Bill Text: IL HR0220 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Urges a moratorium on the enrollment of new beneficiaries for Medicaid services under the program for undocumented immigrants and a moratorium on the expansion of Medicaid services and coverage for any new population of undocumented immigrants not already covered; and urges the Auditor General to conduct a performance audit as soon as reasonably possible, and annually thereafter, to assess the Department of Healthcare and Family Services' administration of the program of Medicaid services and coverage provided to undocumented immigrants.

Spectrum: Partisan Bill (Republican 19-0)

Status: (Introduced) 2024-10-31 - Added Co-Sponsor Rep. Dan Ugaste [HR0220 Detail]

Download: Illinois-2023-HR0220-Introduced.html

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

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related to the expansion of Medicaid for undocumented
immigrants in the House Human Services Appropriations
Committee on Thursday, March 16, 2023, but was not forthcoming
with any information; and
WHEREAS, The Medicaid expansion included in Public Act
101-636 was included last minute in the Budget Implementation
Bill (BIMP), with no time for a committee hearing or expert
testimony; and
WHEREAS, Preliminary cost estimates for this initial
Medicaid expansion to undocumented immigrants over the age of
65 was estimated to be between $70-$100 million in State
Fiscal Year 2021; and
WHEREAS, Public Act 102-16 expanded Medicaid coverage to
undocumented immigrants for ages 55-64 as part of the Fiscal
Year 2022 State Budget; and
WHEREAS, The Medicaid expansion included in Public Act
102-16 was, again, included last minute in the BIMP, with no
time for a committee hearing or expert testimony; and
WHEREAS, Initial cost estimates for this second Medicaid
expansion to undocumented immigrants was estimated to be
$70-$80 million for Fiscal Year 2022; and

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

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

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

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

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

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

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

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WHEREAS, The General Assembly believes that an independent
accounting of the recent expansions of Medicaid services to
undocumented immigrants should be performed to better
understand the cost implications of this new coverage; and
WHEREAS, The General Assembly believes the Auditor General
should cause an annual audit to be made of the Department's
administration of Medicaid services to undocumented immigrants
beginning immediately and continuing annually thereafter; and
WHEREAS, An audit by the State Auditor General would be
helpful in determining the effects of increased Medicaid
coverage to undocumented immigrants; therefore, be it
RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE ONE
HUNDRED THIRD GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that
we urge the Auditor General to conduct a performance audit as
soon as reasonably possible, and annually thereafter, to
assess HFS' administration of the program of Medicaid services
and coverage provided to undocumented immigrants; and be it
further
RESOLVED, That the first audit should include a review of
HFS' initial program enrollment and cost estimates for State
Fiscal Year 2021 and each State fiscal year thereafter up to
the most recently completed State fiscal year that data is

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

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

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