Office of the
Illinois Attorney General
Kwame Raoul

Chicago – Attorney General Kwame Raoul today joined a coalition of 14 attorneys general in opposing a proposed rule by the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) that would severely limit an important tool used by state Medicaid programs to increase access to care.

State-directed payments and supplemental payments under fee-for-service Medicaid – referred to in the letter as Healthcare Affordability Payments – help states support hospitals and other healthcare providers, including those serving rural, urban and underserved communities where Medicaid payments often fall short of the cost of providing care. The proposed rule, intended to implement the One Big Beautiful Bill Act, would sharply restrict these payments beyond what Congress authorized and fails to consider the devastating harms to patients and providers that will flow from further Medicaid cuts.

“Instead of working to expand Americans’ access to affordable healthcare, the administration continues to gut essential healthcare programs like Medicaid at every turn,” Raoul said. “I will continue to advocate for all Illinoisans and people across the country to have access to affordable healthcare.” 

In the comment letter, Attorney General Raoul and the coalition argue that the proposed rule: 

• Imposes cuts beyond those required by the One Big Beautiful Bill Act. The proposal arbitrarily cuts Healthcare Affordability Payments for services Congress spared, like mental healthcare and rehabilitation care.
• Undermines Medicaid expansion under the Affordable Care Act (ACA). Medicaid expansion is a crucial tool to counter the cost-of-living crisis, and language in the proposed rule’s preamble pushes states into abandoning Medicaid expansion. To date, 41 states have expanded Medicaid under the ACA.
• Arbitrarily penalizes large, dynamic urban regions. CMS’ narrow definition of a “geographic region” could unfairly disadvantage large, interconnected urban areas and communities where residents routinely live, work and receive healthcare across county or municipal boundaries, such as the metropolitan Chicago region where individuals may work in Chicago but receive healthcare in neighboring Indiana or Wisconsin.
• Increases uncompensated care costs for hospitals. Hospitals may have to raise prices for care to non-Medicaid consumers to compensate for these funding losses, and the loss of Medicaid funding will force other hospitals to reduce services, merge or shutter completely. 

Medicaid is a federal program that helps states provide health insurance and long-term care for about 80 million Americans. About one in five people in the U.S. rely on Medicaid for key services like primary care, mental healthcare, children’s hospitals, nursing facility services, outpatient services and more. The many harmful provisions under the One Big Beautiful Bill Act are already projected to explode the uninsured rates. However, further changes like those in this proposed rule would expand healthcare costs rather than contain them and further weaken states’ healthcare safety net. The result is that more hardworking Illinoisians will lose access to vital healthcare. 

Joining Raoul in sending the letter are the attorneys general of Arizona, California, Colorado, Delaware, Hawaii, Massachusetts, Michigan, New Mexico, New York, Oregon, Rhode Island, Vermont and Washington.