Federal funding supports about a third of Illinois’ total All Funds operating budget, funding a variety of programs including health and human services. Changes in federal policy create significant fiscal and operational pressure for the State. The enactment of H.R. 1 represents a shift in the federal-state fiscal relationship, increasing Illinois’ responsibility for administering and financing core health and human services programs that the State previously could depend on the federal…
Cook County’s enacted budget for FY2026 totals $10.0 billion, half of which pertains to Cook County Health (CCH), which provides mandatory health services to County residents and others, including those who cannot afford care elsewhere. This report provides detail and context on Cook County Health’s fiscal impacts on the County as a whole. With preliminary FY2025 financial results now available, state budget deliberations underway, and continued federal policy shocks, the time is right to…
The State of Illinois enters the FY2027 budget process at a pivotal moment. After several years of improved fiscal stability, marked by the reduction of the State’s bill backlog, incremental reserve building, and progress toward mitigating chronic structural deficits, the long-standing baseline fiscal pressures are tightening the State’s finances. While recent federal tax law changes initially raised concerns about substantial revenue losses, the State has taken steps to partially mitigate…
Each fall, the Governor’s Office of Management and Budget (GOMB) issues its Illinois Economic and Fiscal Policy report, which serves as the State of Illinois’ (Illinois or the ‘State’) primary long-term fiscal planning document and an early indicator of whether Illinois is structurally balanced heading into the next budget year. The 2025 edition of the report, released on October 9, 2025, about a month earlier than required by statute, signals an increasingly strained fiscal environment due to…
On July 4, 2025, President Trump signed into law a major budget reconciliation bill that significantly reduces federal Medicaid spending, surpassing the cuts proposed in the House version passed in May. In Illinois, the law is expected to result in a $48 billion (20%) reduction in federal Medicaid funding over ten years. The state anticipates millions in administrative costs to comply with the new mandates, and state officials estimate that roughly 330,000 Illinois residents will lose Medicaid…
Over 3.4 million Illinois residents were enrolled in Medicaid healthcare coverage in Fiscal Year 2024 (FY2024). Of those, 44% were children, 9% seniors, and 7% adults with disabilities. Of those 3.4 million, over 772,000 (23%) are adults who received coverage through the Affordable Care Act.
UPDATE: In the final hours of the lame duck session on January 13, the Illinois General Assembly passed legislation providing for spending up to $150 million annually through fiscal year 2027 to modernize safety net hospitals. Senate Bill 1510, as amended, is similar to the transformation funding proposal described below by the State’s Medicaid agency. A new provision would allow for the creation of a category of safety net institutions that would be eligible for priority funding. Last May the…
A key Illinois Medicaid panel has recommended that the State move away from costly and often ineffective hospital detoxification services to treat opioid addiction. The Medicaid Advisory Committee on August 2 urged the State’s Medicaid agency to revise its reimbursement practices to discourage traditional hospital detox stays and provide financial incentives for evidence-based care such as medication-assisted treatment. The panel also recommended that the Illinois Department of Healthcare and…
Governor J.B. Pritzker’s FY2020 budget features an array of revenue-raising proposals, such as recreational cannabis and sports betting, that have attracted considerable attention. Another idea is less flashy but just as important to next year’s budget: a tax on health insurance plans. As outlined by the Governor, the tax on managed care organizations (MCOs) would generate $390 million to be used in place of general operating funds to pay for State Medicaid costs. The tax would also result in…
A new study by the Kaiser Family Foundation found that Medicaid enrollment declined by 0.6% across the United States in 2018—the first nationwide drop since 2007. The decrease was linked to a stronger economy, which caused more people to gain jobs and health insurance, as well as increased efforts in some states to verify eligibility. The Kaiser study did not provide enrollment information for individual states. Data on the State of Illinois’ website, which is not strictly comparable to the…
