Illinois General Assembly - Full Text of HR0220
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Full Text of HR0220  103rd General Assembly




HR0220LRB103 31992 KTG 60799 r


2    WHEREAS, It was recently reported that the Department of
3Healthcare and Family Services (HFS) released information
4dated March 31, 2023 (Report) regarding updated enrollment and
5cost estimates related to Medicaid benefits for undocumented
6immigrant seniors and adults; and
7    WHEREAS, The Report highlights serious runaway costs in
8recent Medicaid expansions to undocumented immigrants; and
9    WHEREAS, The Report shows dramatic growth in undocumented
10immigrant participation which will require $990 million in
11general revenue funds (GRF) to support the Medicaid expansion
12in State Fiscal Year 2024; and
13    WHEREAS, This information was not shared by HFS or the
14Pritzker Administration to the general public or the General
15Assembly as a whole, but instead was published in the news
16media; and
17    WHEREAS, Public Act 101-636 expanded Medicaid coverage to
18undocumented immigrants over the age of 65 as part of the
19Fiscal Year 2021 State Budget; and
20    WHEREAS, HFS was questioned specifically about costs



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1related to the expansion of Medicaid for undocumented
2immigrants in the House Human Services Appropriations
3Committee on Thursday, March 16, 2023, but was not forthcoming
4with any information; and
5    WHEREAS, The Medicaid expansion included in Public Act
6101-636 was included last minute in the Budget Implementation
7Bill (BIMP), with no time for a committee hearing or expert
8testimony; and
9    WHEREAS, Preliminary cost estimates for this initial
10Medicaid expansion to undocumented immigrants over the age of
1165 was estimated to be between $70-$100 million in State
12Fiscal Year 2021; and
13    WHEREAS, Public Act 102-16 expanded Medicaid coverage to
14undocumented immigrants for ages 55-64 as part of the Fiscal
15Year 2022 State Budget; and
16    WHEREAS, The Medicaid expansion included in Public Act
17102-16 was, again, included last minute in the BIMP, with no
18time for a committee hearing or expert testimony; and
19    WHEREAS, Initial cost estimates for this second Medicaid
20expansion to undocumented immigrants was estimated to be
21$70-$80 million for Fiscal Year 2022; and



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1    WHEREAS, Public Act 102-1037 expanded Medicaid coverage to
2undocumented immigrants for ages 42-54 as part of the Fiscal
3Year 2023 State Budget; and
4    WHEREAS, Initial cost estimates for this third Medicaid
5expansion to undocumented immigrants was estimated to be
6$70-$80 million; and
7    WHEREAS, Public Act 102-1037 was added last minute without
8bipartisan consensus to the Medicaid Omnibus bill, with no
9time for committee hearing or expert testimony; and
10    WHEREAS, The Medicaid Omnibus bill has traditionally been
11the result of a bipartisan, bicameral working group that
12determines which Medicaid services and programs can be
13expanded within the framework of available revenues; and
14    WHEREAS, The recently released Report shows initial cost
15overruns in Fiscal Year 2021 related to the first expansion
16specifically stating that "In 2020, the Health Benefits for
17Immigrant Seniors (HBIS) program exceeded its appropriation in
18the first month of implementation"; and
19    WHEREAS, This initial cost overrun should have raised
20alarms within HFS, and the Administration should have shared



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1that information with all members of the General Assembly; and
2    WHEREAS, The Report then states that, "HFS brought in its
3contracted actuarial firm, Milliman, for future program
4enrollment and cost estimates"; and
5    WHEREAS, The Report states that in 2021 and 2022, Milliman
6used "American Community Survey (ACS) census data for
7eligibility and enrollment estimates" and assumed "HBIS and
8Health Benefits for Immigrant Adults (HBIA) enrollees would
9not cost more than Medicaid enrollees"; and
10    WHEREAS, These assumptions were clearly incorrect as the
11Report states that, "Both the 65+ age group and the 55-64 age
12group have more enrollees than Milliman thought would be
13eligible" and that the "42-54 age group has exceeded
14Milliman's enrollment projections 8.5 months into the program,
15and is still seeing more than 10% enrollment growth month over
16month"; and
17    WHEREAS, Original estimates for Fiscal Year 2023 included
18assumptions that 53,700 eligible undocumented immigrants would
19qualify for Medicaid coverage, with an assumed 33,500 enrolled
20into the program; and
21    WHEREAS, Actual active case enrollees through February



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12023 was 51,914, which is 55% higher than original estimates
2for Fiscal Year 2023; and
3    WHEREAS, Fiscal Year 2024 estimates now include 162,100
4eligible undocumented immigrants for Medicaid qualification
5with 98,500 enrollees; and
6    WHEREAS, Fiscal Year 2024 estimates now show growth in
7Medicaid coverage for eligible undocumented immigrants
8totaling 108,400 over original Fiscal Year 2023 estimates, and
9enrollees totaling 65,000 over original Fiscal Year 2023
10estimates, a 202% and 94% increase respectively; and
11    WHEREAS, Participation of undocumented immigrants in the
12Medicaid expansion is only part of the miscalculation leading
13to increased costs within the program; and
14    WHEREAS, The Report states that, "Actual claims experience
15reflects higher enrollee costs than the traditional Medicaid
16population due to more untreated chronic conditions and higher
17hospital costs"; and
18    WHEREAS, The Report indicates that Milliman originally
19projected the estimate for this Medicaid expansion will total
20$221.8 million in Fiscal Year 2023, and then balloon to $990
21million in Fiscal Year 2024, which represents a $768.2 million



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1increase, equaling 346% year over year; and
2    WHEREAS, The State of Illinois receives federal matching
3Medicaid funds totaling no less than 50% of the total cost of
4coverage for citizens and legal residents of the United
5States; and
6    WHEREAS, Undocumented immigrants are ineligible for any
7federal Medicaid match resulting in State GRF being used to
8pay for the entirety of services provided; and
9    WHEREAS, These recent Medicaid expansions did not include
10any additional revenue sources enacted by the General Assembly
11to pay for these expanded services; and
12    WHEREAS, The additional Medicaid pressure for these
13expansions are happening at the same time the State is
14expected to lose $760 million in additional federal funding
15through the enhanced Federal Medical Assistance Percentage
16(FMAP) that was provided to states during the pandemic; and
17    WHEREAS, This loss of the enhanced FMAP was the primary
18reason the Governor proposed an additional $709 million GRF
19deposit for Medicaid to maintain the same level of coverage;



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1    WHEREAS, The lump sum appropriation of State GRF into the
2Healthcare Provider Relief Fund for the State Medicaid Program
3by its nature hides the actual cost of specific Medicaid
4services; and
5    WHEREAS, The General Assembly believes there should be
6more transparency in how State funds are used to fund
7Medicaid, specifically Medicaid coverage that does not include
8federal matching funds; and
9    WHEREAS, There is no statutory requirement for HFS, under
10the direction of the Pritzker Administration, to offer these
11expanded services to undocumented immigrants as the statute is
12permissive in nature; and
13    WHEREAS, HFS has wide latitude in controlling how the
14expanded Medicaid services for undocumented immigrants is
15administered with the statute stating, "The Department is
16authorized to take any action that would not otherwise be
17prohibited by applicable law, including, without limitation,
18cessation or limitation of enrollment, reduction of available
19medical services, and changing standards for eligibility, that
20is deemed necessary by the Department during a State fiscal
21year to assure that payments under this Section do not exceed
22available funds"; and



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1    WHEREAS, Examples of ways to control costs include the
2introduction of more stringent residency requirements,
3implementation of co-pay and premium payments, limitations in
4the types of coverage offered, or a moratorium on new
5enrollees in the expanded Medicaid program to undocumented
6immigrants; and
7    WHEREAS, Several programs in the State are still
8drastically underfunded, and could benefit from the $990
9million in GRF that would go to HFS to continue to provide
10medical services to eligible undocumented immigrants; and
11    WHEREAS, The $990 million could be used to manage the
12systemic challenges within the Department of Children and
13Family Services that have contributed to rising cases of child
14maltreatment deaths and harmful foster care placements; and
15    WHEREAS, The $990 million could be used to support
16services to the Developmentally Disabled as outlined by the
17Guidehouse Rate Study commissioned by the Department of Human
18Services; and
19    WHEREAS, The $990 million could be used in an effort to
20come into faster compliance with various consent decrees and
21court orders, including the Colbert and Ligas Consent Decree;



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1    WHEREAS, The $990 million could be used to address the
2substantial workforce shortage in nursing homes across the
3State that has caused various nursing homes to consider
4closure; and
5    WHEREAS, The $990 million could be used to increase the
6funding available for the statewide database known as the
7Prioritization for Urgency of Need for Services (PUNS List),
8in an effort to increase the number of people served and the
9quality of resources available; and
10    WHEREAS, The $990 million could be used to more
11aggressively fund the Evidence-Based Funding Model which
12targets the neediest K-12 educational institutions; and
13    WHEREAS, The $990 million could be targeted toward our
14institutions of Higher Education in an effort to keep college
15tuition costs down, and keep residents in the State of
16Illinois; and
17    WHEREAS, The $990 million could be used to pay down the
18unfunded liability of the State-funded pension plans, which
19would save billions of dollars in long-term costs and free up
20GRF in future budget years; and



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1    WHEREAS, The General Assembly believes that an independent
2accounting of the recent expansions of Medicaid services to
3undocumented immigrants should be performed to better
4understand the cost implications of this new coverage; and
5    WHEREAS, The General Assembly believes the Auditor General
6should cause an annual audit to be made of the Department's
7administration of Medicaid services to undocumented immigrants
8beginning immediately and continuing annually thereafter; and
9    WHEREAS, An audit by the State Auditor General would be
10helpful in determining the effects of increased Medicaid
11coverage to undocumented immigrants; therefore, be it
14we urge the Auditor General to conduct a performance audit as
15soon as reasonably possible, and annually thereafter, to
16assess HFS' administration of the program of Medicaid services
17and coverage provided to undocumented immigrants; and be it
19    RESOLVED, That the first audit should include a review of
20HFS' initial program enrollment and cost estimates for State
21Fiscal Year 2021 and each State fiscal year thereafter up to
22the most recently completed State fiscal year that data is



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1available; and (ii) for each reported State fiscal year, the
2actual program enrollment numbers and amount of money expended
3by HFS from each fund in the State Treasury used to fund
4medical services and coverage to undocumented immigrants; and
5be it further
6    RESOLVED, That each subsequent audit shall review HFS'
7initial program enrollment and cost estimates for the most
8recently completed State fiscal year for the 12-month
9reporting period and the actual program enrollment numbers and
10amount of money expended by HFS from each fund in the State
11Treasury used to fund medical services and coverage to
12undocumented immigrants; and be it further
13    RESOLVED, That we urge the Pritzker Administration to
14impose a moratorium on the enrollment of new beneficiaries for
15Medicaid services under the program for undocumented
16immigrants and a moratorium on the expansion of Medicaid
17services and coverage for any new population of undocumented
18immigrants not already covered; and be it further
19    RESOLVED, That this moratorium should be effective
20immediately and remain in effect until 12 months after the
21Auditor General conducts a performance audit and issues its
22first audit report to the General Assembly detailing the costs
23of Medicaid expansion to undocumented immigrants; and be it



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2    RESOLVED, That we urge the Pritzker Administration to use
3every option available to control costs and bring those costs
4in line with what the original projections were before
5contemplating any future enrollment in the program; and be it
7    RESOLVED, That we as a body will work with the Pritzker
8Administration, HFS, and the Governor's Office of Management
9and Budget to better identify specific costs within the
10Medicaid program so that we can move away from lump sum
11appropriations into the Healthcare Provider Relief Fund to
12better target which Medicaid costs come without any federal
13matching funds; and be it further
14    RESOLVED, That we as a body will table all future
15discussions regarding expanding age eligibility requirements
16regarding Medicaid coverage for undocumented immigrants until
17such a date that an accurate fiscal impact can be determined,
18and a revenue source can be identified to fund any current or
19additional expansions to this Medicaid program; and be it
21    RESOLVED, That suitable copies of this resolution be
22presented to Governor JB Pritzker, Speaker of the House



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1Emanuel "Chris" Welch, President of the Senate Don Harmon,
2House Minority Leader Tony McCombie, and Senate Minority
3Leader John Curran.