Health & Benefits

Medicaid is a state and federal health insurance program for low-income and disabled US citizens and resident aliens. If you get Social Security Disability Income (SSDI) or Supplemental Security Income (SSI) because of a disability, then you may be eligible for Medicaid. In Illinois, you must apply for Medicaid even if you receive SSDI or SSI. You also need to reapply or get a redetermination of disability every year.

To qualify as disabled, you must have a medical or mental disability that prevents you from being gainfully employed for at least a year or is expected to result in your death. To check whether you may be eligible for Medicaid and what proof is needed to establish your disability, visit the Illinois Application for Benefits Eligibility (or ABE) website.  

If your Medicaid benefits are denied or terminated, you will get a letter telling you how to appeal. Read the appeal instructions carefully to protect your rights. Be sure to appeal on time. If appeal instructions were not included, ask for a copy of them. 

Generally, you must appeal a Medicaid benefits decision within 60 days of the date of the notice. If you already had Medicaid, you may be able to keep your benefits during the appeal. For your Medicaid benefits to continue during your appeal, you must appeal before the Date of Change on the written notice or within 10 calendar days of the date of the notice. Learn more about appealing a Medicaid decision. 

Sometimes, you can receive a denial because you failed to give all of the requested documents in time. If so, you should have 60 days from your receipt of the denial notice to provide the requested documents. If the state receives the requested documents within the 60 days, your case should be reopened. 

If you feel uncomfortable filing the appeal yourself, you can hire an attorney or look into whether free legal help may be available. Even if you choose to get legal help, you still need to file your appeal by the deadline.

Even if you get Medicaid, you may be denied coverage of some medical services. Common reasons for denial include: 

• Not getting prior approval,
• The treatment or equipment is not medically necessary,
• There are more cost-effective alternatives, and
• The medical service or item is not a Medicaid-covered service.

It is important to find out if Medicaid will cover your treatment before agreeing to costly care.