committee. “We are anticipating a provider notice with sufficient time notifying them that on a specific date the copays would reinitiate as well as we would be notifying the actual recipients and advising them what their responsibilities would be as well.”

 

Capitol News Illinois is a nonprofit, nonpartisan news service covering state government. It is distributed to hundreds of print and broadcast outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation, along with major contributions from the Illinois Broadcasters Foundation and Southern Illinois Editorial Association. 

 

Leave a Comment





Local News

Darth Vader and some friends were in attendance at the annual Fan Fest. (Supplied photos)

Oak Lawn Library draws a crowd with Fan Fest

Spread the love

Spread the loveBy Kelly White Comic book lovers gathered together in one common space earlier this month. Oak Lawn Public Library hosted its eighth annual Fan Fest, an all-ages celebration of pop culture, on May 11 at the library, 9427 S. Raymond Avenue. “It’s wonderful to see the community come together in celebration of shared…

Palos Heights wants to chop down this tree, remove the greenspace and pave it over. (Photo by Nuha Abdessalam)

Navajo Hills residents want to save threatened cul-de-sacs

Spread the love

Spread the loveBy Nuha Abdessalam Navajo Hills greenspace islands could be getting the ax and residents are upset. Residents of the East and West Courts of Navajo Hills, aware of the historical significance of the greenspace, spoke up during the Palos Heights City Council meeting May 21. There are five cul-de-sacs in the Navajo Hills…

regional ph summer concerts 2024

Summer concerts coming to Palos Heights

Spread the love

Spread the loveBy Nuha Abdessalam At the May 21 City Council meeting, Ald. Jeff Key shared exciting news about some of the summer activities coming to Palos Heights in the coming months. Key said the Concerts in the Park, a series of family-friendly events featuring live music, food vendors, and fun activities for all ages,…

Orland Park Mayor Keith Pekau speaks during the May 16 State of the Village Address. (Photo by Jeff Vorva)

Nerds and bullies among topics of Orland’s State of the Village

Spread the love

Spread the loveBy Jeff Vorva The 2024 Orland Park State of the Village Address was held at the Orland Park Civic Center, but it could have been held on a playground with talk of nerds and bullies and cool kids. Mayor Keith Pekau spent the first half hour “ripping off the Band Aid” of some…

Marist won the Marist Sectional and will play Payton on Friday, May 31 in the state quarterfinals. Photo by Xavier Sanchez

Boys Volleyball | Marist tops Jones, advances to state quarterfinals

Spread the love

Spread the loveBy Xavier Sanchez Correspondent For the first time since 2019, Marist will play in the IHSA state finals. The RedHawks (36-2) beat Jones, 25-13, 25-13, for their 17th straight victory and a Marist Sectional championship on May 28 in Mount Greenwood. They will face Payton in the state quarterfinals at 11:30 a.m. Friday,…

CRR_NH

Clear-Ridge Reporter and NewsHound May 29, 2024

Spread the love

Spread the love

Peggy Zabicki

Little things make a big difference in West Lawn

Spread the love

Spread the love. By Peggy Zabicki Your correspondent in West Lawn 3633 W. 60th Place •  (773) 504-9327 . Thank you to all who make a positive difference in West Lawn. There are some who are putting enormous efforts into making our neighborhood better and safer. We often hear about these good people and all…

Kathy Headley

Daina Cyvas again pedals with a purpose

Spread the love

Spread the love. Kathy Headley Your correspondent in Chicago Lawn and Marquette Manor 6610 S. Francisco • (773) 776-7778 . As I’m sure you remember, in past years, Daina Cyvas, the Communications and Project Coordinator for the Sisters of St. Casimir, has participated in Bike MS. in honor of one of her heroes, SSC Sister…

Vintage cars will again be rolling in the La Grange Pet Parade. The 78th edition of the parade starts at 9:30 a.m. June 1. (Photo by Steve Metsch)

Folks urged to enter costume contest for La Grange Pet Parade

Spread the love

Spread the loveBy Steve Metsch About 40,000 people are expected along the streets of downtown La Grange on Saturday morning June 1, with some of them dressing in costumes for the 78th annual La Grange Pet Parade. A costume contest has long been part of the parade, Molly Price, the parade’s executive director, said on…

Deputy Supt. of Public Works Ken Tucker (from left), Trustee Tim Kovel, Building Commissioner Matt Struve, Mayor Ernest Millsap, Public Works Superintendent Jody Kovel, Trustee Jorea Touranjeau, Trustee Dominic Misasi, and Trustee Lida Mills at the site of the new public works office building. (Photo by Carol McGowan)

Hodgkins breaks ground on new public works building

Spread the love

Spread the loveBy Carol McGowan The Village of Hodgkins is getting ready to welcome a new public works office building at its facility off of 67th Street, east of East Avenue. Village officials and public works employees gathered last month for a groundbreaking. Hodgkins Mayor Ernest Millsap explained the history behind the Paul G. Struve Public Works Building.…

Neighbors

Darth Vader and some friends were in attendance at the annual Fan Fest. (Supplied photos)

Oak Lawn Library draws a crowd with Fan Fest

Spread the love

Spread the loveBy Kelly White Comic book lovers gathered together in one common space earlier this month. Oak Lawn Public Library hosted its eighth annual Fan Fest, an all-ages celebration of pop culture, on May 11 at the library, 9427 S. Raymond Avenue. “It’s wonderful to see the community come together in celebration of shared…

Palos Heights wants to chop down this tree, remove the greenspace and pave it over. (Photo by Nuha Abdessalam)

Navajo Hills residents want to save threatened cul-de-sacs

Spread the love

Spread the loveBy Nuha Abdessalam Navajo Hills greenspace islands could be getting the ax and residents are upset. Residents of the East and West Courts of Navajo Hills, aware of the historical significance of the greenspace, spoke up during the Palos Heights City Council meeting May 21. There are five cul-de-sacs in the Navajo Hills…

regional ph summer concerts 2024

Summer concerts coming to Palos Heights

Spread the love

Spread the loveBy Nuha Abdessalam At the May 21 City Council meeting, Ald. Jeff Key shared exciting news about some of the summer activities coming to Palos Heights in the coming months. Key said the Concerts in the Park, a series of family-friendly events featuring live music, food vendors, and fun activities for all ages,…

Orland Park Mayor Keith Pekau speaks during the May 16 State of the Village Address. (Photo by Jeff Vorva)

Nerds and bullies among topics of Orland’s State of the Village

Spread the love

Spread the loveBy Jeff Vorva The 2024 Orland Park State of the Village Address was held at the Orland Park Civic Center, but it could have been held on a playground with talk of nerds and bullies and cool kids. Mayor Keith Pekau spent the first half hour “ripping off the Band Aid” of some…

Marist won the Marist Sectional and will play Payton on Friday, May 31 in the state quarterfinals. Photo by Xavier Sanchez

Boys Volleyball | Marist tops Jones, advances to state quarterfinals

Spread the love

Spread the loveBy Xavier Sanchez Correspondent For the first time since 2019, Marist will play in the IHSA state finals. The RedHawks (36-2) beat Jones, 25-13, 25-13, for their 17th straight victory and a Marist Sectional championship on May 28 in Mount Greenwood. They will face Payton in the state quarterfinals at 11:30 a.m. Friday,…

CRR_NH

Clear-Ridge Reporter and NewsHound May 29, 2024

Spread the love

Spread the love

Peggy Zabicki

Little things make a big difference in West Lawn

Spread the love

Spread the love. By Peggy Zabicki Your correspondent in West Lawn 3633 W. 60th Place •  (773) 504-9327 . Thank you to all who make a positive difference in West Lawn. There are some who are putting enormous efforts into making our neighborhood better and safer. We often hear about these good people and all…

Kathy Headley

Daina Cyvas again pedals with a purpose

Spread the love

Spread the love. Kathy Headley Your correspondent in Chicago Lawn and Marquette Manor 6610 S. Francisco • (773) 776-7778 . As I’m sure you remember, in past years, Daina Cyvas, the Communications and Project Coordinator for the Sisters of St. Casimir, has participated in Bike MS. in honor of one of her heroes, SSC Sister…

Vintage cars will again be rolling in the La Grange Pet Parade. The 78th edition of the parade starts at 9:30 a.m. June 1. (Photo by Steve Metsch)

Folks urged to enter costume contest for La Grange Pet Parade

Spread the love

Spread the loveBy Steve Metsch About 40,000 people are expected along the streets of downtown La Grange on Saturday morning June 1, with some of them dressing in costumes for the 78th annual La Grange Pet Parade. A costume contest has long been part of the parade, Molly Price, the parade’s executive director, said on…

Deputy Supt. of Public Works Ken Tucker (from left), Trustee Tim Kovel, Building Commissioner Matt Struve, Mayor Ernest Millsap, Public Works Superintendent Jody Kovel, Trustee Jorea Touranjeau, Trustee Dominic Misasi, and Trustee Lida Mills at the site of the new public works office building. (Photo by Carol McGowan)

Hodgkins breaks ground on new public works building

Spread the love

Spread the loveBy Carol McGowan The Village of Hodgkins is getting ready to welcome a new public works office building at its facility off of 67th Street, east of East Avenue. Village officials and public works employees gathered last month for a groundbreaking. Hodgkins Mayor Ernest Millsap explained the history behind the Paul G. Struve Public Works Building.…