From State Senator Craig Wilcox:

Undocumented Healthcare Program Busts Budget

A recent news article [from Capitol News Illinois] shined a light on a glaring budget liability heading into Illinois’ new fiscal year, as a program that provides free healthcare for undocumented immigrants has ballooned to nearly $1 billion.

In 2020, Illinois implemented the Health Benefits for Immigrant Adults and Seniors, a program that gave Medicaid-type coverage for noncitizens 65 years or older.

Since then, the program has expanded to include those 42 and older.

In its first fiscal year, the program exceeded its entire year’s appropriation within the first month of implementation.

This trend has only increased.

Currently, Fiscal Year 2023 spending is estimated to be $567.6 million, over three times the budgeted amount of $150 million.

The disparity between budgeted and actual spending is expected to continue as the state is now projecting a total cost next fiscal year of $990 million, leaving a program deficit of $770 million. 

Illinois taxpayers are completely on the hook for the cost of this program as there is no matching federal funding like there is for Medicaid.

At a time when the state is failing some of its most vulnerable citizens, such as largely underfunding services for the developmentally disabled by over a half billion dollars over the last three years, I believe the state has its priorities backwards.

I strongly believe the State of Illinois has a responsibility to fully fund its current financial obligations before spending $1 billion on healthcare for non-citizens.

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From the source article:

The actual cost of the program far exceeded that estimate, and the program exceeded its FY 2021 appropriation within the first month of implementation, according to a closed-door presentation by the Illinois Department of Healthcare and Family Services to lawmakers last month.

The cost of care for the 65 and over age group was nearly $188 million between March 2022 and February 2023, per that presentation.

Since the program’s initial passage, lawmakers have expanded it twice, lowering the age limit to 55 in 2021 and 42 a year later. The expanded program is known as Health Benefits for Immigrant Adults.

Outpacing estimates

As the expansion was to be implemented in 2021, IDHFS brought in its own consultant to try to get a clearer picture of what it would cost. For the current fiscal year that concludes June 30, the actuarial firm Milliman estimated the total program costs would be about $222 million.

But the actual cost for all three age groups was $410 million from March 2022 through February 2023, according to the department…

Milliman also underestimated the number of enrollees in the immigrant community, a notoriously difficult population to track. Its estimate of 33,500 total enrollees was exceeded by more than 18,000 with four months to go in Fiscal Year 2023. The number is expected to grow to nearly 99,000 next fiscal year as enrollees in the 42-54 range continue to grow by about 10 percent each month.

When the program’s expansion to the population aged 42-54 passed one year ago, Republicans noted in Senate floor debate that it was tacked onto a bill that had otherwise been agreed to by working group members of both parties.

Milliman’s cost estimate of $68 million for the age 42-54 group was cited in floor debate, but thus far over $104 million in claims has been paid out. That number is expected to grow to $460 million in the upcoming fiscal year for that age group.

All told, the estimated $990 million price tag for the upcoming year represents a $768 million increase over the faulty initial current-year estimate. The Pritzker administration said IDHFS could cover about $300 million of the cost difference within its budget as proposed by the governor, while the rest would be subject to ongoing budget negotiations.

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When I was a Budget Examiner in the United States Bureau of the Budget in 19065-66, a new budgeting tool was inplemented. It was called “PPBS” (“Program, Planning Budget System,” I think), which became known as the “Piss Poor Budgeting System.”

No estimates were anywhere near as faulty as those for this program.