Illinois Health Insurance for Immigrants Costs State $1.6 Billion, Audit Reveals

SPRINGFIELD, Ill. — An audit report released Wednesday revealed that Illinois’ administration, led by Governor JB Pritzker, significantly miscalculated the expenses and appeal of two health insurance programs for non-citizens. Since their inception in late 2020, these programs have cost the state over $1.6 billion, highlighting issues with improper enrollments.

The audit, conducted by Illinois Auditor General Frank Mautino’s office, found that the programs, aimed at immigrants without legal status, experienced not only financial shortfalls but also failures in accurately transitioning eligible individuals into Medicaid, the federal-state healthcare program for low-income individuals.

The report’s timing is critical, arriving just a week after Pritzker announced a budget measure aimed at discontinuing funding for health coverage for individuals under 65, which is projected to save $330 million and help address a looming state budget deficit that was initially estimated to exceed $3 billion.

Costs in programs designed for immigrants aged 42 to 64 were notably higher than expected, with actual expenditures reaching $485 million — nearly four times the initial prediction of $126 million for the three-year period ending June 30, 2023. Similarly, expenditures for those aged 65 and older amounted to $412 million, nearly double the $224 million forecast.

At a news conference in Chicago, Pritzker, while announcing additional medical debt relief for residents, did not directly address why his administration’s cost estimates had been so flawed. He suggested that some individuals remained on the program’s rolls longer than they should have due to changes in their immigration status or employment situations.

“The broader context is people need to get health care,” Pritzker stated. “There’s evidence that an awful lot of people out there need coverage.” At the end of 2024, approximately 41,505 people were enrolled in the two programs, with about 80% being younger immigrants.

The health insurance programs were initiated to cover immigrants aged 65 and older who were undocumented or had not yet qualified for a green card. Initial cost estimations were derived from advocacy groups and projected yearly expenses at $4 million, a figure later admitted to be “very wrong.” The actual first seven-month cost of the program exceeded $67 million.

Healthcare and Family Services spokeswoman Melissa Kula explained that estimates fell short due to higher-than-anticipated rates of chronic health conditions among eligible populations. “Estimates were made with little experiential data to accurately predict program growth,” she noted.

Despite ongoing efforts to refine enrollment projections, actual figures continued to exceed expectations by a significant margin. By mid-2023, enrollment numbers were roughly double initial projections.

The findings from the audit, commissioned by a bipartisan Legislative Audit Commission, surprised state lawmakers, including Rep. Fred Crespo, a Democratic co-chair of the commission. Crespo indicated a need for more responsible budgeting practices. “I was taken aback by the sheer cost and the underestimates,” he remarked, while recognizing the importance of ensuring adequate healthcare access for noncitizens.

Conversely, Republican legislators were quick to criticize the handling of the programs. GOP Senate leader John Curran accused the Pritzker administration of mismanagement and suggested that the audit indicated deeper issues of transparency in fiscal estimates. “This is insane,” said Sen. Chapin Rose, co-chair of the audit commission. “You can’t believe budget estimate numbers.”

The audit also highlighted various improper enrollments, such as nearly 500 duplicate cases and over 6,000 enrollees with Social Security numbers mistakenly classified as undocumented. For individuals incorrectly admitted to the 65-and-over program, many were within three months of their 65th birthday, revealing systemic issues in the registration process.

Rep. Norine Hammond of Macomb questioned the effectiveness of the management of these programs, emphasizing the need for transparency and accuracy in budgeting processes. “If we can’t base our budgets on truthful numbers, then what are we doing here?” she asked.

The auditor general’s office recommended that the Healthcare and Family Services Department engage with the Department of Human Services to validate eligibility data and establish processes to prevent future enrollment errors. Although the department agreed to the recommendations, facing potential difficulties in seeking federal reimbursement due to political tensions surrounding immigration policy, remains a significant challenge.

These revelations come as Healthcare and Family Services initiates a process to review and verify enrollees, addressing the inflated numbers that have emerged since the programs’ launch, particularly during the COVID-19 pandemic.