To get part of $50 billion for a federal health program, Illinois promised to join nurse licensure and physician assistant compacts. Will state lawmakers keep that promise?
Illinois could lose millions in federal funds if it does not join the Nurse Licensure Compact and the Physician Assistant Compact by October 2028.
That’s because the state made commitments to those compacts in its application for $193 million annually for the next five years under the Rural Health Transformation Program included in the One Big Beautiful Bill. If it doesn’t comply and health care unions continue blocking the move, the state may have to pay back millions.
The program provides $50 billion in federal funding for states towards rural health initiatives. States had to apply to receive the funds, but the funds were distributed based on commitments made in those applications.
According to the Centers for Medicare & Medicaid Services, Illinois’ application included “[c]ommitment to nurse licensure compact and PA compact” in its policy commitments.
If Illinois does not implement those policies by October 2028, the federal government could claw back the funds distributed based on a failure to keep those commitments.
One-eighth of the $50 billion grant, or $6.25 billion, is distributed based on how a state ranks on specific policy actions in comparison to other states. While the licensure compacts Illinois committed to are only weighted 1.75% of the total score, a drop in those points would translate to millions the state would likely have to pay back.
The good news: The compacts Illinois has committed to implementing are good policy.
In fact, the Prairie State is one of just 10 states that is not a member of the Nurse Licensure Compact. That compact would enable nurses licensed in other participating states to practice in Illinois. That would go a long way towards solving Illinois’ systemic nursing shortage.
Joining the compact would:
- Attract out-of-state nurses to Illinois.
- Expand career opportunities for Illinois nurses.
- Increase telehealth service availability.
- More efficiently allocate nurses during emergencies.
- Provide more access for Illinoisans to receive timely care.
Most of the same principles apply to the Physician Assistant Compact. At least 20 states have joined that compact so far.
The bad news: Illinois nursing unions have managed to block legislation adopting the compact in the past.
But this January, Illinois state Rep. Yolonda Morris, D-Chicago, herself a Certified Nurse Assistant for 26 years, introduced House Bill 4369 to join the Nurse Licensure Compact. State Sen. Sue Rezin, R-Morris, filed Senate Bill 3074 to join the PA Compact.
Despite previous hurdles facing this legislation, lawmakers now have every incentive to pass them. If they do not, they will have to explain to their constituents why the state failed to live up to its promises when the federal government takes back those funds.
