Provider Notice issued 02/16/2024

This notice announces a change to the original copayment structure for the Health Benefits for Immigrant Adults (HBIA) and Health Benefits for Immigrant Seniors (HBIS) programs. This change affects customers covered under the Medicaid fee-for-service (FFS) program and the managed care organizations (MCOs) for service dates beginning February 1, 2024.  

The Department of Healthcare and Family Services (HFS) is amending its emergency rules to 89 Ill. Admin. Code Sections 118.760 and 118.860 to remove a previously planned $100 copayment for non-emergency hospital emergency department services. The Centers for Medicare & Medicaid Services have confirmed that HFS can obtain federal matching fund reimbursement for all emergency department care.

Hospitals should not charge HBIA and HBIS customers an emergency department copayment. Any emergency department copayment charged beginning February 1, 2024, should be refunded to the customer.

Please note:  Hospitals should not apply for coverage under the Emergency Medical Coverage for Non-Citizens program for patients who have HBIA or HBIS coverage. All services that are eligible for coverage under the Emergency Medical Coverage for Non-Citizens program will be systematically identified for purposes of exemption from copayment/cost sharing and claiming federal match. This includes:

·         All services performed in the hospital emergency department.

·         Inpatient services that originate in the emergency department, or that are otherwise emergent in nature, provided that those services are billed with a Priority Type of Admission 1 or 5.

Hospitals are responsible for maintaining adequate documentation to support the services provided.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the appropriate MCO.

Kelly Cunningham, Administrator
Division of Medical Programs