All Roll Calls
Yes: 245 • No: 84
IllinoisSB2437104th General Assembly (2025–2026)SenateWALLET
MEDICAID-MATERNAL HLTH-DOULAS
Sponsored By: Omar Aquino (Democratic)
Signed by Governor
Summary
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires hospitals and birthing centers to adopt and maintain written policies and procedures authorizing a patient enrolled in the medical assistance program to select an Illinois Medicaid certified and enrolled doula of the patient's choice to accompany the patient within the facility's premises for the purposes of providing support before, during, and after labor and childbirth, and during the patient's entire postpartum stay. Provides that the doula shall be considered part of the patient's care team and shall not be counted as a support person or against any guest quota. Requires hospitals and birthing centers to provide a written copy of their policies and procedures to maternity patients, the facilities' maternity health care providers, and any other person at the patient's request. Requires publication of the written policies on each facility's website. Contains provisions concerning hospital and birthing center liaisons and doulas certification acknowledgment requirements. Permits the Department of Healthcare and Family Services and the Department of Public Health to establish standing recommendations to meet Centers for Medicare and Medicaid Services requirements and ensure access to preventive services, including Medicaid-covered maternal and reproductive health supports and services.
assignmentshealth and human serviceshuman services
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Bill Overview
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30 provisions identified: 20 benefits, 5 costs, 5 mixed.
Crime victims lose one coverage path
The law repeals a medical assistance eligibility path for qualifying foreign-born victims of trafficking, torture, or other serious crimes. It also removes that path for qualifying family members. The former category began January 1, 2018. People who relied on it lose that route to coverage; the provided text gives no repeal date.
Tighter Medicaid rules for long-term care
The law raises the required need score for long-term care applicants from 29 to 37, starting July 1, 2012. This applies to institutional care and home- and community-based care, subject to federal approval. Without that approval, the Department can limit service use or change benefits to achieve similar savings.
Caregiver pay may protect children's Medicaid
With federal approval, Illinois may leave a responsible caregiver's pay for covered care out of a child's Medicaid income test. This authority applies to children receiving or eligible for the specified in-home shift nursing or waiver services. The Department of Healthcare and Family Services must adopt rules to use this option. The law sets no amount of earnings to exclude.
Medicaid adds pregnancy and postpartum supports
Beginning July 1, 2022, eligible Medicaid members receive depression screening coverage for 12 months starting on pregnancy's last day. Screenings must use a state-approved tool. Beginning January 1, 2026, Medicaid covers over-the-counter choline supplements for pregnant members, subject to federal approval. The law sets no dollar limit for those supplements.
Medicaid expands coverage for HPV vaccines
Medicaid covers and pays for FDA-approved human papillomavirus, or HPV, vaccines for people ages 9 through 45. Prior approval for giving the vaccine is prohibited. Coverage also includes people age 46 or older with cervical dysplasia at high risk of returning or worsening, subject to federal approval.
Medicaid patients gain childbirth doula access
Within six months after the act, hospitals with licensed obstetric beds and birthing centers must adopt written doula-access policies. Medicaid patients can bring their chosen Illinois Medicaid-certified and enrolled doula before, during, and after labor and childbirth. Doulas do not count toward support-person or guest limits, though access can be denied when it conflicts with accepted medical practice. Facilities must post policy summaries and contact details online. State health agencies may also issue standing recommendations supporting preventive services, including doulas, lactation consultants, home visitors, and community health workers.
Medicaid patients get cancer care guidance
Care networks must guide cancer patients promptly to comprehensive care and cover at least one accredited cancer program in-network. Since January 1, 2016, adult networks must offer access to at least one breast imaging center certified for excellence. A breast cancer navigation pilot requires initial sites inside and outside metropolitan Chicago. Beginning July 1, 2016, it adds four metropolitan Chicago sites and one each in western, southern, and central Illinois. The state must send and evaluate screening reminders after 18 months without a mammogram for age-eligible members. Primary care providers receive bonuses for meeting state annual-mammogram goals for female patients over age 40; patients do not receive those payments.
Medicaid protects access to addiction treatment
Medicaid covers all FDA-approved medication-assisted treatments prescribed for alcohol or opioid dependence. The listed use controls, prior approvals, lifetime limits, and dose limits do not apply. Prenatal providers who suspect a substance use disorder must immediately recommend referral to a local licensed treatment program or licensed treatment hospital. Medicaid must cover drug abuse or addiction treatment for pregnant recipients. State assistance agencies cannot sanction recipients solely because of substance abuse.
Mental health medicines stay protected
Adults with serious mental illness keep an exception from prior approval and use controls when changing Medicaid programs or managed care plans. They must be stable on a qualifying FDA-approved medicine that was prescribed and approved under their former coverage. The law updates the coverage-change rule for this existing protection.
Payment pathway for certified family caregivers
The law creates a pathway to pay certified family health aides who are responsible caregivers or their chosen helpers, age 18 or older. Recipients must receive or qualify for Medicaid in-home shift nursing through its child health benefit or the specified waiver for medically fragile, technology-dependent people. Certified aides receive an exemption from the relevant nursing-license restriction, and agencies providing their care count as home nursing agencies. Hospitals and children's community-based health centers may provide initial training; home nursing agencies may provide initial and ongoing training. These providers must keep state-required aide records. No part of the program can start until all needed federal approvals arrive, and the law sets no payment amount.
Some immigrants gain limited medical assistance
Subject to available funds, Illinois may cover residents who meet the specified income guidelines but cannot qualify through other listed routes. Qualifying groups include people with specified pending asylum, trafficking-victim, or crime-victim visa applications or appeals, and qualifying family members. People receiving services through a federally funded torture treatment center also qualify. Coverage may last up to 24 continuous months and continue while a qualifying application or appeal remains pending. Approved U-visa holders remain eligible while meeting the other requirements.
Funding helps hospitals reshape community care
Illinois provides a transformation funding pool of up to $150 million annually in state fiscal years 2021–2027, pending federal matching funds. Up to $5 million may support planning and related resources. Proposals from distressed communities or rural areas must reflect community input, collaboration, access and equity goals, measurable results, and minority- or women-led vendor commitments. The state targets specified safety-net, critical-access, distressed-area, cross-provider, and workforce projects, but need not award the amount requested. A hospital receiving transformation payments may become a freestanding emergency center after submitting proof that the project is part of its approved transformation.
Medicaid equipment choices and supplier standards
Medicaid and its managed care plans may offer refurbished equipment through the state assistive technology reuse program. Recipients need a prescription or medical-necessity certificate and cannot already receive the same or similar equipment elsewhere. Equipment must be safely reprocessed, meet needs equally, withstand at least three years of use, and cost less than new equipment including shipping. Specified prosthetic, orthotic, and complex rehabilitation products are excluded, and recipients keep the choice of new equipment. Suppliers must obtain approved accreditation to bill Medicaid within 15 months after the applicable rule takes effect.
Medicaid sets post-hospital care approval rules
Illinois must set criteria for urgent and standard managed care approval requests for post-acute and long-term acute care. The rules govern services provided on or after July 1, 2025. The state must file emergency rules by July 1, 2025, and adopt permanent rules by October 1, 2025.
One application reaches more public benefits
An initial Illinois public assistance application counts as an application for all benefits the applicant may qualify for. Applicants can decline specific benefits in writing. Annual eligibility renewals do not count as initial applications. This rule does not change benefit amounts or eligibility tests.
Job help for eligible noncustodial parents
Beginning July 1, 2025, the Department must arrange employment resources for eligible noncustodial parents through agreements with other state agencies. Resources include job searches, training, placement, job retention, work supports, and state job opportunities. The parent's family must receive child support enforcement services. The parent must have a support order or help establish one, and be unemployed, underemployed, or at risk of nonpayment. Implementation depends on state appropriations and available federal matching funds.
Care homes must post resident protections
Beginning January 1, 2026, long-term care facilities must post information about retaliation complaints and available remedies. Facilities cited for minimum staffing violations must also post notices immediately for 60 consecutive days at required locations and online. These notices must identify the quarter when staffing ratios were not met. Staffing notices are not required within the 10% deviation allowance, and the state may reduce posting requirements or duration based on the facts.
Legal protections supporting doula and preventive services
Hospitals are not liable for a doula's conduct solely because they allow the patient's chosen doula to accompany the patient. This protection covers Illinois Medicaid-certified and enrolled doulas. Hospitals and doulas remain responsible for their own acts or failures to act. Employees of the state healthcare and public health departments also receive protections when issuing standing recommendations for preventive services. Those protections cover civil and criminal liability, plus discipline or other adverse action under the Medical Practice Act.
Screening guidance for Medicaid antipsychotic patients
State healthcare, human services, and public health agencies must develop evidence-based screening guidance for tardive dyskinesia, a movement disorder. The guidance must include structured assessment tools. It concerns providers treating Medicaid patients taking antipsychotic medicines in state-operated residential facilities and community settings. The agencies must consult statewide physician and psychiatrist groups and create provider education materials about the guidance and updates.
Hospital payments follow updated calculation rules
Eligible hospitals received transformation payments in state fiscal years 2019 and 2020 based on their specified 2018 payments. Hospitals with 2017 Medicaid inpatient use of at least 45% received 100%; those at 25% to below 45% received 75%. Hospitals below 25% received 50%. Beginning on the act's effective date, Illinois uses Solventum APR-DRG software for inpatient payments and EAPG software for outpatient payments. Solventum is exclusive unless the state finds it cannot meet required operational or contract terms, allowing consideration of an authorized alternative.
Medicaid payment floors for breast care
Providers must participate in a Department-approved quality improvement program to receive these payment rates. Starting January 1, 2012, screening and diagnostic mammograms are paid at Medicare rates, including higher digital mammography rates. Beginning January 1, 2023, these payments also include breast tomosynthesis, a type of 3D mammogram. Beginning January 1, 2017, breast cancer treatment payments must reach at least 95% of Medicare rates for items included in the quality program. These are provider payments, not cash benefits for patients.
Minimum Medicaid payments for supportive living
Beginning January 1, 2025, Medicaid sets a minimum payment for supportive living services, subject to federal approval. The floor is 54.75% of the average total daily nursing home rate in the Department's defined geographic areas. That average includes the required nursing home add-on payments. Payments go to facilities, not directly to residents.
Some hospitals can share one license
A hospital in an Illinois county with fewer than 325,000 people may apply to operate neighboring-county facilities under one license. A neighboring facility must be separately licensed and acquired through bankruptcy proceedings before the act's effective date. The law adds a licensing option, not a patient payment or coverage benefit.
Closure fees for facilities breaking funding agreements
A healthcare facility that closes in violation of its purchase-of-care funding agreement must pay the agreement's early closure fee. Payment is required before the Health Facilities and Services Review Board considers its closure application. The fee cannot exceed 50% of the funds received under the agreement.
Medicaid providers face claim filing deadlines
Medicaid claims generally must reach the state or its payment processor within 180 days after the claim's latest service date. Late claims are generally ineligible for payment. Exceptions cover specified enrollment delays, state processing errors, retroactive eligibility, and claims where Illinois is not the primary payer.
Stricter enrollment and records for Medicaid providers
Medicaid vendors enter conditional enrollment for one year, or a shorter period based on their risk category. Risk-based screening and oversight apply before enrollment and during that period. The Department can end enrollment without cause, generally without a Department hearing; vendors can reapply without penalty. Providers and dispensers must keep service records for at least six years, or longer when state law requires. If an audit starts during that period, records must remain until the audit ends and every issue is resolved.
Nursing home staffing fines include exceptions
Most listed staff hours count fully toward nursing home staffing ratios; job code 5 counts at 50%, and codes 28, 30, and 31 at 30%. For staffing data beginning January–March 2025, facilities within 10% of staffing requirements receive no violation or penalty. The state may also waive violations and penalties for unforeseen staff call-offs, no more than six times per quarter. Otherwise, fines equal 125% of missing staffing wages and benefits for a first offense, 150% for a second, and 200% for later offenses.
Hospital projects gain exemptions, face funding checks
Hospital transformation projects can qualify for exemptions from state facility planning requirements. Hospitals must submit Department approval linking the project to their transformation to the Health Facilities and Services Review Board. Funded transformation projects must report progress every three months using the Department's form. Reports cover milestones, performance measures, and Business Enterprise Program commitments. The Department can reduce or end payments as the transformation plan allows when those requirements are not met.
Medicaid approval exemptions start later
Certain previously enacted Medicaid managed care requirements apply to services starting July 1, 2026, instead of July 1, 2025. The Gold Card process, which exempts qualifying providers from service approvals, also starts with services on July 1, 2026. The state must adopt Gold Card rules by that date. Plans must notify qualifying providers by June 1 each year for the next state budget year, replacing December 1 notices for the next calendar year. The provided text does not identify the other delayed requirements.
Cancer hospital tax relief shifts other rates
For 2026 and later assessment years, the Department can seek a federal waiver for qualifying nonprofit freestanding cancer hospitals. Hospitals must contract to serve members of at least 50% of the Department's contracted managed care organizations. The waiver request cannot risk continuation of the hospital assessment or authorized payments. With federal approval, qualifying rates generally must be 25% to 50% of other hospitals' rates, with exceptions for federal statistical tests. Other hospital assessment rates must be adjusted to keep total revenue unchanged.
Sponsors & Cosponsors
Sponsor
Omar Aquino
Democratic • Senate
Cosponsors
Adriane L. 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. 1 Senate Concurs
Yes: 36 • No: 19
Senate vote • 6/1/2025
House Floor Amendment No. 2 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
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