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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB5111

Introduced 2/10/2026, by Rep. Kam Buckner

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5H-1
305 ILCS 5/5H-3
305 ILCS 5/5H-7

Amends the Managed Care Organization Provider Assessment Article of
the Illinois Public Aid Code. In provisions concerning tiered managed care
assessment rates, provides that beginning July 1, 2026, the Department of
Healthcare and Family Services may implement a tax that is based on uniform
rates, determined at a level not to exceed limitations imposed by the
federal Centers for Medicare and Medicaid Services, that may be set at
either a percentage of premium revenue or on a per member per month basis.
Removes a provision requiring any upward adjustment to the Tier 3 rate to
be the minimum necessary to meet federal statistical tests. In the
definition of "member months", removes language exempting enrollment in a
Limited Health Services Organization, a Medicare Supplement Plan, or a
Federal Employee Health Benefits Plan from the calculation of member
months. Expands the definition of "managed care organization" to include
an entity that operates as a preferred provider organization. Effective
July 1, 2026.
LRB104 20230 KTG 33681 b

A BILL FOR

HB5111
LRB104 20230 KTG 33681 b
1

AN ACT concerning public aid.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Illinois Public Aid Code is amended by
5
changing Sections 5H-1, 5H-3, and 5H-7 as follows:

6

(305 ILCS 5/5H-1)
7

Sec. 5H-1.
Definitions.
As used in this Article:
8

"Base year" means the 12-month period from January 1, 2023
9
to December 31, 2023.
10

"Department" means the Department of Healthcare and Family
11
Services.
12

"Federal employee health benefit" means the program of
13
health benefits plans, as defined in 5 U.S.C. 8901, available
14
to federal employees under 5 U.S.C. 8901 to 8914.
15

"Fund" means the Healthcare Provider Relief Fund.
16

"Managed care organization" means an entity operating
17
under a certificate of authority issued pursuant to the Health
18
Maintenance Organization Act or as a Managed Care Community
19
Network pursuant to Section 5-11 of this Code
, or as a
20
preferred provider organization
.
21

"Medicaid managed care organization" means a managed care
22
organization under contract with the Department to provide
23
services to recipients of benefits in the medical assistance

HB5111
- 2 -
LRB104 20230 KTG 33681 b
1
program pursuant to Article V of this Code, the Children's
2
Health Insurance Program Act, or the Covering ALL KIDS Health
3
Insurance Act. It does not include contracts the same entity
4
or an affiliated entity has for other business.
5

"Medicare" means the federal Medicare program established
6
under Title XVIII of the federal Social Security Act.
7

"Member months" means the aggregate total number of months
8
all individuals are enrolled for coverage in a Managed Care
9
Organization during the base year. Member months are
10
determined by the Department for Medicaid Managed Care
11
Organizations based on enrollment data in its Medicaid
12
Management Information System and by the Department of
13
Insurance for other Managed Care Organizations based on
14
required filings with the Department of Insurance. Member
15
months do not include months individuals are enrolled in
a
16
Limited Health Services Organization, including stand-alone
17
dental or vision plans,
a Medicare Advantage Plan
, a Medicare
18
Supplement Plan, or a Federal Employee Health Benefits Plan
.
19
(Source: P.A. 103-593, eff. 6-7-24; 104-2, eff. 6-16-25.)

20

(305 ILCS 5/5H-3)
21

Sec. 5H-3.
Managed care assessment.
22

(a) There is imposed upon managed care organization member
23
months an assessment, calculated on base year data, as set
24
forth below for the appropriate tier:
25

(1) Tier 1: $78.90 per member month.

HB5111
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LRB104 20230 KTG 33681 b
1

(2) Tier 2: $1.40 per member month.
2

(3) Tier 3: $2.40 per member month.
3

(b) The tiers are established as follows:
4

(1) Tier 1 includes the first 4,195,000 member months
5

in a Medicaid managed care organization for the base year;
6

(2) Tier 2 includes member months over 4,195,000 in a
7

Medicaid managed care organization during the base year;
8

and
9

(3) Tier 3 includes member months during the base year
10

in a managed care organization that is not a Medicaid
11

managed care organization.
12

(c) For State fiscal year 2020, and for each State fiscal
13
year thereafter, the Department may adjust rates or tier
14
parameters or both in order to maximize the revenue generated
15
by the assessment consistent with federal regulations and to
16
meet federal statistical tests necessary for federal financial
17
participation.
Beginning July 1, 2026, the Department may
18
implement a tax that is based on uniform rates, determined at a
19
level not to exceed limitations imposed by the federal Centers
20
for Medicare and Medicaid Services, that may be set at either a
21
percentage of premium revenue or on a per member per month
22
basis.

Any upward adjustment to the Tier 3 rate shall be the
23
minimum necessary to meet federal statistical tests.
24
(Source: P.A. 103-593, eff. 6-7-24.)

25

(305 ILCS 5/5H-7)

HB5111
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LRB104 20230 KTG 33681 b
1

Sec. 5H-7.
Rulemaking.
The Department may by rule modify
2
or make adjustments to any methodology, assessment amount,
3
assessment tier, or other similar provision specified in this
4
Article, including broadening the tax base in subsection (a)
5
of Section 5H-3, to the extent necessary to meet the
6
requirements of federal law or regulations, obtain federal
7
approval, or to ensure federal financial participation is
8
available.
However, upward adjustments to Tier 3 rates shall
9
be the minimum necessary to meet federal statistical tests to
10
receive federal financial participation.
The Department shall
11
adopt rules to implement this Article under the Illinois
12
Administrative Procedure Act.
13
(Source: P.A. 101-9, eff. 6-5-19.)

14

Section 99.
Effective date.
This Act takes effect July 1,
15
2026.

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