Health & Benefits

Medicaid is a joint state and federal program that pays for medical costs for people with low income. Medicaid covers low-income adults with or without children. There are several different Medicaid programs, including:

• Affordable Care Act Medicaid for Adults,
• All Kids for children up to age 19,
• YouthCare for children whose care is subsidized by the Illinois Department of Children and Family Services (DCFS) or children served by DCFS through guardianship When a person is appointed by a judge to take care of a child or an adult with a disability and adoption When an adult becomes a child's legal parent assistance programs,
• Coverage for young adults under age 26 that were on Medicaid when they left DCFS foster care at age 18 or later
• Moms and Babies, for pregnant women (up to 12 months post-partum and babies
• AABD Medicaid for people who are 65 and older, blind, or disabled,
• Family Health Plans,
• Health Benefits for Immigrant Seniors who are 65 and older,
• Medicare Savings Programs, which help with Medicare Part B premiums, Money that must be paid every month, such as for health insurance
• Non-citizen victims of trafficking, torture, or other serious crimes,
• Breast and Cervical Cancer Program,
• Health Benefits for Workers with Disabilities, and
• Veteran's Care.

This is not a complete list of the available Medicaid programs in Illinois. The Illinois Department of Health and Family Services (IHFS) has a complete list on their website.

In Illinois, Medicaid is available to people who are:

• Children 18 years and younger,
• Parents and caregivers responsible for a child 18 years or younger,
• Low-income adults ages 19 to 64 years,
• Over 65 years,
• Disabled,
• Blind,
• Pregnant, or
• Young adults under age 26 who were formerly in foster care.

IDHS or HFS decides a person’s eligible for Medicaid.

Each group has different income and asset limits. They also have different rules about what kinds of income and assets Anything a person owns that has financial value will count toward these limits.

• For adult Any person 18 years old or over US citizens and eligible non-citizens under 65 and who do not have Medicare, the Medicaid income limit is 138% of the federal poverty level.
• For children, the income limit is 318% of the federal poverty level.
• For pregnant people, and those who have recently given birth, the income limit is 213% of the federal poverty level. They can keep this coverage for up to 12 months after giving birth.

For all of these categories, Illinois’ Medicaid program will look at a household’s size and income based on how many people file taxes or plan to file taxes together. This could include, for example, adult children who are living with their parents. It will then look at countable income from those household members. There is no asset limit for these Medicaid programs.

For adults who are disabled, blind, or age 65 or older (receiving Aged Blind and Disabled AABD benefits) and those who have Medicare benefits, there are different rules. Their countable income must be below 100% of the federal poverty level, and they must have no more than $17,500 of non-exempt resources. Exempt resources are typically assets like a person’s home, a single car, and their personal belongings, some life insurance policies, burial spaces, and more. If someone in this category is over the income or asset limit, they may still qualify for Medicaid with a spend-down. Read more about the income and asset rules for Aged Blind and Disabled (AABD) medical help.

If a person transfers certain kinds of property to someone else to qualify for Medicaid, they could be penalized. For example, if a person is applying for Medicaid coverage for long-term care services, HFS will look at whether they transferred any property in the last five years. If someone transferred property for less than fair market value The price that a normal buyer would pay during that time, they may not be eligible for Medicaid for long-term care for a certain period. Learn more about transferring property and Medicaid for long-term care.

Check with IDHS for the income and resource limits for your type of Medicaid. IDHS has the current standards that are in effect.

Only US citizens and certain non-citizens, such as refugees and people with lawful permanent resident status (LPR or green card) in the US for over five years, qualify for Medicaid.

Note: The non-citizen eligibility requirements for Medicaid will change in October 2026. After the change, some non-citizens who qualified for Medicaid before will no longer be eligible. Refugees, asylees, and victims of trafficking or domestic violence Harm by one household or family member against another household or family member. Harm may be an emotional, mental, or physical injury are losing non-emergency coverage effective October 2026. Medicaid eligibility will be limited to three specific categories of noncitizens: LPRs who have met a 5-year waiting period, Cuban and Haitian family reunification program entrants, and Citizens of the Freely Associated States (Micronesia, Marshall Islands, and Palau). 

In Illinois, these rules do not apply to children 18 years or younger, or to pregnant people.

Non-citizens 65 years or older may be eligible for Illinois' Health Benefits for Immigrant Seniors (HBIS) program. New enrollment is paused for the HBIS program. However, people can continue to receive benefits if they are already enrolled.

People who have applied for or obtained a U-Visa, T-Visa, asylum, or status under the Violence Against Women’s Act (VAWA) might also be eligible for state-funded medical assistance.

If someone cannot Medicaid because of their immigration status, they may be able to buy low-cost insurance. Some noncitizens might be able to get financial assistance through the Get Covered Illinois Marketplace.

Learn more about Government benefits for immigrants.

Medicaid covers medically necessary services for eligible people. Medicaid for children also covers preventive care, such as regular check-ups and shots. 

Illinois has different medical programs, and eligibility requirements are different for each program. Some medical programs cover a limited set of services. Most people covered by Medicaid are covered for comprehensive health care services, though, including:

• Dental care,
• Doctor visits,
• Emergency services,
• Eye care,
• Family planning services and supplies,
• Hospital care,
• Hospice care,
• Long-term care services, such as skilled nursing home care,
• Medical equipment and supplies,
• Mental health care,
• Prescription drugs,
• Substance use disorder services,
• Telehealth services,
• Therapies, such as speech, occupational, or physical therapy, and
• Transportation to medical services.  

This is not a complete list. Also, some services may have special rules or limits. For example, dental care is limited for adults but more comprehensive for children.

Medicaid recipients can learn more about their specific medical program by:

• Calling the number on their medical card to ask about covered benefits,
• Calling the Medicaid Health Benefits Hotline at (800) 226-0768, or
• Reviewing their member handbook, which can generally be found online.

Medicaid covers medically necessary prescriptions and some over-the-counter products. Some drugs require prior approval from HFS. Learn more about Illinois Medicaid prescription coverage on the HFS website.

HFS must approve medications after someone fills four prescriptions in 30 days. This limit generally applies to adults Medicaid recipients. Currently, prescriptions for children under age 19 won’t be rejected because of this policy. Also, residents of Community Integrated Living Arrangements (CILAs) or Supportive Living Facilities (SLFs) won’t be rejected if HFS has person’s living arrangement recorded in their system 

The following types of drugs do not require prior approval:

• Oncolytics, which are used to treat some cancers,
• Anti-retroviral agents, which are used to treat and prevent HIV,
• Contraceptives,
• Immunosuppressives,
• Over-the-counter drugs, and
• Non-drug items such as blood glucose test strips and monitors.

In certain situations, short-term approval will be granted. When HFS is not available to process requests, a pharmacy can give out a 72-hour emergency supply.

There are several ways to check the status of a request:

• Patients may call the Health Benefits Hotline at (800) 266-0768 or (866) 675-8440 (TTY).
• If someone used Illinois Rx Portal to enter a prior approval request, they can check the status of the request in that system.

Learn more about the Four Prescription Policy.

Qualifying for a Medicaid program doesn’t mean a person can go to any doctor for free. Some doctors don't participate in Medicaid. Most people in Illinois on Medicaid are in managed care organizations, depending on where they live. This means they will probably need to choose a network of doctors and hospitals to see with their Medicaid card. Otherwise, they will choose a Primary Care Provider (PCP) who will help coordinate their care. Their PCP will refer them to specialists if they need to see one.

Recipients will receive an enrollment packet after starting Medicaid that explains the process of managed care. The enrollment packet will explain the choices of plans and doctors in their area. People should review the plans and pick the one that is best for them. Once they choose a plan, they might not be able to change plans until the annual open enrollment period. Learn more about managed care.

Some medical care requires prior approval when the patient has a Medicaid plan. Depending on the plan they are on, they may or may not need prior approval. If their plan requires prior approval, their doctor must explain the need for the treatment. Otherwise, their doctor will not receive payment.

This is common for non-routine care. For example, medical equipment or assistive devices.

People may also need prior approval for prescription drugs. The specific Medicaid plan will state whether prior approval is needed for medical care or prescriptions.

People can apply online for Medicaid on the Illinois Application for Benefits Eligibility (ABE) website. They can also apply via mail, in person at an IDHS office, or over the phone. 

If someone is approved, they receive a letter in the mail with information about their medical benefits. Illinois Medicaid does not issue physical Medicaid cards. The approval letter is used to pay for doctor visits and hospital care. It is also used to pay for prescription drugs and other medical care. 

If someone needs to get a new copy of their letter, they can get one online through their Manage My Case account. Or they can visit their local DHS office to ask for another copy.

Learn more about applying for Medicaid.

People have a right to appeal A request to change a court's decision their denial of Medicaid. The deadline for appealing is 60 days after the date of the denial letter. Learn about appealing a Medicaid denial.

The State of Illinois and Cook County Health & Hospitals System (CCHHS) operate a Medicaid managed care program for uninsured adults in Cook County called CountyCare. This is a Medicaid program through the Affordable Care Act (ACA). Recipients of CountyCare get medical care from providers in the CCHHS and others.

To qualify for CountyCare, a person must:

• Live in Cook County,
• Meet income requirements, and
• Be a US citizen or meet certain immigration requirements.

Learn more about CountyCare.

Websites

The Illinois Department of Healthcare and Family Services (HFS) encourages people to apply for and manage their benefits online. There is no penalty for applying even if someone is found ineligible for benefits. People can use this online tool to:

• Check if they might be eligible for benefits,
• Apply for benefits,
• Check their application status,
• View benefit details,
• Report a change,
• Renew their benefits,
• Upload documents, and
• Access the website to appeal A request to change a court's decision their benefits decision.

Information about other ways to apply for Medicaid benefits can be found on the IDHS website.

The ABE Customer Support Page offers resources, including an ABE User Guide, ABE Appeals Guide, instructions on setting up "Manage My Case," answers to frequently asked questions, and more. 

For more information on the various Medicaid programs offered in Illinois, visit the HFS website.

Phone numbers

HFS also offers a benefits hotline where people can get information about:

• Whether they qualify for Medicaid, or
• Whether a healthcare provider participates in Medicaid.

The hotline for most benefits programs is at:

• (866) ALL-KIDS (866-255-5437) toll free, or
• (877) 204-1012 (TTY).

The DHS can help people locate their nearest DHS office or give them other information about health benefits. They can be reached at:

• (800) 843-6154,
• (866) 324-5553 (TTY), or
• Through your local office.

Additional government websites

Social Security Administration

Medicare

Medicaid

Illinois Department of Healthcare and Family Services

Illinois Department of Human Services