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HB 5111

Illinois House•In House Committee

Summary

HB 5111, “DHFS-MCO PROVIDER ASSESSMENT”, was introduced in the House on Feb 5, 2026 by Rep. Kambium Buckner (D). It was referred to Rules, and last saw action on Mar 27, 2026: Rule 19(a) / Re-referred to Rules Committee.

Record

Text

HB 5111 has no co-sponsors and has not gone to a roll call.

hb5111/introduced.txt
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Full Text of HB5111
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	HB5111 - 104th General Assembly
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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
    AN ACT concerning public aid.
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
    Section 5. The Illinois Public Aid Code is amended by
changing Sections 5H-1, 5H-3, and 5H-7 as follows:
    (305 ILCS 5/5H-1)
    Sec. 5H-1. Definitions. As used in this Article:
    "Base year" means the 12-month period from January 1, 2023
to December 31, 2023.
    "Department" means the Department of Healthcare and Family
Services.
    "Federal employee health benefit" means the program of
health benefits plans, as defined in 5 U.S.C. 8901, available
to federal employees under 5 U.S.C. 8901 to 8914.
    "Fund" means the Healthcare Provider Relief Fund.
    "Managed care organization" means an entity operating
under a certificate of authority issued pursuant to the Health
Maintenance Organization Act or as a Managed Care Community
Network pursuant to Section 5-11 of this Code, or as a 
preferred provider organization.
    "Medicaid managed care organization" means a managed care
organization under contract with the Department to provide
services to recipients of benefits in the medical assistance
		HB5111	- 2 -	LRB104 20230 KTG 33681 b
program pursuant to Article V of this Code, the Children's
Health Insurance Program Act, or the Covering ALL KIDS Health
Insurance Act. It does not include contracts the same entity
or an affiliated entity has for other business.
    "Medicare" means the federal Medicare program established
under Title XVIII of the federal Social Security Act.
    "Member months" means the aggregate total number of months
all individuals are enrolled for coverage in a Managed Care
Organization during the base year. Member months are
determined by the Department for Medicaid Managed Care
Organizations based on enrollment data in its Medicaid
Management Information System and by the Department of
Insurance for other Managed Care Organizations based on
required filings with the Department of Insurance. Member
months do not include months individuals are enrolled in [a ]
[Limited Health Services Organization, including stand-alone ]
[dental or vision plans,] a Medicare Advantage Plan[, a Medicare ]
[Supplement Plan, or a Federal Employee Health Benefits Plan].
(Source: P.A. 103-593, eff. 6-7-24; 104-2, eff. 6-16-25.)
    (305 ILCS 5/5H-3)
    Sec. 5H-3. Managed care assessment.
    (a) There is imposed upon managed care organization member
months an assessment, calculated on base year data, as set
forth below for the appropriate tier:
        (1) Tier 1: $78.90 per member month.
		HB5111	- 3 -	LRB104 20230 KTG 33681 b
        (2) Tier 2: $1.40 per member month.
        (3) Tier 3: $2.40 per member month.
    (b) The tiers are established as follows:
        (1) Tier 1 includes the first 4,195,000 member months
    in a Medicaid managed care organization for the base year;
        (2) Tier 2 includes member months over 4,195,000 in a
    Medicaid managed care organization during the base year;
    and
        (3) Tier 3 includes member months during the base year
    in a managed care organization that is not a Medicaid
    managed care organization.
    (c) For State fiscal year 2020, and for each State fiscal
year thereafter, the Department may adjust rates or tier
parameters or both in order to maximize the revenue generated
by the assessment consistent with federal regulations and to
meet federal statistical tests necessary for federal financial
participation. Beginning July 1, 2026, the Department 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. [Any upward adjustment to the Tier 3 rate shall be the ]
[minimum necessary to meet federal statistical tests.]
(Source: P.A. 103-593, eff. 6-7-24.)
    (305 ILCS 5/5H-7)
		HB5111	- 4 -	LRB104 20230 KTG 33681 b
    Sec. 5H-7. Rulemaking. The Department may by rule modify
or make adjustments to any methodology, assessment amount,
assessment tier, or other similar provision specified in this
Article, including broadening the tax base in subsection (a)
of Section 5H-3, to the extent necessary to meet the
requirements of federal law or regulations, obtain federal
approval, or to ensure federal financial participation is
available. [However, upward adjustments to Tier 3 rates shall ]
[be the minimum necessary to meet federal statistical tests to ]
[receive federal financial participation.] The Department shall
adopt rules to implement this Article under the Illinois
Administrative Procedure Act.
(Source: P.A. 101-9, eff. 6-5-19.)
    Section 99. Effective date. This Act takes effect July 1,
2026.

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.

Sponsors

Rep. Kambium Buckner (D) sponsors HB 5111 alone.

Kambium Buckner

Rep. · D–26 · Sponsor

Committees

HB 5111 went before 2 committees: Rules and Human Services.

Rules
Rules
Referred to · Feb 10, 2026 · 5,290 Bills
Human Services
Human Services
Referred to · Mar 4, 2026

History

HB 5111 has taken 5 actions since Feb 5, 2026, the latest on Mar 27, 2026.

ChamberAction
Mar 27, 2026
House
Rule 19(a) / Re-referred to Rules Committee
Mar 4, 2026
House
Assigned to Human Services Committee
Feb 10, 2026
House
First Reading
Feb 10, 2026
House
Referred to Rules Committee
Feb 5, 2026
House
Filed with the Clerk by Rep. Kam Buckner

Votes

HB 5111 has not gone to a roll call.

Source: ilga.gov · legiscan.com