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Yes: 245 • No: 84
IllinoisSB2437104th General Assembly (2025–2026)SenateWALLET
MEDICAID-MATERNAL HLTH-DOULAS
Sponsored By: Omar Aquino (Democratic)
Became Law
assignmentshealth and human serviceshuman services
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Bill Overview
Analyzed Economic Effects
45 provisions identified: 33 benefits, 5 costs, 7 mixed.
Broader Medicaid reproductive and maternal care
Medicaid covers reproductive health care that is legal in Illinois. Pregnant enrollees get dental care and treatment for drug abuse or addiction. The HPV vaccine is covered for ages 9–45 without prior approval; coverage for some 46+ high‑risk patients can start after federal approval. Family planning presumptive eligibility applies to people at or below 208% of the federal poverty level, with coverage effective no later than December 1, 2022 if CMS approved. State health agencies may set standing recommendations to ensure preventive supports like doulas, lactation consultants, and home visitors are available.
Coverage for special treatments and equipment
Medicaid covers amino acid‑based elemental formulas for eosinophilic disorders and short bowel syndrome when a doctor says they are medically necessary. It covers medically necessary reconstruction to restore appearance after trauma. With federal approval, it covers acupuncture by licensed providers (implementation within 12 months after June 2, 2022). The state can provide refurbished durable medical equipment if it is cheaper, safe, lasts at least three years, and meets your needs; certain devices are excluded. Medicaid can provide dental services and eyeglasses for enrollees in DHS education or job programs, and—after federal approval—CPS can procure eyeglass vendors for Medicaid‑eligible CPS students.
Emergency and post‑stabilization care gets paid
Your Medicaid managed care plan must pay emergency providers even if they are out of network. Payment uses the state’s fee‑for‑service method, including policy adjusters. Plans must also pay for post‑stabilization care when the plan authorized it, when care was given within one hour of a request, when the plan did not respond or could not be reached, or when no affiliated provider was available after disagreement. This protects needed care after an emergency.
Kidney transplants for some noncitizens
Noncitizens with end‑stage renal disease who meet state residency and financial rules and already receive emergency dialysis can get kidney transplant services paid by the Department. Only transplant‑related services are covered, and providers must be prior approved and certified. This coverage began October 1, 2014.
No prior authorization for emergencies
Medicaid managed care plans cannot require prior authorization or concurrent review for emergency care, including inpatient stabilization. The hospital must notify your plan within 48 hours of when the inpatient order is written. If notified in time, review cannot start until you are stabilized, and coverage for that 48‑hour period cannot be denied later.
PACE long‑term care covered by Medicaid
When federal authorities approve it, the Program of All‑Inclusive Care for the Elderly (PACE) becomes a covered Medicaid benefit for eligible seniors. PACE provides full long‑term care and health services under federal and state rules.
Extra $26 per day for supportive living
Supportive living facilities get a $26 per‑day supplemental payment for each occupied bed from April 1, 2021 through March 31, 2022. This relies on enhanced federal Medicaid funds and required approvals. The Department may set rules for how the money is used.
Hospital transformation and access funding
During the transition period ending June 30, 2018, the state set aside at least $290 million a year for hospital access payments. In State fiscal years 2019 and 2020, at least $262.9 million a year funded transformation payments tied to each hospital’s 2017 Medicaid inpatient use rate (100%, 75%, or 50% of prior payments). From SFY 2021 through 2027, up to $150 million a year supports transformation projects, focused on distressed, COVID‑impacted, and rural areas, with up to $5 million for planning.
Stronger Medicaid managed care rules
The Department checks that Medicaid plan networks are big enough and posts how it measures that. Plans must keep accurate provider directories and pay Medicaid‑certified providers listed on past rosters, even if not shown in the current directory. The Department posts each plan’s medical loss ratio every year and quarterly performance reports, plus a six‑month claims analysis. A state portal handles provider disputes with clear timelines. For services on and after July 1, 2025, the Department sets standard prior‑auth, review, and appeal rules, with emergency rules by July 1, 2025 and final rules by October 1, 2025.
Higher and updated Medicaid hospital payments
Starting July 1, 2018, the state increases outpatient high‑volume payments by $79.2 million a year and updates standardized outpatient amounts. Critical Access Hospitals get retroactive adjustments back to July 1, 2018, and other hospitals get recalculated amounts prospectively from March 8, 2019. Supplemental payments from 2014 continue as long as the hospital assessment remains in effect. Inpatient rehab gets a $96 per‑day add‑on. The Department must update reimbursement components on a set schedule and post changes 30 days before they take effect, and certain out‑of‑state Level I trauma centers are included in payment eligibility.
One-time $240M cut to hospital fees
The Department reduces hospital assessments so total assessments fall by $240 million by June 30, 2022. Each hospital’s reduced share is permanently forgiven.
Hospital provider taxes for 2020–2026
Hospitals pay an inpatient assessment equal to $221.50 times occupied bed days minus Medicare bed days from July 1, 2020 through 2026. Hospitals also pay an outpatient assessment equal to 1.525% of outpatient gross revenue. For July–December 2020, each assessment is half the annual amount. The state may later adjust the amounts by a uniform percentage.
Better breast cancer screening and pay
Medicaid pays for low‑dose mammograms: a baseline for ages 35–39, yearly at 40+, and as needed under 40 with risk. When medically needed, it also covers ultrasound and MRI for dense breast tissue. Most screening has no deductibles or copays. Providers in approved programs are paid at Medicare rates for mammography (including digital and, after January 1, 2023, tomosynthesis) and at least 95% of Medicare for breast cancer treatment data elements. Expert panels set quality standards for mammography and treatment to guide state rules.
Better cancer screening and care access
Medicaid networks must include at least one ACR‑certified breast imaging center. Networks must provide patient navigation and outreach, and must include access to an academic, Commission on Cancer‑accredited program in‑network for people diagnosed with cancer. The Department runs a pilot patient navigation program in high‑mortality areas and expands sites over time. The state also reminds eligible women who are overdue for mammograms and pays bonuses to primary care providers who meet screening goals.
Caregiver pay ignored in child Medicaid
With federal approval, the state may ignore income a legally responsible caregiver earns for doing or helping with certified family health aide services when checking a child’s eligibility under the MANG (AABD) income rules. This can keep some children eligible for Medicaid by lowering countable household income.
Certified family health aides: training and pay
Illinois creates a "certified family health aide" role for caregivers age 18+. It applies when the person you care for gets, or can get, in‑home shift nursing under EPSDT or a 1915(c) waiver. The health department sets a certification path and rules, and hospitals and children’s community health centers must give and document initial training for home discharge. You must meet all certification rules to be eligible for payment. HFS can pay certified aides for approved services after federal approval and will set which services are covered.
Higher minimum staffing in nursing homes
Since January 1, 2014, nursing homes must give at least 3.8 hours of nursing and personal care per resident per day for residents needing skilled care. For residents needing intermediate care, the minimum is 2.5 hours per resident per day. These are per‑resident, per‑day floors the state enforces.
Medicaid patients can bring certified doulas
Hospitals with obstetric beds and birthing centers must, within 6 months of this law, let Medicaid patients bring an Illinois Medicaid‑certified, enrolled doula for support before, during, and after birth. Facilities must post their doula policies online and include contact info for doulas and doula organizations. When asked by a facility, a Medicaid‑enrolled doula must show written proof of her Medicaid doula certification and enrollment.
More Medicaid help for moms and kids
Medicaid covers a perinatal depression screening during the 12 months after pregnancy when the state‑approved tool is used. Children on Medicaid can get preventive dental care at school under a state program that started January 1, 2022. Community‑based pediatric palliative care is covered for eligible children. If a clinician suspects a pregnant patient has a substance use disorder, the clinician must recommend an immediate referral to licensed treatment. Starting January 1, 2026, Medicaid covers over‑the‑counter choline supplements for pregnant people, if federal approval is granted.
More Medicaid support for supportive living
Starting Jan. 1, 2025 (with federal approval), supportive living rates are at least 54.75% of the area’s average nursing facility per‑diem, including add‑ons. Dementia‑level supportive living must pay at least 1.5 times the regular rate beginning Jan. 1, 2024 (with federal approval). From Jan. 1, 2025, residents get a $120 monthly personal needs allowance. From July 1, 2025, the two‑meals‑a‑day add‑on is at least $6.15 per day.
More preventive and behavioral health coverage
Medicaid covers tobacco quit help, including approved medications and counseling; phone‑based services start after federal approval. With federal approval, Medicaid covers FDA‑recommended PrEP drugs and related tests and counseling for high‑risk people. Starting January 1, 2024 (subject to federal approval), Medicaid covers cognitive assessments and care planning for people with signs of cognitive impairment under DSM‑5.
Stronger MCO payment and directory rules
Managed care plans must pay clean claims within 30 days or notify the biller, and they owe interest on late payments. Providers on the state’s expedited list must be paid on a faster schedule. If a paper claim is required, providers get at least 90 business days after rejection to fix it, and it can only be denied as late if it is over 180 days from service or past the fix window. Good‑faith services based on the eligibility info on hand cannot be denied later (unless the person was truly ineligible), and rules set minimum payment protections. MCOs must add new practitioners to directories within 30 days after getting a complete roster and IMPACT activation; the law also defines when network liability starts.
Stronger Medicaid addiction treatment support
Medicaid covers all FDA‑approved medication‑assisted treatment for alcohol or opioid dependence since July 1, 2015. These treatments are not subject to prior auth, lifetime caps, or dosage limits beyond ASAM rules. Medicaid also covers naloxone and other opioid antagonists, including devices and fees, with no copay for naloxone. Agencies cannot sanction you only because you have substance use.
Stronger Medicaid dental coverage and rates
Medicaid covers adult dental care starting July 1, 2018, including checkups, cleanings, fillings, and gum care. Targeted adult dental services are paid at least the “New Rate” from the Memisovski Consent Decree. The state must update the orthodontic scoring tool by Jan. 1, 2025 (subject to funding and federal approval). Dental sedation evaluation and deep/IV sedation rates rise 33% on Jan. 1, 2025 (after federal approval). Dental hygienist care at FQHCs is paid at the FQHC encounter rate.
Stronger nursing home staffing checks
At least 25% of nursing and personal care time must be by licensed nurses, and at least 10% by registered nurses. The state uses payroll‑based journal data each quarter to check staffing against legal minimums and aligns job codes with federal rules. It also defines which job codes count and how much of their hours count. Separately, once federal approval is obtained, certified medication aides who meet state qualifications may give medicines in supportive living facilities under an RN’s supervision.
Job help for noncustodial parents
Beginning July 1, 2025, the state connects eligible noncustodial parents to job search, training, and work supports. You must be in child support enforcement, have or be helping set up a support order, and be unemployed, underemployed, or at risk of falling behind. This program runs only if the state appropriates money and a federal match is available.
Gold Card: fewer prior auths for providers
By July 1, 2026, rules require Medicaid MCOs to grant a one‑year “Gold Card” prior‑auth exemption for providers who sent 50+ requests last year with at least a 90% approval rate. It applies to inpatient and outpatient hospital services and excludes pharmacy and DME. The exemption is binding on plans and review vendors, is monitored and reviewed twice a year, and the state can audit. This section ends December 31, 2030.
Medicaid funding for Quitline counseling
The Department takes steps to get federal matching funds so phone‑based counseling through the Illinois Tobacco Quitline can be covered by Medicaid. This requires an interagency agreement, a cost plan, and federal approval.
Targeted boosts for key hospital services
Perinatal Level II and II+ hospitals get the same perinatal adjustor Level III had as of December 31, 2017. Burn inpatient cases get the trauma adjustor that was in effect on that date. Safety‑net hospitals receive higher inpatient rates from July 1, 2014 through December 31, 2023. Starting July 1, 2018, hospitals also get an add‑on for expensive outpatient devices and drugs using a set formula, and at least $113 per outpatient youth psychiatric service when a hospital provides over 500 such services a year (from January 1, 2023). Medicaid pays hospitals at least the public health fee for the metachromatic leukodystrophy newborn test, and, for tests added on or after August 9, 2024, at not less than DPH fees if funds and federal approval are in place.
Stricter need score for long-term care
If federally approved, the state may raise the nursing home level‑of‑care score (DON) from 29 to 37 starting July 1, 2012. This makes fewer people eligible for institutional and home‑ and community‑based long‑term care. If federal approval is not granted, the Department may use other cost‑control changes.
Fines for nursing homes that understaff
Starting July 1, 2025, the state fines nursing homes that miss required staffing. The fine equals 125% of the cost of missing hours for the first offense, 150% for the second, and 200% for the third or later. The Department shows the math and may waive cases with small (10% or less) shortfalls or certain unforeseen call‑offs, with limits.
Tighter Medicaid billing and provider rules
Most DME companies must get CMS‑approved accreditation to bill Medicaid, within 15 months of the rule taking effect. Providers must keep medical records at least six years and longer if an audit starts. New vendor enrollment can be conditional with extra checks like site visits, audits, and background checks. Claims are due within 180 days, with listed exceptions. Agencies may share data to verify eligibility and payments. The state may not require handwritten doctor signatures on lab orders for payment.
Family caregivers can give more care
Certified family health aides, who are the legally responsible caregiver or are designated by that caregiver, may perform certain nursing tasks for people who get or qualify for EPSDT in‑home shift nursing or a 1915(c) waiver for medically fragile, technology‑dependent persons. Home nursing agencies can train these aides and must keep records as the Department requires. Aides may only serve people in those EPSDT or 1915(c) programs.
New provider groups for Medicaid care
The Department can contract with Partnerships of medical providers to serve Medicaid patients. The state sets sponsor qualifications, allows payment surcharges and incentives, and requires prenatal and obstetrical care within physician services. Partners sign written contracts with providers under state rules.
Medicaid hospital payment systems updated
Inpatient Medicaid payments use APR‑DRG version 30 for discharges on and after July 1, 2014, with Solventum as the default software provider. Outpatient Medicaid payments use the EAPG system version 3.7 for services on and after July 1, 2014. The Department sets weighting factors and statewide amounts and posts them at least 10 days before they take effect. The state also builds rate adjusters and Medicare‑style outlier add‑ons for critical inpatient services like trauma, transplant, perinatal care, and GME.
New rules for hospital assessment plans
The Department can adopt rules to reduce hospital assessment rates. It must review any plan to tax hospitals for Medicaid to see if it can meet federal standards and submit a State Plan Amendment to the federal Medicaid agency (CMS). No plan takes effect without approval by the General Assembly.
Special hospital tax waivers and adjustments
Starting in 2026, the state may ask CMS to let certain not‑for‑profit freestanding cancer hospitals pay a lower tax rate (25%–50% of other hospitals), with other rates adjusted to keep the budget neutral. For 2024–2026, the state may create a hypothetical tax for a specialty cancer hospital that changed to nonprofit ownership in 2022 and saw a 60%+ drop in inpatient days (with federal approval). From July 1, 2022 to Dec. 31, 2024, a safety‑net hospital with a 2021 ownership change and a 90% inpatient use drop may qualify for a hypothetical‑tax method if found in financial distress. The Department must calculate, notify, and publish assessment adjustments and apply any extra charges or refunds on a set schedule.
Nursing homes must post retaliation steps
Starting Jan. 1, 2026, long‑term care facilities must post the retaliation complaint process and remedies where residents, staff, and visitors can see them. This makes it easier to find and use complaint steps on‑site.
Volunteer dentists can serve through nonprofits
Subject to federal approval, a dentist who volunteers at no cost can give care through an enrolled nonprofit clinic without enrolling as an individual Medicaid provider. The Department sets rules and a claims process for services rendered through the clinic.
Annual Medicaid reports and staff protections
Each year by the second Friday in April, the Department reports to lawmakers on service use, provider trends, rates, and review efforts for the prior three years, with suggested legislation. State employees who issue standing recommendations under this law are protected from discipline and liability for that action.
Faster rulemaking and pay‑change notice
The Department must give hospitals and Medicaid plans at least 30 days’ written notice before reimbursement updates take effect. It also had temporary emergency rulemaking power to implement a specific Medicaid change for one year after that law’s effective date.
One license for multi‑site hospitals
In some lower‑population counties, a hospital may run more than one location under one license if all sites share one board, medical staff, and CEO. Each building must meet emergency services rules. The Department may waive some other licensing rules for a building when services are provided by another facility under the single license.
Limits on dementia care expansions
For sites not approved by January 1, 2024, an expansion can add at most one elderly non‑dementia unit for each dementia unit. Distance limits apply: not within 4 miles in Cook County, 12 miles in listed counties, and 25 miles elsewhere. These limits apply to new applications at unapproved sites.
Doulas allowed; hospitals keep safety control
Hospitals and birthing centers cannot count a Medicaid‑certified doula against a patient’s guest limit before, during, or after birth. A hospital is not liable just because it allowed a Medicaid‑certified doula to be there. Facilities may limit doula access if it conflicts with accepted medical standards.
Regulatory relief for supportive living facilities
Facilities chosen and in good standing as supportive living facilities are exempt from the Nursing Home Care Act and the Illinois Health Facilities Planning Act. This reduces regulatory requirements for these facilities under Department rules.
Sponsors & Cosponsors
Sponsor
Omar Aquino
Democratic • Senate
Cosponsors
Adriane Johnson
Democratic • Senate
Anna Moeller
Democratic • House
Anne Stava
Democratic • House
Barbara Hernandez
Democratic • House
Camille Y. Lilly
Democratic • House
Celina Villanueva
Democratic • Senate
Cristina Castro
Democratic • Senate
Dagmara Avelar
Democratic • House
Doris Turner
Democratic • Senate
Elizabeth "Lisa" Hernandez
Democratic • House
Graciela Guzmán
Democratic • Senate
Harry Benton
Democratic • House
Javier L. Cervantes
Democratic • Senate
Joyce Mason
Democratic • House
Karina Villa
Democratic • Senate
Katie Stuart
Democratic • House
Kimberly Du Buclet
Democratic • House
Laura Faver Dias
Democratic • House
Lilian Jiménez
Democratic • House
Lisa Davis
Democratic • House
Margaret Croke
Democratic • House
Mark L. Walker
Democratic • Senate
Martha Deuter
Democratic • House
Mary Beth Canty
Democratic • House
Mary Edly-Allen
Democratic • Senate
Matt Hanson
Democratic • House
Mattie Hunter
Democratic • Senate
Maura Hirschauer
Democratic • House
Maurice A. West, II
Democratic • House
Michael Crawford
Democratic • House
Michael W. Halpin
Democratic • Senate
Michelle Mussman
Democratic • House
Mike Porfirio
Democratic • Senate
Mike Simmons
Democratic • Senate
Nabeela Syed
Democratic • House
Nicolle Grasse
Democratic • House
Norma Hernandez
Democratic • House
Rachel Ventura
Democratic • Senate
Robert F. Martwick
Democratic • Senate
Robert Peters
Democratic • Senate
Sara Feigenholtz
Democratic • Senate
Sharon Chung
Democratic • House
Suzanne M. Ness
Democratic • House
Terra Costa Howard
Democratic • House
Theresa Mah
Democratic • House
Tracy Katz Muhl
Democratic • House
Will Guzzardi
Democratic • House
Willie Preston
Democratic • Senate
Roll Call Votes
Senate vote • 6/1/2025
House Floor Amendment No. 2 Senate Concurs
Yes: 36 • No: 19
Senate vote • 6/1/2025
House Floor Amendment No. 1 Senate Concurs
Yes: 36 • No: 19
House vote • 5/31/2025
Third Reading - Standard Debate - Passed
Yes: 76 • No: 39
House vote • 5/31/2025
House Floor Amendment No. 1 Recommends Be Adopted Human Services Committee;
Yes: 8 • No: 4
House vote • 5/31/2025
House Floor Amendment No. 2 Recommends Be Adopted Rules Committee;
Yes: 3 • No: 2
House vote • 5/7/2025
Do Pass / Short Debate Human Services Committee;
Yes: 10 • No: 0
Senate vote • 4/10/2025
Third Reading - Passed;
Yes: 56 • No: 0
Senate vote • 4/8/2025
Senate Floor Amendment No. 2 Recommend Do Adopt Health and Human Services;
Yes: 11 • No: 0
Senate vote • 3/19/2025
Do Pass Health and Human Services;
Yes: 9 • No: 1
Actions Timeline
Public Act . . . . . . . . . 104-0009
6/16/2025SenateEffective Date January 1, 2026; Some Provisions
6/16/2025SenateEffective Date June 16, 2025; Some Provisions
6/16/2025SenateGovernor Approved
6/16/2025SenateSent to the Governor
6/11/2025SenateAdded as Co-Sponsor Sen. Mattie Hunter
6/1/2025SenatePassed Both Houses
6/1/2025SenateSenate Concurs
6/1/2025SenateHouse Floor Amendment No. 2 Senate Concurs 036-019-000
6/1/2025Senate3/5 Vote Required
6/1/2025SenateHouse Floor Amendment No. 1 Senate Concurs 036-019-000
6/1/2025Senate3/5 Vote Required
6/1/2025SenateHouse Floor Amendment No. 2 Motion to Concur Be Approved for Consideration Assignments
5/31/2025SenateHouse Floor Amendment No. 1 Motion to Concur Be Approved for Consideration Assignments
5/31/2025SenateHouse Floor Amendment No. 2 Motion to Concur Referred to Assignments
5/31/2025SenateHouse Floor Amendment No. 2 Motion to Concur Filed with Secretary Sen. Omar Aquino
5/31/2025SenateHouse Floor Amendment No. 1 Motion to Concur Referred to Assignments
5/31/2025SenateHouse Floor Amendment No. 1 Motion to Concur Filed with Secretary Sen. Omar Aquino
5/31/2025SenatePlaced on Calendar Order of Concurrence House Amendment(s) 1, 2 - May 31, 2025
5/31/2025SenateSecretary's Desk - Concurrence House Amendment(s) 1, 2
5/31/2025SenateChief Sponsor Changed to Sen. Omar Aquino
5/31/2025SenateAdded Alternate Co-Sponsor Rep. Harry Benton
5/31/2025HouseAdded Alternate Co-Sponsor Rep. Laura Faver Dias
5/31/2025HouseThird Reading - Standard Debate - Passed 076-039-000
5/31/2025HouseChair Rules placed on Standard debate.
5/31/2025House
Bill Text
Engrossed
Enrolled
House Amendment 1
House Amendment 2
Introduced
Senate Amendment 1
Senate Amendment 2