Health & Benefits

What services does Medicaid cover?

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.

Where can I learn more about what is covered by my medical program?

You can learn more about your specific medical program coverage by:

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

Do I need to get prior approval to have my medical care covered?

Some medical care requires prior approval when you have a Medicaid plan. Depending on your plan you may or may not need prior approval.

If your plan requires prior approval, your doctor must explain the need for the treatment. Otherwise, your doctor will not receive payment.

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

You may also need it for prescription drugs.