Up to 330,000 Illinois residents could lose coverage when new rules go into effect Jan. 1, 2027

Cook County Health joined state officials and Cook County leaders today to mark 100 days until federal Medicaid eligibility cuts take effect, urging enrollees to stay engaged with care and stay informed about the upcoming changes.

Beginning in 2027, due to provisions in the federal budget bill House Resolution 1, some Medicaid enrollees will have to:

• Show that they work or volunteer at least 80 hours a month, attend school at least part-time or have an income of at least $580 per month; AND
• Renew their Medicaid coverage every six months (instead of every 12 months)

These new requirements will impact enrollees who are eligible for Medicaid as a result of Affordable Care Act (ACA) Medicaid expansion, also known as “ACA adults.” ACA adults are 1) between ages 19-64, 2) do not also have Medicare and 3) have no dependent children living at home.

“Getting the word out now about these changes is key to minimizing coverage loss for Medicaid customers,” Illinois Department of Healthcare and Family Services (HFS) Director Elizabeth M. Whitehorn said. “HFS is committed to ensuring that everyone who is eligible gets and maintains healthcare coverage and to mitigating the harm these federal changes will cause as much as possible by working with all stakeholders to ensure that those served by Medicaid are aware of what is changing and how they can comply with the federal requirements.”

These changes are estimated to cause up to 330,000 Illinoisans to lose healthcare coverage, half of whom reside in Cook County.

Cook County Board President Toni Preckwinkle and Cook County Health Chief Executive Officer Dr. Erik Mikaitis spoke about the impact these changes will have on the health system. Cook County Health is estimating an increase of $100 million in charity care in 2027, in comparison to 2026.

“Cook County will not stand by while federal cuts put care out of reach for our residents. We are stepping up to protect our health system and its mission to care for everyone, regardless of their ability to pay because the need is only growing,” President Preckwinkle said. “But no county can absorb these cuts alone. We are calling on our partners across the county, including the news media, community organizations and elected officials, to help us reach every resident affected by these new requirements, so no one loses coverage they are entitled to.”

“Cook County Health has long had a historic mission to care for anyone who needs us, regardless of insurance status or ability to pay,” Dr. Mikaitis said. “But these changes will undoubtedly put a strain on our resources. Make no mistake, though, this is not an issue that will be constrained to just safety-net health systems. Everyone will be impacted – the commercially insured, the entire healthcare ecosystem, our business sector. Everyone.”

Cook County Health and CountyCare, the health system’s Medicaid managed care plan, have been working to educate enrollees and the community about the upcoming changes via meetings with local leaders, interactive online discussions and public redetermination events available to all Medicaid enrollees.

“We want our members to know: we are here for you, and we will continue to be here for you as you navigate these changes,” said Aaron Galeener, chief administrative officer for CountyCare. “If you need support with meeting or understanding these new changes, do not hesitate to reach out to your health plan. Whether it’s CountyCare or another HealthChoice Illinois plan, please contact us for help.”

In September 2025, Cook County Health convened the first meeting of the Medicaid Impact Workgroup, comprised of representatives from state and local agencies, healthcare and social service providers, insurers, businesses, academia and community organizations. The workgroup’s singular goal is to help eligible individuals in Cook County keep their Medicaid coverage despite federal cuts and policy changes. 

One of the workgroup’s first outputs was the launch of Get Medicaid Facts, a microsite and communications toolkit designed to help enrollees, community organizations, healthcare providers, insurers and public agencies prepare for the upcoming changes to Medicaid eligibility.

The site has had more than 110,000 unique visitors since it was launched in April 2026.

Cook County Health has also launched a website for patients and residents with a consolidated resource list for free and low-cost healthcare information, food, housing and immigration resources. That site is located at cookcountyhealth.org/resources.

“As an emergency room doctor, I’ve seen too many patients delay preventive care, skip cancer screenings or ration medications because they couldn’t afford care or were worried about the cost,” said Dr. Lauren Smith, chief medical officer of Cook County Health. “When routine health needs go untreated, minor and mundane complaints can become serious — and even life-threatening — emergencies. If you’re unsure what these changes mean for you, Cook County Health is here to help you navigate them.”