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Audit finds thousands of improper enrollments in noncitizen healthcare program, massive cost underestimates (Updated)

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* 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.

…Adding… House Minority Leader Tony McCombie…

“House Republicans warned about the costly expansion of this program when it was first exposed last year. We could not afford it then, and we cannot afford it now. Yet, Democratic leadership forced taxpayers to shoulder the burden of this reckless spending for non-citizens, pushing our state’s finances to the brink.

“Beyond the overwhelming cost, reports of fraud and abuse make it even clearer that this program must end. There is no need to wait until the next fiscal year—immediately shut it down and protect Illinois taxpayers.”

…Adding… Senate Republicans…

A new report from the Illinois Auditor General confirms significant mismanagement in Gov. Pritzker’s taxpayer-funded free healthcare program for noncitizens, revealing thousands of potentially ineligible enrollees and costs far exceeding initial projections. At a capitol press conference, Illinois Senate Republican Leader John Curran (R-Downers Grove) and Senator Chapin Rose (R-Mahomet) highlighted the audit’s findings, calling for more financial transparency from the Pritzker Administration and stronger oversight to prevent further misuse of taxpayers.

“The audit’s findings show the shocking misuse and mismanagement of taxpayer dollars by the Pritzker Administration,” said Curran. “The governor’s overspend on his free healthcare for non-citizens program and gross mismanagement increases costs on all Illinois taxpayers and crowds spending on education and other core services.”

Auditors found that more than 6,000 enrollees classified as “undocumented” actually had Social Security Numbers, raising serious concerns about the integrity of the enrollment process and failure to properly verify eligibility. Senate Republicans voiced concerns that the lack of oversight not only erodes public trust but also leaves taxpayers on the hook for the Pritzker Administration’s failure to manage the program responsibly. Curran and Rose said that Illinoisans deserve transparency and accountability—not more bureaucratic incompetence.

The audit also exposed massive cost overruns, with spending on some age groups running nearly 300 percent over budget. The most extreme overrun came in the 42-54 age group, where costs surged to nearly triple what was projected.

These staggering miscalculations highlight a complete failure of fiscal planning, forcing taxpayers to cover the shortfall, Senators explained.

“Once again, the governor has proven himself unreliable, and we’re finding out after the fact that his estimates weren’t even in the ballpark,” said Senator Rose (R-Mahomet). “If it were up to me, we’d get rid of these programs entirely. Illinois taxpayers shouldn’t be footing the bill for illegal immigrants.”

Senate Republicans have long criticized Gov. Pritzker’s decision to spend billions of taxpayer dollars on non-citizen programs while Illinois families struggle with skyrocketing property taxes, grocery bills, and healthcare costs. Instead of prioritizing hardworking citizens, the Democratic Majority have funneled taxpayer dollars into a program riddled with waste, mismanagement, and a lack of transparency.

The audit’s findings have renewed calls for accountability. Leader Curran reintroduced Senate Bill 1699, which requires detailed annual reports on a range of taxpayer-funded programs for noncitizens—not just healthcare, but also housing, legal aid, and other services. The reports would include total expenditures, specific appropriations, the number of recipients, funding sources, and awarded contracts. To ensure transparency and prevent further misuse of taxpayer dollars, this information would be made publicly available online.

Illinois taxpayers deserve transparency and fiscal responsibility. This audit confirms that mismanagement in Gov. Pritzker’s program has resulted in massive cost overruns and wasted taxpayer dollars. With accountability long overdue, Senate Republicans will continue fighting for reforms that put hardworking families first, demand transparency, and end reckless spending.

The full press conference can be viewed at this link: https://youtu.be/VEL04XfYoGE

* Related…

Sun-Times | Pritzker’s $55.2 billion budget has no new taxes, cuts health care for adults lacking legal status:

posted by Isabel Miller
Wednesday, Feb 26, 25 @ 10:51 am

Comments

This is why we have an Auditor General.

Comment by Friendly Bob Adams Wednesday, Feb 26, 25 @ 11:09 am
===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===

I would be interested in hearing how the Auditor General’s team was able to make these determinations when DHS missed these factors that would have disqualified applicants.

Especially if some of those folks would have been eligible for a different program.

Comment by Candy Dogood Wednesday, Feb 26, 25 @ 11:12 am
Candy Dogood - Wednesday, Feb 26, 25 @ 11:12 am:

Let me correct myself, HFS rather than DHS.

Comment by Candy Dogood Wednesday, Feb 26, 25 @ 11:15 am
Good question Candy, how exactly did they determine that?

Comment by Lincoln Lad Wednesday, Feb 26, 25 @ 11:19 am
Interesting timing given the proposed cuts. Certainly buttress the governor’s case despite criticism from the left and various hispanic groups.

Comment by Nick Wednesday, Feb 26, 25 @ 11:26 am
Of course we wouldn’t bein this position if the Gov and the legislature had done their due diligence in the first place. It’s all well and good to want to help people but you must start with those who are here legally. Then, and only then, you determine who else you can help. When you make decisions rationally and fairly you ensure those who truly need help get it, for example adults with developmental disabilities but are on a waiting list. Bottom line is we can’t help everyone without hurting ourselves.

Comment by Center Drift Wednesday, Feb 26, 25 @ 11:32 am
- Who still hasn’t answered to his own campaign finance “irregularities”. -

Yes he has, and he was cleared over 3 years ago.

https://www.chicagotribune.com/2021/11/16/illinois-board-of-elections-dismisses-campaign-finance-complaint-against-auditor-general-frank-mautino/

Comment by Excitable Boy Wednesday, Feb 26, 25 @ 11:39 am
Yes he has, and he was cleared over 3 years ago

Apologies. I’ve been away a while. Thanks for putting me in my place.

Comment by Capcitynewt Wednesday, Feb 26, 25 @ 11:49 am
People want health care and will try to access it however they can for as cheaply as they can. that’s one thought. too bad they did not take care of details in administration. they gave themselves the reason to end things by not administering correctly.

Comment by Amalia Wednesday, Feb 26, 25 @ 11:53 am
“you must start with those who are here legally”

“make decisions rationally and fairly”

So which is it?

– MrJM

Comment by @misterjayem Wednesday, Feb 26, 25 @ 11:58 am
DHS new inspector general just got through the senate some time this year. Godspeed to them.

Comment by Macon Deliberations Wednesday, Feb 26, 25 @ 12:11 pm
- I would be interested in hearing how the Auditor General’s team was able to make these determinations when DHS missed these factors that would have disqualified applicants. -

They reviewed the enrollment records? I’m not an auditor but I think reviewing records is involved.

Comment by Excitable Boy Wednesday, Feb 26, 25 @ 12:19 pm
Always grateful for Frank Mautino!

Comment by grateful gayle Wednesday, Feb 26, 25 @ 12:20 pm
==but you must start with those who are here legally. Then, and only then, you determine who else you can help==

See you in church. Sheesh. Everyone deserves help.

Comment by Demoralized Wednesday, Feb 26, 25 @ 12:21 pm
==those who truly need help get it==

Also, are you suggesting these people don’t “truly” need help?

Comment by Demoralized Wednesday, Feb 26, 25 @ 12:22 pm
- I would be interested in hearing how the Auditor General’s team was able to make these determinations when DHS missed these factors that would have disqualified applicants. -

The Governor spoke about redetrminations and people’s status changing between them.

Comment by Anyone Remember Wednesday, Feb 26, 25 @ 12:37 pm
I wonder what all those dollars would have done on the south or west side of Chicago?

Of some of our veterans homes and such. . .

Comment by Todd Wednesday, Feb 26, 25 @ 12:38 pm
JB never admits to waste fraud and abuse in his administration

Comment by Anonymous Wednesday, Feb 26, 25 @ 12:57 pm
Who answers for cost estimates that were 4x lower than the actual cost? That’s fiscal and legislative malpractice.

The biggest mistake was expanding the program to ages 42-64 without properly assessing if we could effectively manage the costs for the 65+ cohort.

Comment by City Zen Wednesday, Feb 26, 25 @ 1:02 pm
The billion six should be paid out of JB’s campaign funds as the whole program was to embellish his street creds with progressives

Comment by Sue Wednesday, Feb 26, 25 @ 1:08 pm
I agree with Sue and nobody will be held accountable. HFS director should be fired.

Comment by Dpiman Wednesday, Feb 26, 25 @ 1:14 pm
=== I would be interested in hearing how the Auditor General’s team was able to make these determinations when DHS missed these factors that would have disqualified applicants. ===

I would be interested too, since you do not have to be a US citizen to get a Social Security number, aka Taxpayer ID number.

Redeterminations do not need to be done on an annual basis, though. that’s a crazy way to do it.

And if Illinois finds through redetermination that someone had employer-based coverage, we should claw back those funds from the responsible insurer.

Comment by Thomas Paine Wednesday, Feb 26, 25 @ 1:23 pm
=Of course we wouldn’t bein this position if…=

Ahh, the sweet sounds of monday morning quarterbacks who never hold their party accountable.

Comment by JS Mill Wednesday, Feb 26, 25 @ 1:28 pm
- the whole program was to embellish his street creds with progressives -

You could apply this logic to every program supported by every politician in every political party for all time. It’s meaningless, which is par for the course with you.

Comment by Excitable Boy Wednesday, Feb 26, 25 @ 1:37 pm
===Who answers for cost estimates that were 4x lower than the actual cost?===

The number of people who enrolled was double the number estimated, and the cost is slightly more than double because of that. Could the estimate have been better? Maybe, but it has to be a major challenge to guess how many noncitizens exist in those age groups, how many of them lack health insurance, how many of them would put in the effort to sign up, and how many would utilize the insurance. Do you have some magic crystal ball to create a better estimate?

===HFS director should be fired.===

See above. If you expect officials to be able to predict the future, you are going to have a lot of disappointment and turnover.

Comment by thechampaignlife Wednesday, Feb 26, 25 @ 2:38 pm
- If you expect officials to be able to predict the future, you are going to have a lot of disappointment and turnover. -

I’m not completely disagreeing, but they did predict the future, and they were way off. Mistakes happen, but there are ways to safeguard against them, perhaps by capping enrollment based on your forecast.

I say that as someone who believes everyone deserves healthcare, but until the federal government steps up the state needs to properly budget for it.

Comment by Excitable Boy Wednesday, Feb 26, 25 @ 2:43 pm
Yet another example of Pritzker mismanagement.

Comment by Back to the Future Wednesday, Feb 26, 25 @ 3:36 pm
Thomas Paine, an ITIN is very different from a SSN as an ITIN is issued by IRS. If a person has a SSN it does not necessarily mean they have resided in the US long enough to meet the 5 year threshold to qualify for Medicaid/CHIP. That said some of this should have been caught through effective computer programming. If eligible for regular Medicaid/CHIP the persons medical costs would have generated federal match and reduced costs to the state. When I worked at IDHS it drove me crazy that staff did not understand that entering immigration information correctly was critical to ensuring the state received matching funds. I had hoped the programming of ABE would have done a better job catching this information.

Comment by illinifan Wednesday, Feb 26, 25 @ 4:04 pm
Illinois contracts with Deloitte who designed the IES system and other systems within State Gov. A quick google search informs u of how other states fired or took them to court over poor systems the company designed. Talk to many caseworkers who work hard but deal with what they have to work with. A common phrase of most casework’s “IES is working as designed”.

Comment by Dpiman Wednesday, Feb 26, 25 @ 4:23 pm
==it has to be a major challenge to guess how many noncitizens exist…Do you have some magic crystal ball to create a better estimate?

You actually made the problem sound far worse.

Comment by City Zen Wednesday, Feb 26, 25 @ 4:49 pm
This is campaign ad runs itself in 2028

Comment by Almost the Weekend Wednesday, Feb 26, 25 @ 6:21 pm
The HFS director needs to go. This is an embarrassing mismanagement on top of the broken relationships she and her staff have had with electeds. I haven’t seen an agency head become this infamous in such a short amount of time.

Comment by Time for a Change Wednesday, Feb 26, 25 @ 6:21 pm
== Illinois contracts with Deloitte who designed the IES system==
As an I.T. leader I have issues with what Deloitte does but the agency specifies what the requirements are and has equal responsibility for the outcome.

Comment by I.T. Guy Wednesday, Feb 26, 25 @ 7:22 pm