Though Erica does not qualify for state-funded medical health care for people in the country without legal permission because she is not yet 42 years old, she dedicates her time as a community health worker to inform those who do qualify about how they can enroll.

“It’s a blessing to help others because I know how it feels to have no safety net,” said Erica, a mother of two who did not want to share her last name for privacy reasons.

On Tuesday morning, she and dozens of community health workers and immigrant advocates urged state legislators and Gov. J.B. Pritzker to pass the Healthy Illinois For All bill under the new state budget, set to begin July 1, which would expand Medicaid-like coverage to immigrants 19 to 42 years old who are in the country without legal permission.

If the bill passes, Erica would qualify for state-funded health insurance along with nearly 120,000 other Illinoisans.

But the estimate for the existing program, which provides state-funded health insurance to immigrants 42 and over who are in the country without legal permission, has grown to $1.1 billion — a fivefold increase from the $220 million the state projected in February — and already threatens to blow a hole in Gov. J.B. Pritzker’s $49.6 billion proposal for the budget year that begins July 1, the first of his second term.

Healthy Illinois — a coalition pro-immigrant and health care that advocated for the program’s creation — has lobbied for the passage of the expansion of health care coverage for noncitizens for more than a decade. They argue that the state numbers are inaccurate and that actual spending on the program is half of what the state projects for 2024.

The coalition estimates it would cost $202 million to expand the program to cover adults age 19 to 42, while the state projects a $380 million cost in the first year.

John Bouman, director of Legal Action Chicago, who is leading the policy work for Healthy Illinois, said that the new programs are no different than the expansion to All Kids or The Affordable Care Act.Those two programs “drastically expanded Medicaid eligibility” and are now running fully implemented, he said.

“The price projection is inflated and enrollment is larger than expected because people are doing a good job in enrolling people,” Bouman said.

Department of Healthcare and Family Services Director Theresa Eagleson told a state Senate committee on Monday that the $1.1 billion estimate was produced by actuaries the department uses regularly for both the new program for immigrants and the traditional Medicaid program.

The department asked the actuaries to run new projections early this year after costs were coming in higher than expected, Eagelson told the Senate Executive Appointments Committee.

A department spokeswoman did not respond Tuesday to requests for a more detailed explanation of how it arrived at those projections, but officials previously said the program is also running over budget in the current year, with the total tab now expected to be about $690 million, more than three times what was budgeted.

Tovia Siegel, campaign director for Healthy Illinois said the higher than expected enrollment is a testament to the desperate need of people in the U.S. without legal permission to obtain access to health care and that the price could be higher for the first several years since many of the enrollees may have avoided going to the doctor for most of their lives due to their immigration status and its implications in this country.

“When we hear politicians say that they can’t expand this year, it’s too expensive. Frankly what they’re really saying is they’re OK with immigrants getting sick and dying,” Siegel said.

Tovia Siegel, director of the Healthy Illinois Campaign, speaks during a press conference at Alivio Medical Center on on May 16, 2023, in Chicago.

Advocates that back the program pointed out that most working adults pay taxes even if they live in the country without authorization. And that the state will save money in the long run by avoiding advanced and chronic diseases caused by the lack of access to preventive and primary care or sudden visits to the emergency room, thus costing the state more than the projected cost.

“It is expected that when people had not had coverage, they’re going to deal with program that haven’t been treated. It may cost a little more the first couple of years, but then it backs up,” added Bouman. “It is the same pattern with enrollment, when there is an initial hike but then it stops.”

Illinois was the first state to provide health care coverage for older adults in the county without legal permission in 2020. Several states have followed, including California, which now provides publicly funded coverage for adults 19 and older regardless of their immigration status.

Siegel also added that there has been little information on how the state may be leaving federal money on the table by not getting reimbursement for qualifying emergency health services provided to immigrants without documents. Eagleson told the Senate committee Monday that the department estimates it will be able to recover $67 million from the federal government for emergency services covered since the start of the program and projects $100 million or more in recoverable expenses next year in the state’s health care program for undocumented immigrants.

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Natalie Raghu, a doctor at Erie Family Health said that she has seen firsthand the impact that the program has had on the older community, giving her the ability to diagnose cancer, chronic diabetes and other diseases that could drastically affect a person’s life and therefore their ability to contribute to society.

Passing a bill to provide basic care for all adults in the country without legal permission could have a domino effect to improve the lives of those immigrants, prolonging their working years and the lives of those around them, Raghu said.

“Immigrants pay taxes too,” said Erendira Rendon, instructing the rest of the community members and health care workers to join her in a chorus. “We deserve health care. Health care is a human right!”

Rendon is vice president for the Immigrant Advocacy and Defense Project at Chicago’s Resurrection Project and will be spending her week in Springfield.

Erica joined the chant. She said she will continue to advocate for legislation that humanizes people like herself and her family who immigrated to Chicago with the sole purpose of working and creating a better world for their children; even if she cannot have access to the benefits she has fought for.

Chicago Tribune’s Dan Petrella contributed

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