Article Summary
- Last year, as part of the “One Big Beautiful Bill Act,” Congress cut off Medicaid eligibility to nearly all groups of noncitizens except lawful permanent residents, effective Oct. 1.
- To comply with the new federal rules, state lawmakers passed legislation implementing that change in the state’s Medicaid program.
- The change will affect an estimated 10,000 people in Illinois, most of whom are lawfully present in the country on humanitarian grounds.
- Legislation that would have enabled most of those affected to keep their coverage beyond Oct. 1 stalled in the General Assembly due to budget pressures.
This summary was written by the reporters and editors who worked on this story.
SPRINGFIELD – A bill that will soon head to Gov. JB Pritzker’s desk will officially remove an estimated 10,000 people from the state’s Medicaid program, leaving them without any form of health coverage.
That group is made up mainly of people who are not U.S. citizens but who are in the country legally, according to the Illinois Coalition for Immigrant and Refugee Rights. That includes refugees and asylum-seekers, many of whom came to the United States with pre-existing health conditions.
“If they are enrolled, then they still have Medicaid up until Oct. 1,” Edith Avila Hesser, ICIRR’s health justice and policy director, said in an interview. “This adds to the number of uninsured populations that we have here in the state of Illinois, and so obviously we will be working to educate this community about the resources that are available to them through community clinics like FQHCs (Federally Qualified Health Centers) and free and charitable clinics available throughout the state.”
Medicaid is a public health coverage program that is jointly funded by the federal government and the states.
In 2025, Congress amended the federal eligibility rules for Medicaid with passage of H.R. 1, commonly known as President Donald Trump’s “One Big Beautiful Bill Act.” It removed eligibility for nearly all noncitizens except lawful permanent residents, Cuban and Haitian entrants, and migrants from certain Pacific island nations known as the Compact of Free Association.
Illinois’ Medicaid bill
In order to comply with that change in federal law, Illinois lawmakers included language in this year’s annual Medicaid omnibus bill, Senate Bill 3365, removing most groups of noncitizens from eligibility under state law.
They include, among others, immigrants who are honorably discharged U.S. veterans and their families, refugees and asylees, noncitizens identified as victims of trafficking, Amerasians from Vietnam, and American Indians born in Canada.
“We had to make that change to comply with H.R. 1 so that we didn’t put our entire Medicaid program in jeopardy,” Rep. Anna Moeller, D-Elgin, who chairs the House working group that wrote the omnibus bill, said in an interview.
Although Illinois also provides health coverage outside the Medicaid system that is funded entirely with state dollars, the language in this year’s bill specifically states that it “shall not require any category of non-citizens or part thereof to be funded at state-only cost.”
For example, in 2020, Illinois launched a program to provide Medicaid-like coverage known as Health Benefits for Immigrant Seniors for noncitizens age 65 and over, regardless of their immigration status. The following year, it expanded that program with Health Benefits for Immigrant Adults, which covered adults age 42 to 64, regardless of immigration status.
But the latter program was closed in 2025 amid budget and political pressure and enrollment in the seniors program has been limited while many of its enrollees have been shifted to other subsidized coverage programs.
Stalled programs
Illinois also participates in a limited program that provides health benefits to asylum applicants and victims of torture, trafficking and other serious crimes. And to minimize the impact of the upcoming change in eligibility rules, immigrant rights advocates introduced legislation this year to expand that program.
House Bill 4824, sponsored by Rep. Dagmara Avelar, D-Romeoville, and Senate Bill 3462, sponsored by Sen. Graciela Guzmán, D-Chicago, would have extended coverage under that program to several additional categories of noncitizens who are in the country for various humanitarian reasons. But neither of those bills was ever assigned to a substantive committee.
Moeller said budget pressures were the primary reason the bills were not considered this year, and she said that is not likely to change anytime soon.
“We’re looking at enormous budget pressures next year because of the cuts in H.R. 1 to the Medicaid program, which is going to affect our overall budget,” she said. “Hopefully, at some point we can get many of the provisions that were contained in H.R. 1 overturned federally.”
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