IL Medicaid overhaul effective Jan. 1 sparks backlash
[December 23, 2025]
By Catrina Barker | The Center Square contributor
(The Center Square) – A sweeping Medicaid and maternal-care overhaul
taking effect Jan. 1 draws sharp criticism from Illinois Republicans,
who say Senate Bill 2437 crams too many major policy changes into one
bill and opens the door to costly new mandates.
State Rep. Bill Hauter, R-Morton, said the bill was pushed through as an
end-of-session omnibus with little transparency or input from
Republicans.
“We hate those omnibus bills, said Hauter, who is also a physician.
“These huge Medicaid bills have so many policies shoved into them. We’re
frozen out of the final decision-making.”
Hauter says the most controversial change creates a new category of
noncitizens eligible for Medicaid-style benefits. The bill allows asylum
seekers and people from countries with documented human-rights abuses to
qualify, an expansion he calls a “backdoor” increase in taxpayer-funded
coverage as border encounters rise and many asylum claims are denied.
“In our view, this is just another way to include a disputed group of
immigrants or noncitizens, especially given how the Biden administration
has opened the border and labeled people as asylum seekers when many of
those claims are fraudulent,” said Hauter. “So now Illinois wants to
include those asylum seekers in Medicaid, which will balloon the budget.
To me, it looks like as they closed one door on the immigrant adult
health-care program, they opened another for undocumented or
illegitimate asylum seekers who stayed past their determinations.”
Gov. J.B. Pritzker’s administration ended the Health Benefits for
Immigrant Adults program on July 1, 2025, after costs far exceeded
estimates, freezing new enrollments and phasing it out while keeping
seniors’ coverage.
Supporters frame SB 2437 as expanding maternal support, including doula
care, but Hauter says it asks too much of taxpayers. Though his wife is
a doula and he supports the profession, he argues the bill’s approach is
financially reckless.
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Photo: Alan Wooten / The Center Square
“Not all insurance companies pay for a doula. Usually you pay out of
pocket,” he said. “This bill makes Illinois taxpayers pay for doula
care for Medicaid patients. I don’t think that’s the wisest use of
our health-care dollars.”
What he finds “outrageous,” he said, is that the bill includes
abortion doulas, meaning the state will cover doula services for
individuals undergoing abortions or taking abortion-inducing
medication.
“They’re going to have doulas who will hold your hand while you have
an abortion,” Hauter said. “Not only does Medicaid pay for your
abortion, but now it pays for someone to help you through it. Most
Illinoisans would say that’s way too far.”
Hauter noted that SB 2437’s doula expansion was heavily championed
by state Sen. Lakesia Collins, D-Chicago, as a way to improve
maternal outcomes.
“We are enabling the continuous support for mothers to have a doula
by their side and be able to rely on their services,” said Collins.
“With this legislation, we continue our commitments to the mothers
of Illinois, and especially those on Medicaid, with better support
and more resources available throughout their pregnancy.”
Hauter disputes that the evidence supports such a broad mandate.
“It sounds good, but there’s no hard evidence that doulas improve
maternal and newborn mortality across the board,” Hauter said. “To
extend it to those who have an abortion is really counterintuitive.”
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