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The lump on M.R.’s arm didn’t bother him. As the darkened mass grew in diameter, it itched at most, he said. Then it began to bleed.
“I never felt anything, and because I never felt anything, I never had it checked. It wasn’t until it looked like it exploded. It started bleeding. So, that’s when the clinic sent me to the hospital,” he said, referring to the Community Health Care Clinic [CHCC] in Normal.
M.R. is a McLean County resident. He’s using his initials to maintain anonymity for this story due to fear for his safety.
A physician from CHCC sent him immediately to Carle BroMenn Medical Center in Normal. From there, he was referred to a hospital in St. Louis for surgery and cancer treatment.
M.R. obtained insurance through a state-run program that offered low-income, undocumented noncitizen adults ages 55-64 Medicaid-like benefits. The program began in 2021. The state extended coverage to noncitizen adults ages 42-54 in 2022.
M.R. was uninsured at the time of his cancer diagnosis. The hospital assisted with his application for the Medicaid-like program. It paid for the surgery to remove the tumor and subsequent chemotherapy.
The program covering participants ages 42-64 became known as Illinois Health Benefits for Immigrant Adults [HBIA], and Health Benefits for Immigrant Seniors [HBIS] for ages 65 and older. The former is slated for termination June 30, after Gov. JB Pritzker did not include funding for HBIA in the FY26 Illinois budget proposal that starts July 1.
State enrollment data shows 118 McLean County residents are among 33,000 Illinoisians who relied on this program for their health care. They will soon need to find other options. Advocates say it could be a life-or-death proposition for some.
“Let me make this clear: If funding is cut to HBIA, people will die."Enddy Almonord, Healthy Illinois
In 2023, stomach pain brought M.R. back to Carle. This time he received a stomach cancer diagnosis, but the health benefits he’d once qualified for were no longer available; he missed the deadline to appeal his termination of benefits.
M.R. holds out hope that he will someday requalify for medical benefits.
“More than anything, I would really like to recover that card. I know it’s difficult but with some help, I think it’s possible. That card really did help me a lot," he said.
His subsequent surgery, and the once-a-month infusions he receives at a hospital in Chicago, are covered by the hospital’s charity care.
Advocacy groups allege HBIA and HBIS reduce medical provider’s uncompensated care. Research conducted by the University of Chicago estimated the programs are linked to a 15% reduction in hospital’s bad debt.
Enddy Almonord is director for Healthy Illinois, a campaign that advocates for health care for all Illinoisans, regardless of immigration status. Almonord said taxpayers pay more to cover uncompensated care than if patients had access to care through programs like HBIA.
“This also means that people have to wait until their situation is so dire that they have to end up in the emergency room rather than being able to have direct access to a primary care provider or the specialist that they may need to be able to manage their treatment.”
Costs 'ballooned'
State Rep. Steven Reick, a Republican from Woodstock, said HBIA was fraught with controversy from its inception.
“All I know is that it was sold to us as a program that was going to cost no more than $2 million with an 'm' and when it finally got to the point of being brought before the House of Representatives, we found out that the cost had ballooned to $1.2 billion," Reick said.
Many Republican lawmakers raised concerns about the cost of the programs, with many arguing the state should not be providing health care for undocumented immigrants at all.
Almonord said the need was higher than they anticipated.
“With that being said, we don't think it makes sense for a program to be cut because of the need. And we are also are in a place now in Illinois where the HBIA and HBIS has been closed for enrollment since the end of 2023, so the numbers that we're dealing with, and that the General Assembly sees now, are numbers that we are able to anticipate.”
A report from the Illinois Auditor General indicated that the nearly 54,000 enrollees in the two HBIA programs more than doubled what the state anticipated [26,800].
The state stopped taking new enrollees in June 2023.
When HBIA wasn’t included in the state’s FY26 proposed budget, Illinois Department Healthcare and Family Services [HFS] invoked an emergency rule to end the program. That move bothered some members of the Illinois General Assembly Joint Committee on Administrative Rules [JCAR].
Reick, a member of JCAR, said he had a big problem with HBIA having an emergency rule-making statue. JCAR monitors rule making and is the last backstop before their implementation.
“The way emergency is defined, is defined as earthquake, flood, tornado, disaster – things that actually constitute an emergency,” Reick said. “If statute provides for emergency rule making without an explanation as to what the emergency is, it’s not an emergency that should be subject to emergency rule making.”
When the bill was argued on the floor of the House, Reick asked, “What is the emergency here?” He said the sponsor of the bill said, ‘Well, we have to be nimble in our dictation of who’s eligible, and limitations on eligibility,’ which I thought was very unpersuasive.”
‘People will die’
The proposed ruling to end HBIA would have fatal consequences for participants, Almonord believes.
“Let me make this clear: If funding is cut to HBIA, people will die," Almonord said.
Almonord said HBIA participants losing coverage will have to choose between paying their rent or buying their medication.
“Those who are currently undergoing treatment for chronic illnesses, cancer, kidney failure, diabetes, heart disease ... will no longer have access to their medication and the doctor’s visits that are keeping them alive," she said.
For people like A.G., another McLean County resident who used only their initials to conceal their identity for concerns for their safety, Almonord’s warning rings true.
“The truth is I have really needed it so much because of my health condition. I have some health problems, and my medical condition has been deteriorating. And yes, I have needed it, and now that I need it the most, they’re taking it away," she said.
She said receiving the termination of benefits has caused turmoil.
“Just recently, I received treatment for an issue with my white blood cells,” she said while exposing her swollen arm. “What am I going to do when I can no longer get my medicine and see the specialist?”
Where to turn
The Illinois HFS website lists Federally Qualified Health Centers [FQHCs] and charity clinics as options for preventative care for those losing HBIA benefits. In McLean County, Community Health Care Clinic in Normal and Chestnut Health Systems in Bloomington are those options.
CHCC Executive Director Holly Wayland-Hall said her clinic helped patients enroll in HBIA when it became available, but as participants began losing coverage during the redetermination period or for other reasons, they returned as patients to the clinic.
HFS said some HBIA recipients will qualify for insurance through the Affordable Care Act Marketplace. Wayland-Hall said the clinic assists patients searching for options.
“When we deal with an individual who is either without coverage, losing coverage, whatever their circumstances may be, we very much take, you know, that social work approach of trying to help them through the process,” she said, adding that includes considering ACA coverage for those who may qualify. “If an individual needs help with that process, you know specifically, if we have an individual who has language barriers and needs help with that process, for that reason, we are here to help in any way that we can.”
Determining if a patient is eligible for services at the clinic is done through an application process during clinic open hours or via an online application.
“You do have to be 18 years or older. You do have to prove that you are a resident of McLean County, and you do have to meet some low-income requirements,” said Wayland.
Those requirements include being at or below 250% federal poverty level for income. Documentation must be presented when applying. “So, there are some information that we ask be provided with the application just to support each individual case so that we can determine whether an individual qualifies," she said.
Chestnut Health Systems Chief Clinical Officer Matt Mollenhauer said their clinics have capacity to serve patients in McLean County.
“Part of why we have such solid capacity in primary care right now is that we are a family medicine residency site for OSF [St. Joseph Medical Center] and so it's not only our Chestnut staff, but it's family medicine residents who are in our building, and we actually have first, second, and third-year residents,” he said.
In addition, Mollenhauer said Chestnut Family Health Center moved to a walk-in model on their primary healthcare side. They offer a sliding fee scale for those that qualify, including undocumented noncitizens.
The combination of their own existing staff, the residency collaboration with OSF St. Joseph Medical Center, and a partnership with CHCC, he believes leaves Chestnut with a solid level of capacity.
