* Tribune reporters Jeremy Gorner and Dan Petrella…

Gov. JB Pritzker’s administration vastly underestimated the cost and popularity of a pair of health insurance programs for immigrants who are not citizens that has ended up costing the state $1.6 billion since the initiative began in 2020, according to an audit report released Wednesday.

Aside from inaccurate projections of the programs’ cost and the number of people who would enroll, the audit uncovered more than 6,000 people enrolled in the programs who were listed as “undocumented” despite having Social Security numbers, and nearly 700 who were enrolled in the program for people 65 and older despite being younger than that. In addition, almost 400 people were enrolled in the programs but appeared to have been in the country long enough to qualify for Medicaid, which is jointly funded by the federal government.

The report from Illinois Auditor General Frank Mautino’s office was published a week after Pritzker proposed eliminating funding for the program that provides Medicaid-style insurance coverage for people younger than 65 who are in the country without legal permission or are in the U.S. legally but have not yet qualified for a green card. The cut, estimated to save $330 million, was part of Pritzker’s plan to close a budget hole once pegged at more than $3 billion.

The cost overruns were particularly pronounced in the program for younger recipients, with the actual expenditure of $485 million through the three years ending June 30, 2023, coming in at nearly four times the estimated cost of $126 million, according to the audit.

* From the Auditor General’s Health Benefits for Immigrant Seniors and Adults audit…

Key Findings:

Actual enrollment and actual costs exceeded the initial program estimates for both the HBIS and HBIA programs. Regarding estimated number of enrollees, in FY23:

- for HBIS (65+), the initial estimated number of enrollees was 6,700,
while the actual number enrolled was 15,831;
- for HBIA (55-64), the initial estimated number of enrollees was 8,000, while the actual number enrolled was 17,024; and
- for HBIA (42-54), the initial estimated number of enrollees was 18,800, while the actual number enrolled was 36,912.

Regarding the initial cost estimates for all three fiscal years 2021, 2022, and 2023:

- for HBIS (65+) the total estimate was $224.0 million, while the actual total cost was $412.3 million or 84 percent higher;
- for HBIA (55-64) the total estimate was $58.4 million, while the actual total cost was $223.1 million or 282 percent higher; and
- for HBIA (42-54) the total estimate was $68.0 million, while the actual total cost was $262.2 million or 286 percent higher.

In FY21, 6,884 individuals were enrolled in HBIS (65+). HBIS (65+) enrollment increased to 11,362 in FY22, 15,831 in FY23, and decreased to 11,464 in FY24. The HBIA (55-64) enrollment increased from 6,675 in FY22, to 17,024 in FY23, before decreasing to 13,596 in FY24. The HBIA (42-54) enrollment increased from 5,823 in FY22, to 36,912 in FY23, before decreasing to 27,941 in FY24. According to HFS officials, the FY24 numbers exclude those who have been removed from the
program due to redetermination or due to the change in eligibility that removed legal permanent residents from the program.

Click here for the full report.

…Adding… Governor Pritzker was asked about the audit during an unrelated press conference…

Reporter: Governor, there was an audit released this morning that showed that your administration underestimated the cost and the popularity of the immigrant healthcare programs that have been discussed in recents years. I’m wondering what happened to cause those estimates off, particularly for program for people under 65?

Pritzker: So I think the thing that is missing from the reporting, and what I would point out to you, is that number one people’s immigration status changes during the course of a year. You’ve got people who were eligible for the program, who became uneligible for the program. So even though you expect that people will move on because, well, it may be their immigration status, it may be because they got a job that has health care coverage associated with it. But you expect them to move on, and maybe they didn’t move on either because they didn’t know they could, should. But that happens, I hate to tell you, on Medicaid as well.

It’s why we do every year redeterminations, and we did it with this program as well. One of the reasons that we even know about some of those people is because of the redeterminations. So people get removed from the program as a result of the redeterminations. But before they got redetermined to not be eligible, they were still on the program and that cost taxpayers money. So that’s a lot of I think what I would say about that.

But the broader context is people need to get healthcare. I am in favor of universal healthcare however that comes together. And we can talk about the myriad ways that we could do that. But people don’t go get healthcare [or] get treated when they don’t have a problem. And so it’s some evidence that there are an awful lot of people out there who need coverage, who aren’t getting it, or who will do anything to get it. And I think that’s a sad state of affairs in our society.

Reporter: For redeterminations, the issue is on the cost estimates?

Pritzker: No, I’m saying, I think when you look at who’s covered, how much it costs to cover them. Some of those people become ineligible mid-year, and you’re still paying for them because we don’t know and maybe they don’t know that they’re no longer eligible for that program. We find out when we do redeterminations. We did that for the larger Medicaid population, as you know, in the state of Illinois, which we were kept from doing for three years because of COVID, but we also did it in this program to determine who’s no longer eligible for it. So the program is became a lot less expensive as a result of the work that we did and and as you know, you know we’re no longer operating, or we will no longer operate that earlier the 42-63 cohort, and instead focus on the most vulnerable, who are the seniors that are covered by that program.

Please pardon all transcription errors.

* Related…

* Sun-Times | Pritzker’s $55.2 billion budget has no new taxes, cuts health care for adults lacking legal status: Pritzker’s budget plan excludes funding for health care for immigrant adults who lack legal status and are between the ages of 42 and 64. Last year, the Democratic governor included $629 million to provide health care benefits to immigrants without legal status 42 and up, and seniors who would otherwise qualify for Medicaid. The governor’s office called that intentional omission a reflection of difficult decisions being made to bring the proposal into balance. The office, however, said funding for health care for seniors who lack legal status will be maintained. The program for adults will end June 30, the end of the fiscal year.