ILLINOIS — The cost of Illinois’ state-funded health care program for noncitizens has surged to an estimated $1.1 billion for the upcoming fiscal year, far exceeding the original projections included in Governor JB Pritzker’s February budget plan.
The program, which covers individuals aged 42 and older who would qualify for Medicaid if not for their immigration status, was initially estimated to cost $220 million. But updated projections shared by Illinois Department of Healthcare and Family Services (IDHFS) Director Theresa Eagleson during a recent Senate Appropriations Committee hearing show a drastic upward revision.
Enrollment and Cost Growth Surging Month Over Month
The revised figures indicate that Illinois could see enrollment grow to over 120,000 noncitizens in Fiscal Year 2025, driven by a consistent 10% monthly growth rate. This surpasses the earlier estimate of 98,500 enrollees.
The unexpected increase stems from underestimating both the number of eligible residents and the actual costs of care, according to IDHFS Chief of Staff Ben Winick, who stated that the Census Bureau’s American Community Survey data proved insufficient for precise forecasting.
“A lot of this is just based on the trends we’re seeing,” Winick noted. “We’re not tying projections to a fixed universe of eligibles anymore.”
Illinois Remains the Only State With Full Coverage for Undocumented Adults Over 42
Illinois is unique nationwide in offering this level of comprehensive health coverage for undocumented adults. At a press conference, Sen. Dave Syverson (R-Cherry Valley) warned that Illinois’ generous policy could become a magnet for sick individuals from across the country.
“As the only state that fully covers health care for undocumented residents over 42, people know this is the place to come if you have medical needs,” Syverson said.
By contrast, Sen. Omar Aquino (D-Chicago) praised the expansion as a point of pride, noting the need for services to treat underdiagnosed chronic conditions like diabetes and cancer.
Majority of Enrollees Reside in Cook County
A large percentage of current participants live in Cook County, where access to preventive and specialty care has significantly reduced reliance on the county-run health system.
“They’re not using only emergency services anymore,” Winick said. “They’re getting treated for chronic illnesses early and accessing more comprehensive providers.”
Eagleson added that the per-patient cost has started to level off for older populations, especially those 65 and up, as patients receive ongoing care rather than emergency intervention.
Funding Gaps and Search for Solutions
The $880 million budget gap between the governor’s projection and the current cost estimate has become a focal point in budget discussions. The Pritzker administration believes approximately $300 million in extra funding can be absorbed into the current framework but is working with lawmakers to identify more cost coverage solutions.
Because the program supports undocumented residents, it’s not eligible for federal Medicaid matching funds. However, Eagleson said Illinois recently received a verbal commitment for $67 million in federal reimbursement for emergency services, with expectations of up to $120 million in the coming year.
Debate Over Managed Care and State Priorities
Unlike most Medicaid recipients in Illinois, noncitizens are not currently enrolled in managed care programs, which limits the state’s ability to collect provider assessments. Eagleson acknowledged that enrolling this population in Managed Care Organizations (MCOs) could generate additional revenue.
“We expected this population to remain small,” Winick said. “That assumption no longer holds, so we’re considering accelerating managed care integration.”
Still, some lawmakers are questioning the opportunity cost. Sen. Chapin Rose (R-Mahomet) argued that the funds could have supported a 20% Medicaid base rate increase for hospitals or better services for residents with developmental disabilities.
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