Last updated: January 2008

Young adults in Illinois may qualify for Medicaid. Medicaid, which is run by the Illinois Departments of Human Services and Public Aid, provides payment for certain medical services and equipment.

Am I eligible for Medicaid?

Young adults in Illinois may be eligible for Medicaid if they are in one of the following groups:

Also, young adults must be United States citizens or in an eligible group of immigrants.

Medicaid eligibility decisions are handled by the Illinois Department of Human Services (IDHS). Medical service and item coverage issues are handled by the Illinois Department of Public Aid (IDPA).

Unlike most states, persons who get SSI disability benefits must apply separately at an IDHS office and meet stricter eligibility guidelines to get Medicaid. In other words, getting SSI does not mean you will be eligible for Medicaid in Illinois.

What are the income and asset limits for Medicaid?

IDHS looks at a young adult’s income to determine Medicaid eligibility. IDHS, however, will not consider the income and assets of parents in determining Medicaid eligibility once the young adult turns age 18.

The income rules for persons with disabilities are as follows: $25 deduction from all income and an earned income deduction, counting only net income (what is left after the payroll deductions for taxes, etc.), of $30 of the first $60 in earned income (for blind individuals, $85 plus 1/2 of the amount over $85). Any impairment related work expenses may also be deducted. SSI income, however, is not counted. Social Security income is counted except for adult disabled children.

Countable income is compared to the income limits listed in the table below (in 2008):

Young adults whose countable income falls below these levels will qualify for a Medicaid card automatically each month, so long as all other eligibility requirements are met.

Young adults whose countable monthly incomes are above these levels may still be eligible for Medicaid under two separate provisions: the § 1619 program and the spenddown program (each discussed below).

Young adults must also meet an asset test. Their countable assets (resources) cannot exceed $4,000 for one person, or $6,000 for a family of two or more. Assets that are not counted include a house; a motor vehicle up to $4,500 equity value (unlimited if necessary for medical treatment, modified for handicapped, or needed for employment); personal belongings; and household furnishings.

What is spenddown?

Young adults whose income and/or assets are higher than the limits described above may still qualify for Medicaid coverage under the spenddown program. When a Medicaid applicant is over the income and/or asset limits, IDHS is required to figure out the amount by which income and/or assets are over the limits. This amount is called the spenddown amount. The spenddown amount works like an insurance deductible - this means that Medicaid will pay for the cost of additional medical care in a month once the spenddown amount has been met. To meet the spenddown amount, a young adult, once enrolled in Medicaid, must show IDHS all the bills or receipts for medical care, drugs, or supplies in an amount that equals or goes over the spenddown amount.  (Unlike a deductible, the spenddown amount does not have to be paid before a medical card is issued - it only has to be incurred.)

If the spenddown amount is met, the young adult will receive medical coverage for the rest of the month in which the bills or receipts are presented or for a later calendar month if the young adult so chooses. The amounts of bills used to meet the spenddown amount each month are the responsibility of the young adult.

What will Medicaid cover for me?

Covered services for young adults include hospital services, prescription drugs, physician services, optical and eyeglasses, dental, laboratory and x-rays, home health care, long term care, durable and non-durable medical equipment, respiratory equipment and supplies, hospice care, some substance abuse treatment; and community mental health treatment.

Some services and items require prior approval. IDPA has responsibility for coverage and payment issues under Medicaid.

Where do I apply for Medicaid?

Medicaid applications are filed at an Illinois Department of Human Services office. Once filed, IDHS has 45 days to determine Medicaid eligibility (60 days if the person seeks Medicaid because of disability).  Temporary medical cards should be offered if these deadlines are missed by more than 15 days. 

To find the closest office visit the Illinois Department of Human Service's website.

Can I appeal a Medicaid denial?

Persons who apply for Medicaid and are denied eligibility or coverage for medical care may appeal. The appeal must be filed within 60 days of the date of the decision. Generally speaking, once the appeal is filed, the person appealing will have a hearing (either in person or by telephone) with an IDHS hearing officer. If the person loses the hearing, s/he can file a lawsuit in the state circuit court for relief.   To file an appeal, call 1-800-435-0774.

Are there any special coverage areas for Medicaid?

Adult Disabled Children

Young adults who are getting Social Security benefits on the earnings record of a parent may qualify to get Medicaid without a spenddown even if their monthly Social Security payments are higher than the limits set forth above if they meet the following criteria: (1) they get Social Security benefits on a parent’s earning record for a disability that began before age 22; (2) they get SSI benefits previously due to their disability; and (3) SSI benefits were lost due to qualifying for Social Security benefits.

§ 1619 Benefits

Young adults who are getting Medicaid, and start working, are allowed to continue to get Medicaid as long as their incomes do not exceed certain limits. When monthly wages are greater than $940, or if they are no longer eligible for a SSI check because of their monthly earnings, to the point where they are earning about $2,600 a month or $31,200 annually, they are still eligible for Medicaid through Section 1619 of the Social Security Act and administered by DHS. This applies even if the income results in the SSI benefits being reduced to 0. In Illinois, these Medicaid benefits are administered by the DHS. Young adults would also be eligible to get SSI benefits until their monthly income reaches $1,359.

Other Medical Benefits

Young adults, who reside in the City of Chicago, may qualify for Transitional Assistance cash and medical benefits. 

Click below for more information on public benefits:

General Assistance 

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