Fund Healthcare for Immigrant Adults (HBIA) in the FY26 Budget
HBIA is a lifesaving, economy-driving program that is set to end June 30, 2025. It currently provides healthcare coverage for nearly 33,000 low-income adults ages 42 to 64 whose immigration status makes them ineligible for Medicaid. But it does so much more:
- HBIA saves money: Illinois has saved $65 million a year since starting the program in 2021 and the Health Benefits for Immigrant Seniors program in 2022, as noted in a recent study by the Embodying Race(ism) Project at the University of Chicago. Hospitals that care for uninsured undocumented immigrants have seen bad debt drop by an average of 15% and as much as 28%. more clearly than ever that our health is interdependent. We are all safer when everyone has meaningful access to healthcare.
- Protecting HBIA would cost less than half a percent of the state’s total budget for healthcare. Budget estimates for FY26 show that continued coverage access for those currently enrolled in HBIA will cost approximately 0.07% of the state’s budget for healthcare.
- Ending HBIA affects the whole state, not just the people enrolled in the program. In 2021, immigrants in Illinois had $54.9 billion in spending power, paying $8.6 billion in state and local taxes and $13.1 billion in federal taxes. Immigrants work and pay taxes. Noncitizens are slightly more likely to be employed than citizens. Lack of access to health services will result in decreased economic productivity impacting local business and state revenue generation.
- Increasing the uninsured population in Illinois negatively impacts healthcare access for everyone. Health centers with HBIA-enrolled patients will suffer financially if those reimbursable patients become uninsured, possibly resulting in staff layoffs and clinic closures. Cook County Health is slated to lose an estimated $110 million. Health Centers will continue to serve patients to their fullest capacity, though the added pressure from absorbing more uninsured patients will impact all patients.
- The cost of HBIA will not surpass cost estimates for FY26. The HBIA and HBIS programs have been closed for new enrollment since 2023. In 2024, HFS transitioned 96% of HBIA enrollees into Managed Care Organizations (MCO). A consistent, capitated rate is paid to MCOs which allows the state to accurately budget for the program, without risk of overspending.
- HBIA has no viable alternative. Governor Pritzker has said that the 33,000 people who would lose coverage under HBIA can find jobs that offer health insurance, but this is highly unlikely. Working adult immigrants often work in low-wage jobs that do not offer affordable employer-sponsored health insurance. Like Medicaid, HBIA serves low-income individuals, many of whom work in industries like agriculture and service that have historically low rates of employer-sponsored insurance. In 2023, fewer than half of workers in these sectors were even eligible for job-based coverage, and part-time workers—who make up a significant portion of low-wage labor—had even lower eligibility rates. Even when coverage is technically offered, it’s often unaffordable.
People on HBIA are undergoing treatment for chronic conditions or life-threatening diseases, like diabetes or cancer, or waiting for organs on transplant lists. Abandoning them is not only economically ruinous but will damage our positionality as a leader in providing for the lives of people in our state. In the face of the federal government’s threats and attacks on our most vulnerable, we must not follow suit.