HBIA-HBIS
Understanding the healthcare and economic impacts of Illinois’ landmark insurance programs for immigrant older adults
Analyzing Health Benefits for Illinois Immigrants
In 2020, Illinois became the first state in the nation to offer state-funded healthcare coverage for low-income immigrant seniors who are ineligible for federal health insurance programs due to their immigration status through Health Benefits for Immigrant Seniors (HBIS). In 2021, insurance was extended to low-income older adults through Health Benefits for Immigrant Adults (HBIA).
Funded by the National Institutes on Aging, this study aims to understand the healthcare and economic impact of HBIA/HBIS by studying changes in uncompensated care in hospitals and emergency room and hospital utilization in Illinois.
Learn about our latest research on HBIA/HBIS and uncompensated care ▶▶▶▶
What We Wanted to Know
We wanted to understand whether expanding state-funded health coverage to low-income immigrant adults and seniors through HBIA and HBIS reduced hospitals’ uncompensated care. Uncompensated care includes both charity care and bad debt—costs hospitals incur when patients are unable or unwilling to pay and when insurers fail to reimburse. We hypothesized that after HBIA and HBIS were implemented, hospitals in Illinois would see a decline in bad debt, particularly in counties with high enrollment in these programs. Our rationale was that by expanding coverage to previously uninsured populations, hospitals would be more likely to receive reimbursement for care that otherwise would have gone unpaid, thereby reducing their financial burden.
What We Did
We used a difference-in-differences analysis—a standard method in economics—to measure the impact of HBIA and HBIS on hospitals’ uncompensated care from 2017-2023. We compared uncompensated care in hospitals in Illinois (treated state) to hospitals in Wisconsin and Indiana (control states) before and after HBIA/HBIS were passed. Data sources included hospital-level uncompensated care data from the RAND Hospital Data, enrollment data from the Illinois Department of Healthcare and Family Services, and county demographic information from the American Community Survey
What Did We Find?
HBIA/HBIS were associated with an estimated 15% reduction in bad debt*—a key component of uncompensated care—in Illinois hospitals. Notably, we did not observe similar reductions in Wisconsin and Indiana, our control states, suggesting that these changes may have been linked to the implementation of HBIA/HBIS
*importantly, our study results are preliminary and analysis is ongoing*
Widespread Enrollment
HBIS coverage was initially restricted to older adults aged 65+, but was extended to those 55-64 and 42-54 in 2021 and 2022, respectively, through the creation of HBIA. At their peak, approximately 70,000 Illinoisans were enrolled in the programs.
Bad Debt Reduction
From 2020-2023, hospitals in Illinois saw an estimated 15% reduction in bad debt. The largest and most significant reductions occurred in counties with high levels of HBIA/HBIS enrollment.
Hospital Savings
Our preliminary analysis indicates that from 2020-2023, following the implementation of HBIA and HBIS, the average hospital in Illinois may have experienced an estimated annual reduction of $1.5 million in bad debt.
What Does This Mean For You?
HBIA/HBIS provides health insurance and may also save hospitals moeny
Programs like HBIA and HBIS can help close significant healthcare access grants among vulnerable Illinois residents, and might also contribute to cost savings for hospitals by reducing uncompensated care.
The Future of HBIA and HBIS is unclear
In the 2025 Illinois state budget, the governor and legislators are considering eliminating funding for HBIA. Without this program, thousands of Illinois residents would lose coverage—and hospitals might absorb the costs that they had previously saved from the program