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*** UPDATED x1 *** Copays and co-insurance to be imposed on undocumented immigrant healthcare starting tomorrow

Wednesday, Jan 31, 2024 - Posted by Rich Miller

* Press release…

New copays and coinsurance for existing enrollees in the Health Benefits for Immigrant Seniors (HBIS) and Health Benefits for Immigrant Adults (HBIA) programs will go into effect on Feb. 1, as the Department of Healthcare and Family Services (HFS) previously announced.

Most services covered by the HBIA and HBIS programs, which provide health care coverage for individuals who would be eligible for Medicaid coverage if not for their immigration status, will continue to be free for customers, including primary care visits, prescription medications and vaccinations at a pharmacy or doctor’s office. The new copays and co-insurance will apply to the use of non-emergency hospital or surgical center services, like nonemergent elective surgeries, physical therapy and lab work.

Copays are fixed amounts paid for health care services covered by a health plan, while coinsurance is a type of cost-sharing where a customer pays a percentage of the total price for a covered health care service, and their insurer pays the remainder. Both copays and coinsurance are common cost-sharing practices used in both commercial insurance and in Medicare. Enrollees should always check with their provider on whether they will be charged out-of-pocket costs for a service.

The impact of copays and cost-sharing will vary for participants based on their enrollment in Medicaid Managed Care, which many HBIA and HBIS participants will be transitioning to over the next several months. The copays and coinsurance and the transition to managed care for HBIA and HBIS enrollees are among the cost-saving measures HFS has implemented in order to bring program costs within the budgeted amount for State Fiscal Year 2024.

For those already enrolled or in the process of enrolling in a Managed Care Organization (MCO), out-of-pocket costs will depend on the MCO. Some MCOs are waiving all or some of the allowable charges, which means hospitals or surgical centers will not charge members of that MCO an out-of-pocket cost for some or all non-emergency procedures and services. Those not enrolled in an MCO can be charged copayments or coinsurance.

No copay or cost-sharing may be charged for an emergency service needed to evaluate or stabilize an emergency medical condition, which is a condition with symptoms severe and painful enough that a reasonable person would think they are life-threatening and need immediate medical care. Individuals who have severe symptoms that could be life threatening should not hesitate to seek immediate treatment, and in those instances will not have cost sharing requirements.

Copays and cost-sharing may only be charged on the following services:

    • Non-emergency Inpatient hospitalizations: $250 copayment per stay.
    • Non-emergency Hospital Outpatient Services or Ambulatory Surgical Treatment Center: 10% of what HFS would pay the provider. The amount an enrollee can be charged will vary depending on the service and the provider, and enrollees should check with the provider on whether they will need to pay an out-of-pocket cost for a service.

HFS has removed a previously planned $100 copay for non-emergency hospital ER services, after consulting with the Centers for Medicare & Medicaid Services and confirming that the state can seek reimbursement for all emergency room care. In addition, some of the MCOs are waiving copays for certain service types: CountyCare, which only serves customers in Cook County and will serve the majority of HBIA and HBIS enrollees, is waiving all copays and coinsurance for HBIA and HBIS customers.

Beginning January 1, 2024, many HBIA and HBIS customers have begun receiving services through HealthChoice Illinois, the State of Illinois’ Medicaid Managed Care Program. Previously, services were delivered to HBIA and HBIS customers solely via a fee-for-service model. The shift to managed care provides a level of care coordination for customers that isn’t available with fee-for-service. Care coordinators help customers connect with the medical care and social services they need.

MCO enrollment for HBIA and HBIS customers is taking place in waves, with the last cohort of HBIA and HBIS customers enrolling with an MCO April 1. HBIA and HBIS customers are receiving enrollment packets in the mail that explain the transition to managed care and what they need to do. A sample MCO enrollment letter is available here.

HBIA and HBIS enrollees who have comprehensive private insurance or spenddown will remain in fee-for-service and will not enroll with a managed care plan or receive an MCO enrollment mailing.

More information about the HBIA and HBIS transition to managed care is available here.

*** UPDATE *** Healthy Illinois Campaign…

Today, the Illinois Department of Healthcare and Family Services (HFS) will implement co-payments and co-insurance for some nonemergency services for enrollees in the State’s Health Benefits for Immigrant Adults (HBIA) and Health Benefits for Immigrant Seniors (HBIS) programs. Yesterday, HFS announced it would no longer go forward with the implementation of co-pays for emergency services. Healthy Illinois Campaign Director Tovia Siegel released the following statement in response to the announcement:

“Healthy Illinois Campaign is pleased the Illinois Department of Healthcare and Family Services announced they will no longer be instituting co-pays for some emergency room visits. This decision will keep Illinoisans safer and allow them to seek the healthcare they need in emergencies.

“However, the two co-payments that will go into effect on February 1 will place a significant burden on both providers and patients, limiting access to healthcare for Illinois’ immigrant community. We urge the Department of Healthcare and Family Services and Managed Care Organizations to reconsider implementing these charges, which will generate a relatively small amount of money but can be the difference between life and death for low-income Illinoisans.

“Healthy Illinois Campaign stands ready to work with HFS and the Governor’s Office to find fiscally responsible and sustainable ways to ensure equitable access to health care for the state’s lowest-income residents.”

       

7 Comments
  1. - Almost retired - Wednesday, Jan 31, 24 @ 4:55 pm:

    I have adult son who worked paid taxes and now due to automobile accident is completely disabled and on Medicare and Illinois Medicaid. He has more copays etc. than is in the plans described. I work and pay taxes. How does this fit with equity that many on this blog hold dear. Why does he have to pay more than newly arrivals who have not yet paid taxes.


  2. - Medicare Savings Program - Wednesday, Jan 31, 24 @ 6:19 pm:

    @Almost Retired - don’t have an answer to your question, but perhaps there’s more support available for your son that you recognize. Lots of people (and the government sometimes) overlook the Medicare Savings Program. It’s not much but it’s not nothing either.


  3. - lol - Wednesday, Jan 31, 24 @ 8:11 pm:

    Migrants don’t get HBIA/S, which is who I’m assuming you’re talking about. This is for undocumented residents that pay taxes.


  4. - Bolingbrook party or 7 - Thursday, Feb 1, 24 @ 6:22 am:

    My daughter is disabled. Why is her policy not as good as this?


  5. - Former ILSIP - Thursday, Feb 1, 24 @ 7:29 am:

    As many of the folks potentially using this program already utilize ERs as their primary care service, this is unlikely to stop that serious misallocation of finite healthcare resources. An effort needs to be made to disincentivize ER visits before a primary care/prompt care physician can be consulted or incentivize visiting these much less expensive and specialty options rather than clogging up emergency care desperately needed for actual emergency situations.


  6. - Probably should retire soon - Thursday, Feb 1, 24 @ 9:50 am:

    Every poor Illinois citizen on Medicaid has worse coverage than this population. Absolutely disqusting where this Administration’s priorities lie.


  7. - Rebuttal - Thursday, Feb 1, 24 @ 10:50 pm:

    To Probably Should Retire Soon, I understand your frustration, but it is misplaced and inaccurate, and creates a false equivalency and pits a vulnerable group against another vulnerable group. First, the enacting legislation for this program does not permit access to long-term care services (e.g., nursing homes) and home and community-based services; every Illinois citizen who is on Medicaid has access to those services, so long as they qualify. Second, the coverage allowed under HBIA/HBIS is straight medical comprehensive coverage that mirrors the Medicaid program, nothing more nothing less (e.g., physician visits, dental, vision, prescription drugs, etc.). Things I would argue are rather essential to someone’s ability to live. Don’t you agree?

    It’s frustrating when this type of commentary enters the ether because it ignores the enormous contributions that undocumented immigrants have given not just to Illinois, but nationwide. If they’re getting a paycheck, they’re paying income tax. If they’re buying goods and groceries, they’re paying sales tax. And if they’re getting paid under the table you best believe that it’s below a living wage.

    And let’s not forget about the Dreamers who are left in suspense as to whether they have a future in this country even though this nation, and state, is their home. Nearly 600,000 DACA recipients live across the United States, raise 300,000 U.S.-citizen children, and pay $9.4 billion in taxes each year.

    All to say, I think your frustration is better aimed towards our congressional delegation and federal administration. Without going into a diatribe of unjust foreign policy ventures into Latin America, our federal government has utterly failed to reform the United States’ immigration system and, in my opinion, has not done enough to intervene in the current migrant crisis. Let’s not forget that Texas used federal funds to send migrants to Chicago and New York “ahem”.

    Thanks for listening.


Sorry, comments for this post are now closed.


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