Illegal immigrant mystery health tab

SPRINGFIELD -- As the state's unpaid medical bills continue to climb, Illinois has enrolled thousands of undocumented immigrant children into Gov. Rod Blagojevich's All Kids insurance program, yet officials don't know how much taxpayers are spending on their care.

"The figure is not available," Mark Iocca, an attorney handling information requests for the administration, said in responding to a Daily Herald legal request about those costs.

A total of 1.4 million children receive state-provided health care under All Kids. Many of them were previously enrolled in Kid Care, which was folded into the new All Kids program in 2006.

All Kids spent $1.85 billion on children's care in the 2007 budget year. Iocca said fewer than 4 percent of the enrollees were undocumented but said specific cost information was unavailable. He also said 2008 budget information was not available.

The distinction is key as undocumented immigrants' health care generally is not eligible for federal Medicaid dollars. That means Illinois taxpayers foot the bill for the health care of undocumented children.

Critics say such coverage expansions -- especially those with undocumented immigrants -- are overburdening a system that has long had problems paying medical providers on time.

Health care and social service providers have been urging lawmakers for more money simply to continue offering services. Increasingly, groups and doctors who participate in state coverage programs wait months to be reimbursed. A recent state audit found the Blagojevich administration routinely delays nearly $1.5 billion in health care payments from one budget year to the next to balance the books.

Those who provide the services on the state's behalf say the lengthening delays are taking their toll.

For example, in the last decade, the Rev. Frederick Aigner, head of Lutheran Social Services of Illinois, has cut his 4,200-member work force by more than half because of increased costs and late state payments.

"When I can't give them a raise, and I'm asking them to be kind to someone, it's very difficult to keep morale up and to keep providing those crucial services for those people," Aigner said. "And people of power in this state could do something about it. They have the means; now only if they had the will to do something about it."

State Sen. Carole Pankau, a Roselle Republican, introduced legislation that would have forced All Kids applicants to document their immigration status. Those who couldn't wouldn't be enrolled. Those who could would be eligible for federal matching dollars.

In Illinois, children are eligible for All Kids, regardless of their immigration status, if they live in the state, are 18 years or younger and meet certain insurance requirements. While the state is lawfully obligated to ask an All Kids applicant for proof of citizenship, children can be enrolled in the program without showing those documents.

Pankau said her plan could save the state millions.

"It's a good program and those that do qualify should be let into the program --those are the costs that we should all bear," Pankau said. "But in these times when we have limited financial ability, we have to concentrate on those who do belong in the program."

She claims that nearly 60 percent of All Kids applicants have not provided proof of immigration status. Her numbers are based on a 2006 Daily Southtown report that, using state information, examined those who'd signed up in the initial stages of the All Kids expansion.

The Blagojevich administration now says that figure is inflated.

Pankau's Senate proposal has never been called for a vote.

But in the House, lawmakers approved legislation that opponents said could make it easier to enroll undocumented immigrants.

State Rep. Susana Mendoza, a Chicago Democrat, proposed and passed legislation that would allow day labor agencies to serve as All Kids enrollment officers. The measure is now pending in the state Senate.

Critics contend it opens the door for more undocumented immigrants and those with loose ties to Illinois to get taxpayer-provided benefits when the state can't pay its traditional bills.

"We haven't paid our nursing home bills in six months, yet we're opening up an entitlement package to a whole class of individuals who aren't citizens," said state Rep. Chapin Rose, a Mahomet Republican.

The governor's health care aides said covering undocumented immigrant children is the right thing to do. From the beginning of the program two years ago, they've stressed the point is to provide affordable health care for all children in Illinois, without exception. The All Kids Web site, allkids.com, devotes a page to immigration questions and notes that undocumented immigrants who apply for the program will not be reported.

"It would be morally wrong and incredibly shortsighted not to cover every child through this program," said Ruth Igoe, spokeswoman for the Illinois Department of Healthcare and Family Services. "When kids are uninsured, we all pay -- private insurance premiums go up to cover the cost of the uninsured."

But questions about All Kids' costs have prompted lawmakers to call for an audit of the program. On Thursday, the Illinois Senate overwhelming sent the audit request onto the governor. It would have state auditors examine the premiums enrollees pay and who's getting All Kids contracts.

Although state officials say information regarding undocumented All Kids enrollees is not available, they also acknowledge taking extra steps to track their care.

Igoe said the state separates all undocumented immigrants' health claims to make sure they're not submitted for federal funding because they're not eligible.

"The main point is we don't risk losing federal funds because we don't apply for them," Igoe said.

But when asked for specifics on how many of those undocumented cases exist and how much the care has cost, the state wouldn't provide any numbers.

Before the Daily Herald filed a legal request for the information, Igoe declined repeatedly to provide any numbers, saying to do so was like "playing with a political football."

Asked why she wouldn't provide details, Igoe said, "Because this issue becomes so inflammatory so fast."

"At the end of the day," she said, "it's a minuscule number of participants that's undocumented."

All Kids questions

A look at Illinois' All Kids health insurance program. Here are the Illinois Department of Healthcare and Family Services' answers to questions posed by the Daily Herald in a Freedom of Information Act request:

Q. How many children are enrolled in All Kids? A. Approximately 1.4 million.

Q. How many children in All Kids are ineligible for Medicaid because of their citizenship status? A. Less than 4 percent.

Q. What was the fiscal year 2007 cost for All Kids? A. Approximately $1.85 billion.

Q. What was the fiscal year 2007 cost for children enrolled in All Kids who are ineligible for Medicaid because of their citizenship status? A. That figure is not available.

Q. What is the estimated fiscal year 2008 cost for All Kids and the estimated cost for non-citizen portion of All Kids enrollees? A. That figure is not available.