Illinois Medicaid Benefits
Medicaid is a jointly funded state and Federal government program that pays for medical assistance services. Medicaid pays for medical assistance for eligible children, parents and caretakers of children, pregnant women, persons who are disabled, blind or 65 years of age or older, those who were formerly in foster care services, and adults aged 19-64 who are not receiving Medicare coverage and who are not the parent or caretaker relative of a minor child. Primary services funded through Medicaid are physician, hospital and long term care. Additional coverage includes drugs, medical equipment and transportation, family planning, laboratory tests, x-rays and other medical services.
Illinois Medicaid is a state and federally funded program that provides healthcare coverage to eligible low-income individuals and families in the state of Illinois. It is administered by the Illinois Department of Healthcare and Family Services (HFS). The program aims to ensure that low-income individuals have access to necessary medical services, including doctor's visits, hospital care, prescription medications, and other essential treatments.
Medicaid in Illinois covers a wide range of healthcare services, including but not limited to:
- Doctor visits
- Hospital stays
- Laboratory and X-ray services
- Prescription drugs
- Nursing home care
- Home health services
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for children
- Family planning services
- Mental health services
- Substance abuse treatment
- Preventive services
To qualify for Illinois Medicaid, individuals must meet certain income and other eligibility requirements. Eligibility is determined based on factors such as income, household size, age, disability status, and citizenship. Illinois has expanded Medicaid under the Affordable Care Act (ACA), which allows individuals with incomes up to 138% of the federal poverty level to qualify for Medicaid.
The Illinois Medicaid program has undergone several changes and expansions over the years to improve access to healthcare for low-income residents. It is an essential component of the state's healthcare system, providing vital services to individuals and families who might not otherwise be able to afford healthcare coverage.
Who is eligible for Illinois Medicaid?
To be eligible for Illinois Medicaid, you must be a resident of the state of Illinois, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be one of the following:
- Pregnant, or
- Be responsible for a child 18 years of age or younger, or
- Blind, or
- Have a disability or a family member in your household with a disability.
- Be 65 years of age or older.
Illinois Medicaid Income Limits 2023
In order to qualify, you must have an annual household income (before taxes) that is below the following amounts:
|Household Size||Maximum Income Level (Per Year)|
For households with more than eight people, add $7,093 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.
How do I apply for Illinois Medicaid?
To apply for Illinois Medicaid, you can follow these steps:
- Check your eligibility: Before applying, make sure you meet the eligibility requirements for the Illinois Medicaid program. Eligibility is based on factors such as income, household size, age, disability status, and citizenship. You can use the screening tool available on the Illinois Department of Healthcare and Family Services (HFS) website to determine your eligibility.
- Choose an application method: There are several ways to apply for Illinois Medicaid:
- a. Online application: You can apply online through the Illinois Department of Healthcare and Family Services website. Visit the 'Apply for Benefits' page and follow the instructions provided.
- b. In-person application: You can apply in person at your nearest Illinois Department of Human Services (DHS) office or at a local community partner organization.
- c. By phone: You can apply by calling the Illinois Department of Healthcare and Family Services helpline. They can provide assistance and guidance through the application process.
- Gather necessary documentation: Prepare the necessary documentation that may be required during the application process. This may include proof of income, proof of residency, Social Security numbers, and other relevant documents. Make sure to have these documents readily available to expedite the application process.
- Complete the application: Whether you apply online, in person, or by phone, you will need to complete the application form with accurate and up-to-date information. Provide all the necessary details and answer all the questions truthfully.
- Submit the application: After completing the application, submit it as instructed by the application method you chose. If you apply online, you can typically submit the application electronically. If you apply in person or by phone, the representative assisting you will guide you through the submission process.
- Follow up on your application: After submitting your application, you may need to follow up to ensure that it has been received and processed. You might also need to provide additional information or documentation if requested by the Illinois Department of Healthcare and Family Services.
If you have any questions or need assistance with the application process, you can contact the Illinois Department of Healthcare and Family Services or visit their website for more information and resources.Disaster Assistance and Emergency Relief Program Benefits
Illinois Medicaid Program
The Illinois Department of Healthcare and Family Services (HFS) is committed to improving the health of Illinois' families by providing access to quality healthcare. This mission is accomplished through HFS Medical Programs that pay for a wide range of health services, provided by thousands of medical providers throughout Illinois, to about two million Illinoisans each year. The primary medical programs are:
- Medical Assistance, as authorized under the Illinois Public Aid Code (305 ILCS 5/5 et seq.) and Title XIX of the Social Security Act, Medicaid; and
- Children’s Health Insurance, as authorized under the Illinois Insurance Code (215 ILCS 106/1 et seq.) and Title XXI of the Social Security Act, the State Children’s Health Insurance Program (SCHIP).
Necessary medical benefits, as well as preventive care for children, are covered for eligible persons when provided by a healthcare provider enrolled with HFS. Eligibility requirements vary by program. Most people who enroll are covered for comprehensive services, including, but not limited to; doctor visits and dental care, well-child care, immunizations for children, mental health and substance abuse services, hospital care, emergency services, prescription drugs and medical equipment and supplies. Some programs, however, cover a limited set of services.
ACA Adults – under the Affordable Care Act (ACA), adults age 19-64 who were not previously eligible for coverage under Medicaid can now receive medical coverage. Individuals with income up to 138 percent of the federal poverty level (monthly income of $1,366/individual, $1,845/couple) can be covered.
Aid to Aged Blind and Disabled (AABD) Medical covers seniors, persons who are blind and persons with disabilities with income up to 100 percent of the federal poverty level (FPL) and no more than $2,000 of non-exempt resources (one person). Federal matching funds are available under Medicaid for these individuals. More information on how to apply for these programs may be found on the Department of Human Services Website
Department of Children and Family Services (DCFS) – Coverage is provided to children whose care is subsidized by DCFS under Title IV-E (Child Welfare) of the Social Security Act as well as children served by DCFS through its subsidized guardianship and adoption assistance programs. Federal matching funds are available under Medicaid for nearly all of these children. More information on DCFS programs may be found on the DCFS Website.
Former Foster Care – covers young adults under age 26 who were on Medicaid when they left DCFS foster care at age 18 or later. This group is eligible for Medicaid regardless of income.
Coverage for Immigrant Seniors -- For seniors 65 years and older who are not eligible for Medicaid due to their immigration status. This program offers a benefit package with $0 premiums and $0 co-payments. Covered services include doctor and hospital care, lab tests, rehabilitative services such as physical and occupational therapy, home health, mental health and substance use disorder services, dental and vision services, and prescription drugs. Learn more at the Coverage for Immigrant Seniors resource page.Supplemental Nutrition Assistance Program Benefits
Family Health Plans
The All Kids and FamilyCare programs are comprised of five plans: FamilyCare/All Kids Assist; All Kids Share; All Kids Premium Level 1; All Kids Premium Level 2; and Moms and Babies. Children are eligible through 18 years of age. Adults must be either a parent or caretaker relative with a child under 18 years of age living in their home, or be a pregnant woman. For all plans, non-pregnant adults must live in Illinois and be U.S. citizens or legal permanent immigrants in the country for a minimum of five years.
Children and pregnant women must live in Illinois and are eligible regardless of citizenship or immigration status. For more information visit the All Kids and FamilyCare Websites. The All Kids Web site is maintained to provide easily accessible and current information about the program. Families may apply online through both an English and Spanish Web-based application. Both English and Spanish applications are also available for download by persons who want to apply for All Kids by mail.
Those using the Website may also ask questions about the program. Information is provided about All Kids income guidelines/cost sharing, FamilyCare income guidelines and cost sharing, and All Kids Application Agents (AKAAs), who provide assistance to families when applying. FamilyCare/All Kids Assist provides a full range of health benefits to eligible children 18 years of age and younger, and their parents or caretaker relatives.
To be eligible, children must live in families with countable family income within 147 percent of the federal poverty level (FPL). The parents/caretaker relatives are eligible for coverage if the countable income is up to 138% FPL. Children covered under All Kids Assist have no co-payments or premiums. FamilyCare Assist parents have a co-payment per medical service or prescription received.
All Kids Share provides a full range of health benefits to eligible children. To be eligible children must have countable family income over 147 percent and at or below 157 percent of the FPL. Children in All Kids Share have a co-payment for each medical service and prescription received, up to a maximum of $100 per family per year. There are no co-payments for well-child visits and immunizations.
Families with members who are American Indians or Alaska Natives do not pay premiums or co-payments. All Kids Premium Level 1 provides a full range of health benefits to eligible children. For children to be eligible, families must have countable income over 157 percent and at or below 209 percent of the FPL.
Families eligible for All Kids Premium Level 1 pay monthly premiums based upon the number of children covered (ranging from one child to five or more). All Kids Premium Level 1 children have a co-payment for each medical service or prescription received, up to a maximum of $100 per family per year. There are no co-payments for well-child visits and immunizations. Families with children who are American Indians or Alaska Natives do not pay premiums or co-payments. All Kids Premium Level 2 provides a full range of health benefits to eligible children in families with income above 209 percent and at or below 318 percent of the FPL.
Monthly premiums are paid for one child and for two or more children. Co-payments vary by service. Moms and Babies provides a full range of health benefits to eligible pregnant women and their babies up to one year of age. To be eligible, pregnant women must have countable family income at or below 213 percent of the FPL. Babies under one year of age are eligible at any income as long as Medicaid covered their mother at the time of the child’s birth. Moms and Babies enrollees have no co-payments or premiums and must live in Illinois.
Illinois Breast and Cervical Cancer Program (IBCCP) covers uninsured women at any income level who need treatment for breast or cervical cancer. Federal matching funds, at the enhanced rate of 65 percent, are available under Medicaid for women with income up to 200 percent of the FPL. Under the program, the Department of Public Health (DPH) provides screenings for breast and cervical cancer. HFS administers the treatment portion of the program.
Individuals who are not enrolled in IBCCP should call the DPH Women’s Health Line at 1-888-522-1282 (1-800-547-0466 TTY). The Women’s Health Line will be able to walk women through the eligibility requirements and the screening process. Those who are already receiving coverage under the treatment portion of the program may call the HFS IBCCP Unit at 1-866-460-0913 (1-877-204-1012 TTY). Visit the IBCCP Website for more information.
Health Benefits for Workers with Disabilities (HBWD) covers persons with disabilities who work and have earnings up to 350 percent of the FPL who buy-in to Medicaid by paying a small monthly premium. Eligible people may have up to $25,000 in non-exempt resources. Retirement accounts and medical savings accounts are exempt. Federal matching funds are available under Medicaid for these benefits. Comprehensive program information, as well as a downloadable application can be found on the HBWD Website.
Medicare Cost Sharing covers the cost of Medicare Part B premiums, coinsurance, and deductibles for Qualified Medicare Beneficiaries (QMB) with incomes up to 100 percent of the FPL. Medicare cost sharing covers only the cost of Medicare Part B premiums only for persons with incomes over 100 percent of the FPL but less than 135 percent of the FPL under the Specified Low-Income Medicare Beneficiaries (SLIB) or Qualifying Individuals (QI) programs. Resources are limited to $7,280 for a single person and $10,930 for a couple. The federal government shares in the cost of this coverage. Additional information on the Medicare Cost Sharing program can be found on the HFS Medical Brochures page.
Pay-In Spenddown provides individuals whose income and/or assets are too high for regular Medicaid to enroll and pay their spenddown amount to the department, rather than having to accumulate bills and receipts of medical expenses on a monthly basis and provide them to the Department of Human Services, Family Community Resource Center (DHS FCRC). After enrolling in the Pay-In program, monthly statements of the spenddown amount are issued to the client providing the opportunity to meet spenddown through money order, cashier’s check, debit or credit card payment. Additional information on the Pay-In program can be found on the department’s Medical Brochures page.
State Hemophilia Program provides assistance to eligible patients to obtain antihemophilic factor, annual comprehensive visits and other outpatient medical expenses related to the disease. This program does not cover a comprehensive array of health services. Participants must complete a financial application each fiscal year. Some participants may be responsible for paying a participation fee prior to the program paying for eligible medications.
Participation fees are determined by the individual’s family income and family size, and are similar to an annual insurance deductible. The program is always the payer of last resort, meaning that it only pays after other third party payers, such as private insurance or Medicare, have made a benefit determination. The program is available to any non-Medicaid eligible resident of Illinois with a bleeding or clotting disorder. Questions regarding applications or the eligibility of participants in the State Hemophilia Program should be directed to the HFS, Bureau of Comprehensive Health Services at 1-877-782-5565.
State Renal Dialysis Program covers the cost of renal dialysis services for eligible persons who have chronic renal failure and are not eligible for coverage under Medicaid or Medicare. This program does not cover a comprehensive array of health services. Eligibility for the program is reviewed and determined on an annual basis. Participants must be a resident of Illinois, and meet citizenship requirements. The program assists eligible patients who require lifesaving care and treatment for chronic renal disease, but who are unable to pay for the necessary services on a continuing basis.
The program covers treatment in a dialysis facility, treatment in an outpatient hospital setting and home dialysis, including patients residing in a long-term care facility. Individuals determined eligible for the program may be responsible for paying a monthly participation fee based on family income, medical expenses and liabilities, family members, and other contributing factors. All participation fees are paid directly to the dialysis center that provided the treatment. These benefits are financed entirely with state funds. Individuals may learn more or download an application at State Renal Dialysis Program
State Sexual Assault Survivors Emergency Treatment Program pays emergency outpatient medical expenses and 90 days of related follow-up medical care for survivors of sexual assault. This program does not cover a comprehensive array of health services. The program will reimburse an Illinois hospital for a patient’s initial emergency room (ER) visit and for related follow-up care for 90 days following the initial ER visit. If the patient receives a voucher at the hospital for the program’s follow-up program, then the patient can seek their 90 days of follow-up care from the community providers of their choosing.
HFS maintains an online registry for hospitals to register the sexual assault survivor in order to produce a voucher that allows the survivor to obtain needed follow-up care outside of an Illinois hospital. The program is always the payer of last resort, meaning that it only pays after other third party payers, such as private insurance or Medicare, have made a benefit determination. Participants currently eligible for Medicaid are not eligible to receive benefits under this program.
Veterans Care provides comprehensive healthcare to uninsured veterans under age 65 who were not dishonorably discharged from the military, are income eligible, and are not eligible for federal healthcare through the U.S Veterans Administration. Eligible individuals pay a monthly premium of either $40 or $70 depending on their income. Veterans may apply for Veterans Care by either downloading an application from the Web site, or by going to their local Illinois Department of Veterans Affairs Office.
The Department of Healthcare and Family Services determines eligibility, notifies the Veteran and handles the premium payments. Individuals may learn more about this program on the Illinois Veterans Care Web site. Medical Assistance for Asylum Applicants and Torture Victims provides up to 24 months coverage for persons who are not qualified immigrants but who are applicants for asylum in the U.S. or who are non-citizen victims of torture receiving treatment at a federal funded torture treatment center. Such person must meet all other eligibility criteria.
For Persons Using TTY: 1-800-447-6404
Or go to a DHS Family Community Resource Center
In Illinois: 1-866-468-7543
Outside of Illinois: 1-217-785-8036
Persons Using TTY: 1-877-204-1012
Illinois Medicaid Recovery
Medicaid is a State and Federally funded program that offers healthcare access for nearly one out of every four Illinoisans. Some of these services are provided to people as they grow older. Medicaid pays for services that help people stay in their own homes. It also pays for people to live in long-term care facilities when these are appropriate for their care.
To help pay for these long-term services, every state must have a Medicaid Estate Recovery Program. For those who received assistance through the Aid to the Aged, Blind or Disabled (AABD) program, the state of Illinois has the obligation to ask for money back from their estate after they pass away. In some cases, the state may not ask for anything back, and the state will never ask for more money than it paid for services.
Similarly, if you are injured in an accident at work or due to another person's negligence and Medicaid paid for your medical treatment, the state is required by law to seek repayment from the other party's medical or Workers' Compensation insurance carrier. These recoveries along with the Estate Recovery Program help to ensure funds are available to pay for the care and treatment of other Medicaid customers now and in the future.
This program is administered by the Illinois Department of Healthcare and Family Services Bureau of Collections in cooperation with the Illinois Department of Human Services. The information contained on these pages is intended to help answer your questions and provide direction for requesting additional information and assistance. Please note that any differences between actual statutes and the information contained on this site are unintentional; statute language is the definitive source.
More information is available from caseworkers at your local Department of Human Services office. For information call: 1-800-843-6154 Monday through Friday (except state holidays) from 7:30 am – 7:00 pm. Persons using a teletypewriter (TTY) can call toll-free at 1-800-447-6404.Temporary Assistance For Needy Families Program
Illinois Medicaid Renewals Information Center
For Medicaid Customers : There are two ways to change your Medicaid address:
- Click Manage My Case at abe.illinois.gov to:
- Verify your address (under 'Contact Us')
- Find your renewal due date (under 'Benefit Details')
- Complete your renewal when you are due
Resuming Medicaid Renewals
Starting May 2023, we must ask Medicaid customers in Illinois to renew their healthcare coverage. People who use Medicaid have had continuous coverage since the start of the Covid-19 pandemic, but Congress has ended the pause on annual eligibility verifications, known as redeterminations, or simply, renewals.
Renewing My Medicaid Illinois
To keep getting care through HealthChoice Illinois, you are asked to renew your Medicaid coverage every year. It is a simple process just to make sure you are still qualified to receive benefits. You may also know this annual renewal as “redetermination.” Watch your mailbox. When it’s your time for renewal, the Department of Healthcare and Family Services will be sending you a letter with details. Or you can automatically renew at that point if you’re signed up with Manage My Case.
If it is time for you to renew, please don’t delay. If you do not respond, your coverage will automatically end. And all the benefits you’re getting through your health plan will be lost. Learn More. For more information and help with your renewal, visit https://hfs.illinois.gov/medicalclients/medrede.html. Questions about renewing your Medicaid coverage? Call 1-866-255-5437 (TTY: 1-877-204-1012). The call is free! Monday to Friday from 7 a.m. to 7:30 p.m. and Saturday from 8 a.m. to 1 p.m.