Gov. JB Pritzker unveiled a nearly $53 billion spending plan Wednesday that addresses medical debt for over 300,000 Illinoisans, Black maternal health outcomes and care for asylum seekers. [Health News Illinois]

Additionally, Pritzker announced a sweeping proposal on how insurers handle network adequacy and prior authorization that he said would put “power back into the hands of patients and their doctors.”

Under the governor's proposed budget, Illinois would provide $10 million for a program to relieve an estimated $1 billion in medical debt for more than 300,000 Illinois households. The plan mimics an initiative from Cook County, which announced last fall it has erased more than $280 million of medical debt for over 158,000 residents.

“Let’s make this a reality for all of Illinois,” Pritzker said during his State of the State and Budget Address in Springfield. 

The proposal also pledged $23 million to expand maternal healthcare, with just over half of that for a child tax credit intended to help reduce child poverty in low- and middle-income families with children under 3 years old. 

The Department of Public Health would receive $4.4 million to assess Illinois’ maternal mortality rate and create an action plan centered on reproductive care. The Department of Human Services would receive $5 million for a program to connect new moms and babies with resources.

“In Illinois, a serious effort to reduce maternal mortality rates is long overdue,” said Pritzker, noting a state report last fall found Black women are three times more likely to die from pregnancy-related causes than white women. “It’s imperative that we act now, ensuring that as we do, we also reduce and eliminate racial disparities.”

The proposal would also allocate $629 million for programs that provides Medicaid-like coverage for undocumented individuals ages 42 and older. Of the funds, the state would cover an estimated $440 million. About $100 million would come from a federal emergency services match, $50 million from drug rebate payments and $40 million from managed care organization taxes.

Pritzker also called on lawmakers to approve $181.7 million for shelter, healthcare and other services related to asylum seekers coming to the state.

“I won’t pretend any of this is easy, but it would be irresponsible to do anything but come here, lay out the scope of the challenge, tell you what I think we need to do and then work with you to make it happen,” he said.

Recent discussions between the state, Cook County and the city of Chicago estimate the cost to maintain shelters and services for the population will total $321 million for the calendar year. Cook County Board President Toni Preckwinkle has pledged around $70 million to address the shortfall. Chicago officials have not made their intentions known about the city’s financial commitment.

The spending plan also calls for $35 million to continue funding and implementing recommendations from the Children’s Behavioral Health Transformation Initiative. Of that, $31.3 million would go to expand a program that offers services like assessments, crisis stabilization and housing to youth who are at risk of involvement in the child welfare system or the juvenile justice system.

And Pritzker is proposing $23.8 million to establish a state-based Affordable Care Act marketplace, which is set to go live for plan year 2026.

Other parts of Pritzker’s plan include:

• More than $181 million to support unhoused populations seeking shelter and services.
• A $104.4 million increase for a program that supports seniors who receive in-home and community-based services to accommodate caseload growth and utilization, as well as to annualize a rate increase that went into effect this year.
• $50 million for a Medicaid tiered safety-net hospital add-on. 
• Maintaining $18 million to support existing reproductive health initiatives, including a navigation hotline and a learning and training collaborative for providers. 
• $6 million for the Department of Public Health to hire 100 additional staff for licensing, inspecting and certifying that healthcare facilities are compliant with state and federal regulations.

Pritzker used Wednesday’s speech to introduce a plan to implement further regulations on the insurance industry.

The proposal would ban “step therapy,” or the practice of an insurer asking a patient to try a less costly treatment before authorizing the more expensive alternative. It would also bar short-term, limited duration health plans and prior authorization for inpatient adult and children’s mental healthcare.

He said the proposal would also require insurance companies to update their in-network directories of doctors “to reflect the actual availability of healthcare.” It would also prevent insurers from “unfairly increasing rates on consumers," he said.

“I know how hard the insurance industry will fight me on this,” Pritzker said. “But let me be perfectly clear: I am willing to spend serious political capital and put my shoulder to the wheel to get this done. It will save lives and lower healthcare costs for millions of Illinoisans.”

Laura Minzer, president of the Illinois Life and Health Insurance Council, said they look forward to learning more about the governor’s plan and how it will “build on all of the existing insurance reform laws we have negotiated in good faith over the last decade.”

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