Copays Restart for Undocumented Health Care Plans
Governor JB Pritzker’s administration launched, abruptly ended, and restarted copays Thursday for a state-run health care program for undocumented/illegal immigrant adults and seniors.
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The state announced Wednesday new copayments and coinsurance costs for undocumented/illegal immigrants in the “Health Benefits for Immigrant Adults” and “Health Benefits for Immigrant Seniors” program took effect Thursday.
Copayments were instituted in July but were quickly reversed after problems integrating them into the program.
From the state release:
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.
The program has seen a large increase in enrollees in recent years and the legislature gave the Pritzker adminsitration less money to manage it, leaving copays as the way to keep spending in check.
Social service advocacy group Healthy Illinois opposes the premiums.
“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,” said Tovia Siegel, the Health Illinois Campaign Director.
Asylum-seeking migrants who have been bussed to Chicago from Texas are not eligible for the plan, as their health care needs are covered by the federal government.