The Illinois Department of Healthcare and Family Services (HFS) recently issued a provider notice updating policy for the Health Benefit for Immigrant Adults (HBIA) and Health Benefits for Immigrant Seniors (HBIS). The updates include 1) the removal of the previously announced $100 copayment for non-emergency hospital emergency department services and 2) guidance that individuals with HBIS or HBIA coverage should not apply or be applied for the Emergency Medical Coverage for Noncitizens (Emergency Medicaid). 

BACKGROUND ON HBIA AND HBIS  

Health Benefits for Immigrant Seniors (HBIS) and Health Benefits for Immigrants Adults (HBIA) are state-funded programs that provide health care coverage for those who do not qualify for federally funded Medicaid in Illinois due to their immigration status. On June 16, 2023, the Department of Healthcare and Family Services (HFS) filed emergency rules for the HBIS and HBIA programs that, among other changes, authorized the implementation of copays for certain services. Click here to read the full notice.  

At that time, HFS also said in a press release that the programs would be moved to managed care in 2024. Avisery issued a January 19th alert summarizing the planned transition of most HBIA/HBIS enrollees to managed care. That alert also clarified how co-pay policies would vary by which, if any managed care plan covered a given customer. 

MOST RECENT CHANGE TO THE HBIA/HBIS COST-SHARING STRUCTURE: 

In a February 16th provider notice, however, HFS further amended their cost-sharing policies. Specifically, the $100 copayment requirement for non-emergency hospital emergency department services has been removed. Providers have been notified that they should not be collecting copayments for non-emergency hospital emergency department services. Any emergency room copayment charged after February 1, 2024, should be refunded to the customer. 

The following features of the initially announced cost-sharing structure have not changed and will remain in-effect: 

• Non-emergency inpatient hospitalization: $250 
• Hospital or Ambulatory Surgical Treatment Center Outpatient Services: 10% of Department rate to the provider

Per HFS, whether coinsurance for outpatient services can be charged by a hospital or ambulatory surgical center depends on how the provider is set up to bill Medicaid for the service.

• Services billed on an 837P (Professional Services) form will not result in coinsurance.
• Services billed on an 837I (Institutional) form may have coinsurance, if the provider charges it. A provider can, at their discretion, elect not to charge the Medicaid customer for any cost-sharing.

HBIA/HBIA enrollees are therefore encouraged, whenever possible, to call the provider billing office prior to treatment to ask whether any cost-sharing (copayments or coinsurance) will be charged.

Reminder that CountyCare has chosen to waive all cost-sharing for its members. So anyone enrolled in CountyCare should not be charged any cost-sharing. If they are, the customer should call CountyCare’s member services line for help. 

HBIS/HBIA RECIPIENTS SHOULD NOT APPLY FOR EMERGENCY MEDICAID 

Along with this change, HFS has clarified in the provider notice that HBIS and HBIA recipients should not be applying for medical coverage through Emergency Medical Coverage for Non-Citizens (Emergency Medicaid) for any hospital emergency department services, nor should hospitals be applying for Emergency Medicaid coverage for these customers. Program eligibility will be systematically determined by HFS. 

ADDITIONAL RESOURCES FROM HFS 

Health Benefits for Immigrants Webpage 

HBIA/HBIS FAQ in English 

HBIA/HBIS FAQ in Spanish 

For any questions, email avisery@ageoptions.org