HR0220 103RD GENERAL ASSEMBLY

HR0220 LRB103 31992 KTG 60799 r

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 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

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 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 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 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

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

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

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

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