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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB5646

Introduced 2/19/2026, by Rep. Robyn Gabel

SYNOPSIS AS INTRODUCED:

Makes appropriations for the ordinary and contingent expenses of the
Department of Healthcare and Family Services for the fiscal year beginning
July 1, 2026, as follows:

General Funds

$8,781,379,200

Other State Funds

$37,892,170,000

Federal Funds

$775,000,000

Total

$47,448,549,200

OMB104 00202 JCB 10202 b

HB5646
OMB104 00202 JCB 10202 b
1

AN ACT concerning appropriations.

2

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

4
ARTICLE 1
5

Section 5.
The following named sums, or so much thereof as
6
may be necessary, respectively, are appropriated to the
7
Department of Healthcare and Family Services for the purposes
8
hereinafter named:
9
PROGRAM ADMINISTRATION
10
Payable from General Revenue Fund:
11

For Personal Services
............................
20,320,500
12

For State Contributions to
13

Social Security
..................................
1,554,500
14

For Contractual Services
..........................
1,760,100
15

For Travel
..........................................
101,200
16

For Commodities
...........................................
0
17

For Printing
..............................................
0
18

For Equipment
.............................................
0
19

For Electronic Data Processing
...................
13,165,000
20

For Telecommunications Services
...........................
0
21

For Operation of Auto Equipment
......................
34,000
22

For Deposit into the Public Aid
23

Recoveries Trust Fund
...........................
48,995,000

HB5646
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1

Total

$85,930,300
2
Payable from the HFS Technology Initiative Fund:
3

For Costs Associated with the Illinois
4

Health and Human Services Innovation
5

Incubator Program, including Operational
6

and Administrative Costs
........................
15,000,000
7
Payable from Public Aid Recoveries Trust Fund:
8

For Personal Services
.............................
5,169,200
9

For State Contributions to State
10

Employees' Retirement System
.....................
2,246,300
11

For State Contributions to
12

Social Security
....................................
395,400
13

For Group Insurance
...............................
1,566,400
14

For Contractual Services
..........................
5,367,200
15

For Commodities
.....................................
232,600
16

For Printing
........................................
360,700
17

For Equipment
.....................................
1,248,800
18

For Electronic Data Processing
....................
2,620,800
19

For Telecommunications Services
...................
1,185,000
20

For Costs Associated with Information
21

Technology Infrastructure
.......................
54,754,000
22

For State Prompt Payment Act Interest Costs
..........
25,000
23

Total

$75,171,400
24
OFFICE OF INSPECTOR GENERAL
25
Payable from General Revenue Fund:
26

For Personal Services
.............................
6,690,800

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1

For State Contributions to
2

Social Security
....................................
511,800
3

For Contractual Services
..................................
0
4

For Travel
...........................................
40,000
5

For Equipment
............................................
0
6

Total

$7,242,600
7
Payable from Long-Term Care Provider Fund:
8

For Administrative Expenses
.........................
282,000
9
Payable from Public Aid Recoveries Trust Fund:
10

For Personal Services
............................
11,723,600
11

For State Contributions to State
12

Employees' Retirement System
.....................
5,094,500
13

For State Contributions to
14

Social Security
....................................
896,900
15

For Group Insurance
...............................
3,872,000
16

For Contractual Services
..........................
8,618,500
17

For Travel
..........................................
108,800
18

For Commodities
...........................................
0
19

For Printing
..............................................
0
20

For Equipment
.............................................
0
21

For Telecommunications Services
...........................
0
22

Total

$30,314,300
23
CHILD SUPPORT SERVICES
24
Payable from General Revenue Fund:
25

For Deposit into the Child Support
26

Administrative Fund
.............................
61,800,000

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Payable from Child Support Administrative Fund:
2

For Personal Services
............................
66,708,200
3

For State Contributions to State
4

Employees' Retirement System
....................
28,988,000
5

For State Contributions to
6

Social Security
..................................
5,103,200
7

For Group Insurance
..............................
27,244,800
8

For Contractual Services
.........................
86,850,700
9

For Travel
..........................................
140,700
10

For Commodities
.....................................
292,000
11

For Printing
........................................
360,000
12

For Equipment
.....................................
1,553,100
13

For Electronic Data Processing
...................
16,197,600
14

For Telecommunications Services
...................
1,900,000
15

For Child Support Enforcement
16

Demonstration Projects
.............................
500,000
17

For Administrative Costs Related to
18

Enhanced Collection Efforts including
19

Paternity Adjudication Demonstration
.............
7,500,000
20

For Costs Related to the State
21

Disbursement Unit
...............................
11,500,000
22

For State Prompt Payment Act Interest Costs
..........
50,000
23

Total

$254,888,300
24
PUBLIC AID RECOVERIES
25
Payable from Public Aid Recoveries Trust Fund:
26

For Personal Services
............................
10,657,700

HB5646
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1

For State Contributions to State
2

Employees' Retirement System
.....................
4,631,300
3

For State Contributions to
4

Social Security
....................................
815,300
5

For Group Insurance
...............................
4,333,500
6

For Contractual Services
.........................
12,898,600
7

For Travel
..........................................
107,200
8

For Commodities
...........................................
0
9

For Printing
..............................................
0
10

For Equipment
.............................................
0
11

For Telecommunications Services
...........................
0
12

Total

$33,443,600
13
MEDICAL
14
Payable from General Revenue Fund:
15

For Deposit into the Medicaid Technical
16

Assistance Center Fund
.............................
500,000
17

For Costs Associated with the Critical
18

Access Care Pharmacy Program
....................
10,000,000
19

Total

$10,500,000
20
Payable from Public Aid Recoveries Trust Fund:
21

For Personal Services
............................
18,389,600
22

For State Contributions to State
23

Employees' Retirement System
.....................
7,991,200
24

For State Contributions to
25

Social Security
..................................
1,406,800
26

For Group Insurance
...............................
7,172,800

HB5646
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1

For Contractual Services
.........................
82,597,500
2

For Commodities
...........................................
0
3

For Printing
..............................................
0
4

For Equipment
.............................................
0
5

For Telecommunications Services
...........................
0
6

For Costs Associated with the
7

Development, Implementation and
8

Operation of a Data Warehouse
...................
21,368,200
9

Total

$138,926,100
10
Payable from Healthcare Provider Relief Fund:
11

For Operational Expenses
.........................
73,155,600
12

For Payments in Support of the
13

Operation of the Illinois
14

Poison Center
....................................
4,750,000

15

Section 10.
The amount of $2,383,299,400, or so much
16
thereof as may be necessary, is appropriated to the Department
17
of Healthcare and Family Services from the General Revenue
18
Fund for deposit into the Healthcare Provider Relief Fund.

19

Section 15.
In addition to any amounts heretofore
20
appropriated, the following named amounts, or so much thereof
21
as may be necessary, respectively, are appropriated to the
22
Department of Healthcare and Family Services for Medical
23
Assistance and Administrative Expenditures:
24
Payable from General Revenue Fund:

HB5646
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1

For Medical Assistance Providers and
2

Related Operating and Administrative
3

Costs
.......................................
$6,077,606,900

4

The amount of $0, or so much thereof as may be necessary, is
5
appropriated to the Department of Healthcare and Family
6
Services from the General Revenue Fund for Medical Assistance
7
pursuant to subsections (a-6) and (a-7) of Section 12-4.35 of
8
the Illinois Public Aid Code.

9

The amount of $110,000,000, or so much thereof as may be
10
necessary, is appropriated to the Department of Healthcare and
11
Family Services from the General Revenue Fund for deposit into
12
the Healthcare Provider Relief Fund for Medical Assistance
13
pursuant to subsection (a-5) of Section 12-4.35 of the
14
Illinois Public Aid Code.

15

In addition to any amounts heretofore appropriated, the
16
following named amounts, or so much thereof as may be
17
necessary, are appropriated to the Department of Healthcare
18
and Family Services for Medical Assistance for reimbursement
19
or coverage of prescribed drugs, other pharmacy products, and
20
payments to managed care organizations including related
21
administrative and operation costs:
22
Payable from Drug Rebate Fund
...................
2,000,000,000

HB5646
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1

In addition to any amounts heretofore appropriated, the
2
following named amounts, or so much thereof as may be
3
necessary, are appropriated to the Department of Healthcare
4
and Family Services for costs related to the operation of the
5
Health Benefits for Workers with Disabilities Program:
6
Payable from Medicaid Buy-In Program

7

Revolving Fund
.......................................
892,600

8

Section 20.
In addition to any amount heretofore
9
appropriated, the amount of $25,000,000, or so much thereof as
10
may be necessary, is appropriated to the Department of
11
Healthcare and Family Services from the Medical Interagency
12
Program Fund for i) Medical Assistance payments on behalf of
13
individuals eligible for Medical Assistance programs
14
administered by the Department of Healthcare and Family
15
Services, and ii) pursuant to an interagency agreement,
16
medical services and other costs associated with programs
17
administered by another agency of state government, including
18
operating and administrative costs.

19

Section 25.
In addition to any amounts heretofore
20
appropriated, the following named amounts, or so much thereof
21
as may be necessary, respectively, are appropriated to the
22
Department of Healthcare and Family Services for Medical
23
Assistance and Administrative Expenditures:
24
Payable from Care Provider Fund for Persons

HB5646
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OMB104 00202 JCB 10202 b
1

with a Developmental Disability:
2

For Administrative Expenditures
.....................
300,000
3
Payable from Long-Term Care Provider Fund:
4

For Skilled, Intermediate, and Other Related
5

Long-Term Care Services and Payments
6

to Managed Care Organizations
..................
950,000,000
7

For Administrative Expenditures
...................
6,109,600
8

Total

$956,109,600
9
Payable from Hospital Provider Fund:
10

For Hospitals, Capitated Managed Care
11

Organizations as necessary to comply
12

with Article V-A of the
13

Illinois Public Aid Code, and Related
14

Operating and Administrative Costs
...........
7,900,000,000
15
Payable from Tobacco Settlement Recovery Fund:
16

For Medical Assistance Providers
................
550,000,000
17
Payable from Healthcare Provider Relief Fund:
18

For Medical Assistance Providers
19

and Related Operating and
20

Administrative Costs
........................
21,000,000,000
21

For Medical Assistance Pursuant to
22

subsections (a-6) and (a-7) of Section 12-4.35
23

of the Illinois Public Aid Code
..........................
0
24

For Medical Assistance Pursuant to
25

subsection (a-5) of Section 12-4.35
26

of the Illinois Public Aid Code
................
143,600,000

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1

Total

$21,143,600,000

2

Section 30.
In addition to any amounts heretofore
3
appropriated, the following named amounts, or so much thereof
4
as may be necessary, respectively, are appropriated to the
5
Department of Healthcare and Family Services for Medical
6
Assistance and Administrative Expenditures:
7
Payable from County Provider Trust Fund:
8

For Medical Services
..........................
4,100,000,000
9

For Administrative Expenditures Including
10

Pass-through of Federal Matching Funds
..........
25,000,000
11

Total

$4,125,000,000

12

Section 35.
The following named amounts, or so much
13
thereof as may be necessary, respectively, are appropriated to
14
the Department of Healthcare and Family Services for refunds
15
of overpayments of assessments or inter-governmental transfers
16
made by providers during the period from July 1, 1991 through
17
June 30, 2026:
18
Payable from:
19

Care Provider Fund for Persons
20

with a Developmental Disability
..................
1,000,000
21

Long-Term Care Provider Fund
......................
2,750,000
22

Hospital Provider Fund
............................
5,000,000
23

County Provider Trust Fund
........................
1,000,000
24

Total

$9,750,000

HB5646
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1

Section 40.
The amount of $4,000,000, or so much thereof
2
as may be necessary, is appropriated to the Department of
3
Healthcare and Family Services from the Trauma Center Fund for
4
adjustment payments to certain Level I and Level II trauma
5
centers.

6

Section 45.
The amount of $375,000,000, or so much thereof
7
as may be necessary, is appropriated to the Department of
8
Healthcare and Family Services from the University of Illinois
9
Hospital Services Fund to reimburse the University of Illinois
10
Hospital for medical services.

11

Section 50.
The amount of $5,000,000, or so much thereof
12
as may be necessary, is appropriated to the Department of
13
Healthcare and Family Services from the Medical Special
14
Purposes Trust Fund for medical demonstration projects and
15
costs associated with the implementation of federal Health
16
Insurance Portability and Accountability Act mandates.

17

Section 55.
The amount of $1,000,000, or so much thereof
18
as may be necessary, is appropriated to the Department of
19
Healthcare and Family Services from the Medicaid Technical
20
Assistance Center Fund for all costs, including grants and
21
related operating and administrative costs, associated with
22
the establishment, administration, and operations of the

HB5646
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1
Medicaid Technical Assistance Center.

2

Section 60.
The amount of $475,000,000, or so much thereof
3
as may be necessary, is appropriated to the Department of
4
Healthcare and Family Services from the Special Education
5
Medicaid Matching Fund for payments to local education
6
agencies for medical services and other costs eligible for
7
federal reimbursement under Title XIX or Title XXI of the
8
federal Social Security Act.

9

Section 65.
In addition to any amounts heretofore
10
appropriated, the amount of $10,200,000, or so much thereof as
11
may be necessary, is appropriated to the Department of
12
Healthcare and Family Services from the Money Follows the
13
Person Budget Transfer Fund for costs associated with
14
long-term care, including related operating and administrative
15
costs. Such costs shall include, but not necessarily be
16
limited to, those related to long-term care rebalancing
17
efforts, institutional long-term care services, and pursuant
18
to an interagency agreement, community-based services
19
administered by another agency of state government.

20

Section 70.
The amount of $8,000,000, or so much thereof
21
as may be necessary, is appropriated to the Department of
22
Healthcare and Family Services from the Illinois Health
23
Benefits Exchange Fund for all costs, including but not

HB5646
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1
limited to grants, outreach, operations, and administrative
2
expenses associated with the establishment and operation of
3
the Illinois Health Benefits Exchange and coordinating
4
operations of the Exchange with State medical assistance
5
programs.

6

Section 75.
In addition to any amounts heretofore
7
appropriated, the following named amounts, or so much thereof
8
as may be necessary, respectively, are appropriated to the
9
Department of Healthcare and Family Services for State Prompt
10
Payment Act interest costs:
11
Payable from the General Revenue Fund
...............
5,000,000
12
Payable from Long-Term Care Provider Fund:
.............
10,000
13
Payable from the Hospital Provider Fund:
..............
200,000
14
Payable from the Trauma Center Fund:
...................
10,000
15
Payable from the Money Follows the Person

16

Budget Transfer Fund:
.................................
10,000
17
Payable from the Medical Interagency

18

Program Fund:
........................................
200,000
19
Payable from the Drug Rebate Fund:
....................
200,000
20
Payable from the Tobacco Settlement

21

Recovery Fund:
........................................
10,000
22
Payable from the Medicaid Buy-In Program

23

Revolving Fund:
..........................................
500
24
Payable from the Healthcare

25

Provider Relief Fund:
..............................
5,000,000

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Payable from the Medical Special

2

Purposes Trust Fund:
..................................
50,000

3

Section 80.
The amount of $40,000,000, or so much thereof
4
as may be necessary, is appropriated from the General Revenue
5
Fund to the Department of Healthcare and Family Services for
6
the purpose of updating prospective payment system rates for
7
Federally Qualified Health Centers (FQHCs).

8

Section 85.
The amount of $46,696,000, or so much thereof
9
as may be necessary and remains unexpended at the close of
10
business on June 30, 2026, from a reappropriation heretofore
11
made for such purpose in Article 61, Section 85 of Public Act
12
104-0003, as amended, is reappropriated to the Department of
13
Healthcare and Family Services from the Medical Special
14
Purposes Trust Fund for a demonstration project for preventive
15
health.

16

Section 90.
The amount of $15,000,000, or so much thereof
17
as may be necessary, is appropriated to the Department of
18
Healthcare and Family Services from the Medical Debt Relief
19
Pilot Program Fund for grants and administrative costs
20
associated with a pilot program for the purchase of medical
21
debt incurred by patients.

22

Section 95.
The amount of $85,000,000, or so much thereof

HB5646
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1
as may be necessary, is appropriated to the Department of
2
Healthcare and Family Services from the Healthcare Provider
3
Relief Fund for making loans under the Distressed Hospital
4
Loan Program.

5

Section 100.
The amount of $300,000,000, or so much
6
thereof as may be necessary, is appropriated to the Department
7
of Healthcare and Family Services from the Rural Healthcare
8
Transformation Fund for all costs, including grants and
9
related operating and administrative costs, associated with
10
the Rural Health Transformation Program created under Public
11
Law 119-21, Section 71401, including prior years' costs.

12

Section 999.
Effective date.
This Act takes effect July 1,
13
2026.

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