In 2020, Illinois became the second state (California did it a year earlier) to extend Medicaid coverage to illegal immigrants. Activists wanted to extend the plan to everyone but in the end the state went with a plan that was limited to those aged 65 and older.

Healthy Illinois pushed state lawmakers to offer health benefits to all low-income immigrants. But the legislature opted instead for a smaller program that covers people 65 and older who are undocumented or have been legal permanent residents, also known as green card holders, for less than five years…

Under federal law, undocumented people are generally not eligible for Medicare, nonemergency Medicaid and the Affordable Care Act’s health insurance marketplace. The states that do cover this population get around that by using only state funds…

The Illinois policy is initially expected to cover 4,200 to 4,600 immigrant seniors, at an approximate cost of $46 million to $50 million a year, according to John Hoffman, a spokesperson for the Illinois Department of Healthcare and Family Services. Most of them would likely be undocumented.

Since then the program has been expanded twice and now covers those aged 42 and older. Some Democrats are pushing to expand that to everyone older than 19 but there’s a problem. The estimated cost of the program has expanded much more quickly than anyone expected.

In February Gov. J.B. Pritzker set aside $220 million for the program in the state budget but just three months later cost estimates expanded to over $1 billion.

The $49.6 billion budget Illinois Gov. J.B. Pritzker introduced in February estimated the cost of a program that provides state-funded health insurance to adult immigrants who are in the country without legal permission at $220 million.

Just three months later, that estimate has grown fivefold, swelling to $1.1 billion and threatening to blow a hole in the Democratic governor’s proposal for the budget year that begins July 1, the first of his second term…

What’s more, the legislature’s bipartisan forecasting commission just lowered its revenue estimate for the current year, essentially erasing a projected budget surplus, after tax receipts dropped substantially in April, compared with the same month last year.

It’s not just the estimate for next year that is way off, it’s also the estimate for this year.

The administration also estimated the current-year expenditures for the program at $220 million, but it has cost over $400 million thus far with two months to go in the fiscal year.

The program has been growing about 10% a month, much faster than anyone expected. A Republican state senator suggested there are costs associated with being the first in the country to do something like this.

Sen. Dave Syverson, R-Cherry Valley, raised concerns over the fact that no other states offer the same level of health care coverage for noncitizens as Illinois. That, he said, could result in ever-increasing enrollment and upward adjustments to cost estimates.

“As Illinois is the only state in the nation that fully covers health care for undocumenteds from age 42 and older, when they’re crossing the border, and they realize they have health conditions, they know there’s one state to come to if you have health issues,” he said at a Thursday news conference. “Illinois now, because of the policies of this state of being a welcoming state, is now being inundated with every sick individual from around the country that’s coming here.”

With no way to pay for this increase, this week Gov. Pritzker put the brakes on the program.

Illinois is pulling back on its program to extend free health care to noncitizens, regardless of immigration status, by pausing enrollment for adults aged 42 to 64, imposing co-pays and reducing reimbursement to some hospitals…

Beginning July 1, the HBIA program, for people between the ages of 42 to 64, will not take new enrollees. HFS said it would also close enrollment before July 1 if the number of individuals enrolled in the program reaches 16,500…

HFS will also put in place co-pays for HBIA and HBIS enrollees for hospital services when they are not eligible for federal match. Program participants would pay a $250 co-pay for inpatient visits, $100 for emergency room visits and 10% co-insurance for any outpatient treatment at a hospital or ambulatory surgery center…

The health care advocacy group Healthy Illinois said Gov. J.B. Pritzker was turning his back on communities and slashing life-saving health care.

So the activists aren’t happy but at least for now it seems Illinois is acknowledging that there’s a significant cost associated with sanctuary policies, one the state can’t currently afford.