Amid uncertainty in Washington, Illinois lawmakers pass slimmed-down Medicaid package

By Editor | June 4, 2025 |

By Peter Hancock

Capitol News Illinois

Nearly every year, Illinois lawmakers pass a package of measures dealing with the state’s Medicaid program, the joint federal and state health care program that covers low-income individuals.

Known as the Medicaid omnibus bill, it sometimes includes bold components, like a 2021 initiative that made millions of dollars available to local communities to help them plan and design their own health care delivery systems. Other packages have focused on smaller changes like guaranteeing coverage for specific conditions and medications or adjusting reimbursement rates for different categories of healthcare providers.

The Illinois General Assembly passed a scaled-back Medicaid package on the last day of the session Saturday.st years, the packages receive bipartisan support because they are negotiated, largely behind closed doors, by an unofficial, bipartisan Medicaid Working Group.

This year, however, lawmakers passed one of the narrowest packages in recent memory, due mainly to the Trump administration’s vows to make sweeping cuts in federal funding for the program while state lawmakers faced their own set of budget constraints.

“There were many, many, very worthy program expansions, rate increases that we considered during this process that we were unable to include because of the uncertainty in Washington,” Rep. Anna Moeller, D-Elgin, the current chair of the Medicaid Working Group, said on the House floor Saturday.

The Illinois Medicaid program currently costs about $33.7 billion a year, according to the Department of Healthcare and Family Services. Of that, $20.9 billion, or about 62%, comes from the federal government while much of the state’s share comes from taxes levied on hospitals, nursing homes and managed care organizations – money the state uses to draw down federal matching funds.

The program covers nearly 3.5 million people in Illinois, or about a quarter of the state’s population. According to the nonpartisan health policy think tank KFF, the program pays for 40% of all child births in Illinois while covering 69% of all nursing home residents.

This year’s Medicaid omnibus bill, a 231-page amendment inserted into Senate Bill 2437, contains items that could be hugely beneficial to many Medicaid enrollees, but which don’t carry large price tags. In fact, the entire package is estimated to cost just under $1 million.

One of this year’s additions would make it easier for family members of medically fragile children who qualify for in-home nursing care to receive training to become certified family health aides, a designation that would enable them to administer medications, help with feeding and perform many of the same tasks as a certified nursing assistant.

Another provision would require all hospitals with licensed obstetric beds and birthing centers to adopt written policies that permit patients to have an Illinois Medicaid certified doula of their choosing to accompany them and provide support before, during and after labor and delivery.

Although those provisions enjoyed bipartisan support, another provision that extends coverage to certain categories of noncitizens drew Republican opposition Saturday, resulting in a partisan roll call vote.

The program covers noncitizens who meet the income requirements for Medicaid and have pending applications for asylum in the United States or for special visas as victims of trafficking, torture or other serious crimes. Those individuals can receive coverage for up to 24 months, provided they continue to meet the eligibility requirements.

Moeller said the language was not a new extension of health care benefits to noncitizens, but instead a “technical and administrative fix” to an existing program that had been requested by the Department of Healthcare and Family Services.

But for Republicans, the programs sounded too similar to the more controversial programs, Health Benefits for Immigrant Seniors and Health Benefits for Immigrant Adults, that extend health care to a large category of people who are not U.S. citizens, including some who are in the country illegally.

“For us on this side of the aisle, that is the poison pill,” said Rep. Noreen Hammond, R-Macomb, the deputy House minority leader. “So in spite of the fact that we have article after article in here, that is very worthy of a yes vote, I would urge a no vote.”

At Gov. JB Pritzker’s request, the budget bill lawmakers passed Saturday night cancels the program for immigrant adults, which had covered about 31,000 noncitizens age 42-64. But it provides $110 million over the next year, all in state funds, for the immigrant seniors program, which covers about 8,900 noncitizens age 65 and over.

The Medicaid bill passed the House late Saturday night, 76-39. It then passed the Senate shortly after midnight, 36-19.

It next goes to Pritzker’s desk for his consideration.

Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.