Cook County leaders and health officials sounded the alarm Wednesday, warning that only 100 days remained until major, new Medicaid requirements take effect – changes that they worry may lead to hundreds of thousands of Illinois residents losing coverage.
“We’re 100 days away from some real devastation here,” said Cook County Commissioner Alma Anaya at a news conference Wednesday.
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Under HR1, also called the One Big Beautiful Bill Act, starting Jan. 1 certain adults who are on Medicaid must meet new work requirements to keep their coverage. Medicaid is a state and federally-funded health insurance program for people with low incomes and disabilities.
The changes will apply to more than 700,000 adults in Illinois – people who gained Medicaid under the Affordable Care Act’s expansion of the program. Under that expansion, adults ages 19 to 64 without children, making up to 138% of the federal poverty level, became eligible for Medicaid for the first time.
Starting next year, to keep their coverage, those adults will have to show they’re spending at least 80 hours a month working or volunteering; are going to school at least half-time; or making a monthly pre-tax income of at least $580 a month, according to the Illinois Department of Healthcare and Family Services.
“The changes that HR1 is making to the Medicaid program … represent the largest policy shift in the program’s 60-plus year history,” said Elizabeth Whitehorn, director of the Illinois Department of Healthcare and Family Services.
An estimated 165,000 to 300,000 Illinois residents could lose Medicaid because of the work requirements, according to the department.
Though many health officials have decried the new work requirements, the Trump administration has said they’re meant to promote economic stability, self-sufficiency and independence. Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, said in a June news release that the work requirements will help “Americans build skills and independence through work, education, job training or community service, creating new opportunities for themselves and their families.”
The new law overall will cut an estimated $1 trillion from Medicaid over the next 10 years to help pay for tax cuts and enhanced border and national security, the Congressional Budget Office has said.
Though state and local leaders worry that many Illinois residents will lose Medicaid because they don’t meet the new work requirements, they’re also concerned that others who still qualify for Medicaid will lose coverage because of paperwork problems.
HR1 also will require those adults undergo redetermination — the process by which the state decides if they’re still eligible for Medicaid – every six months rather than once a year.
About 55% of almost 2,000 adults with Medicaid across the country said they weren’t aware of the new work requirements, an April survey conducted by The Health Management Academy revealed.
“All of these new requirements increase the steps affected customers must take to keep their coverage …,” Whitehorn said. “The last thing we want is someone to miss a step, a deadline or not understand that they need to take action to keep their coverage and lose their Medicaid when they’re still eligible.”
For now, Whitehorn is urging people on Medicaid to make sure the state has their current addresses and phone numbers so they don’t miss important communications about the changes.
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The state sent out letters in recent weeks to about 700,000 Illinois residents who could be affected, as first reported by the Chicago Sun-Times.
Whitehorn said the department is hoping to automatically renew Medicaid for some of the affected individuals, if it has enough information about them. But if the state doesn’t have enough information, people may be asked to submit more.
Under the changes, people won’t lose coverage Jan. 1, but rather they may have to prove they meet the new requirements when they’re up for redetermination after Jan. 1. Redeterminations happen at different times of the year for different people. The first group of people who will be affected are those whose redeterminations are in March.
Others, however, will lose Medicaid at the end of this month because of a different change within HR1, unrelated to work requirements. HR1 also removes Medicaid eligibility for certain lawfully present immigrants, including refugees, asylees and survivors of human trafficking. In Illinois, about 9,300 people are slated to lose Medicaid by Oct. 1 because they fall into those groups, Whitehorn said.
Cook County Health Chief Medical Officer Dr. Lauren Smith urged people Wednesday to learn more and renew their Medicaid coverage, if possible, even if the paperwork seems difficult. People can go to getmedicaidfacts.com to learn more about the changes and how to prepare for them.
“Please do not sacrifice your health because of fear, uncertainty or inability to pay,” Smith said. “I’ve seen too many patients delay preventive care, skip cancer screenings or ration medications because they couldn’t afford care or were worried about the cost. When routine health needs go untreated the minor and mundane complaints can become serious and even life-threatening emergencies.”