ILLINOIS — Major changes are on the horizon for healthcare access in Illinois, with new systems and potential funding cuts set to take effect beginning in January 2026. These updates include a possible loss of Medicaid expansion, a new state-run ACA marketplace, and a transition for dual Medicare-Medicaid recipients.
Health experts urge Illinois residents to begin preparing now — especially those who rely on public health coverage or need help selecting plans for next year.
Medicaid Expansion at Risk if Federal Funding Drops
Illinois has a trigger law that will automatically end Medicaid expansion in the state if federal funding ever drops below 90%. While that hasn’t happened yet, the possibility looms as budget negotiations in Washington continue to fluctuate.
If triggered, the change could leave thousands of Illinoisans without coverage, particularly those currently enrolled under expansion guidelines. According to the Civic Federation, such a rollback would have serious consequences for both low-income individuals and the broader healthcare system.
Illinois Launching Its Own ACA Marketplace
Starting in November 2025, Illinois will roll out a state-based health insurance marketplace to replace the federal Healthcare.gov platform. The move stems from House Bill 579, which aims to redirect federal platform fees back into state coffers to fund a more localized enrollment system.
This new Illinois marketplace will go live for plan year 2026 and is expected to offer more tailored plan options for residents. The official state announcement confirmed that the switch is part of a long-term strategy to improve coverage access and reduce administrative costs.
New Managed Care Plans for Dual Medicare-Medicaid Recipients
Illinois is also shifting how it serves dual-eligible individuals — residents who qualify for both Medicare and Medicaid. The state will move from its current Medicare-Medicaid Alignment Initiative (MMAI) to a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) structure.
Four healthcare providers — Aetna Better Health, Humana Health Plan, Meridian Health Plan, and Molina Healthcare — have secured contracts to manage these plans from 2026 through 2029. As reported by The VBP Blog, the shift will streamline services and coordination for over 100,000 dual-eligible residents.
Are you prepared for these healthcare changes? Let us know your concerns or questions at ChicagoSuburbanFamily.com.
