Time is running out for approximately 4,000 Illinois children who’ve been covered by Illinois’ All Kids Medicaid program. On July 1, they won’t meet the latest eligibility guidelines. The program’s biggest supporters hope to reverse the decision, but Illinois is facing a budget crisis and lawmakers are considering massive Medicaid reform to make ends meet.

The Wright household is wrapping up dinner this weekday night. Vinita Wright cooked fried rice and husband Jim rinses bowls as he loads the dishwasher.

The couple has guardianship over Sara Opsenica, the daughter of a family friend. Sara’s a high school freshman diagnosed with cancer, specifically, non-Hodgkin’s lymphoma. Vinita shows me a bag of liquid Sara gets hooked up to overnight.

VINITA WRIGHT: This is nutrition. We call it TPN. I don’t know what that means. But it’s basically nutrition. There are lipids in it, that’s why it’s white. it’s a fatty substance.

Sara’s prescriptions, hospital visits, chemotherapy have all been paid for underAll Kids. Sara was diagnosed last fall but had been on All Kids for several years. Sara’s father had been unemployed but he’s now a shuttle bus airport driver, and his health insurance coverage is haphazard; he’ll be off it a while, then he’ll have coverage, only to be off again. The family says All Kids has been a relief.

SARA OPSENICA: My dad doesn’t make a lot of money. We just have Social Security because my mom passed away. The All Kids have paid for everything. I don’t think - we have a small co-pay of my prescriptions but I don’t think my dad has gotten any hospital bills.

But things will likely change for Sara because Illinois is making new rules about who can be on All Kids. Families that make 300 percent above the poverty level are getting kicked off. That means the cut-off is about $60,000 for a family of four. President Barack Obama’s health care plan would cover kids like Sara, but not until 2014, and only if the law survives a challenge in the U.S. Supreme Court.

STEPHANIE ALTMAN: It’s not a lot of of people when you think all the people in Illinois, but it is a group of children who generally can’t get insurance any other way.

Stephanie Altman directs programs and policy at a non-profit group called Health and Disability Advocates. She worries what will happen to the 4,300 kids after July 1.

STEPHANIE ALTMAN: The families are working class and working at jobs where health insurance is not offered and the family is kind of living by the rules and doing all the right things and has too much money for Medicaid.

Illinois spends about $14 billion on Medicaid, and All Kids accounts for about $75 million of that. But the program is in trouble in Illinois. Governor Pat Quinn says the state needs to balance the budget, so he wants to cut Medicaid by $2.7 billion.

There’s some legislative support for shaving the state’s Medicaid spending. Here’s state Senator Matt Murphy, a Republican from Palatine.

MURPHY: Illinois right now is in the unique situation of having to cut the largest percentage of their Medicaid overall budget than any state in the country. So we’re going to have to make difficult choices within our Medicaid program and prioritize for whom those dollars should be spent.

Illinois lawmakers are working on Medicaid reform this spring. One idea on the table is to keep All Kids as it is for two more years, until the National Health Care Act kicks in. State Senator Heather Steans is a Democrat from Chicago who supports an extension.

STEANS: You know in the long run it makes a lot more economical sense as well as much better health outcomes to get people in and seeing the doctor regularly, get them their immunizations, make sure they’re doing all their well visits that they can so people are not ending in much more expensive care situations.

Policymakers say the worst case scenario is that families will skip giving medicine to their kids, and those kids will end up in emergency rooms.

Back in Chicago’s West Chesterfield neighborhood, Vinita Wright is considering what will happen to Sara Opsenica, the girl in her care. Vinita says Sara’s chemo treatment should last another 16 months, but All Kids runs out in less than three.

VINITA WRIGHT: There’s so much stress connected to this cancer business…to not have to deal with a whole other several layers of stress having to do with which bill do we attempt to pay first.

Sara’s family is seeking alternatives, hoping maybe another agency can step in to pay the bills.