Medicaid in Illinois, managed by the Department of Health Care and Family Services, is a vital health insurance program that serves about 3.3 million residents, roughly one-quarter of the state's population—originating from the Social Security Amendments of 1965, which also established Medicare, Medicaid targets explicitly families and individuals with low income and limited resources, unlike Medicare which is a federal program available to all seniors. The program is a collaboration between the federal government and states, with the federal government providing matching funds to states to assist in delivering medical care to those who can't afford it.

Each state, including Illinois, can administer its own Medicaid program. This involves setting eligibility requirements, defining the scope and types of services offered, and establishing payment rates. In Illinois, Medicaid encompasses various coverage groups catering to different population segments, such as All Kids, FamilyCare, Affordable Care Act (ACA) Adults, Moms and Babies, Former Foster Care, and Aid to Aged, Blind and Disabled (AABD) medical.

For anyone seeking further information or clarification about Illinois Medicaid, inquiries can be directed to hfs.webmaster@illinois.gov.

This program plays a crucial role in ensuring that vulnerable populations in the state have access to necessary medical services. Medicaid in Illinois offers a comprehensive range of services akin to private health insurance plans. However, it's important to note that not all services are covered in every situation, and some may have limits or require pre-approval.

Here's an overview of the key services covered:

• ‍Ambulatory Services: Office visits, outpatient hospital services, family planning and supplies, diagnostic services, services from rural health clinics and federally qualified health centers, emergency room services, and emergency transportation.‍
• Inpatient Hospital Care: Includes services during and after hospital stays.‍
• Maternity and Newborn Care: Services during and after pregnancy, inpatient hospital care, nurse-midwife services, free-standing birth center services, and smoking cessation help for pregnant women.‍
• Mental Health and Substance Use Services: Rehabilitation services at community mental health centers, alcohol and substance abuse services, detox services, and inpatient hospital services.‍
• Prescription Drugs: Coverage for various prescribed medications.‍
• Rehabilitative and Habilitative Services: Skilled nursing facilities, physical therapy, occupational therapy, speech, hearing, and language therapy.‍
• Medical Supplies and Equipment: Including prosthetic devices, eyeglasses, and other optical materials.‍
• Lab and X-Ray Services: Essential diagnostic services.‍
• Preventive and Wellness Services: Includes many recommended screenings and vaccinations.‍
• Pediatric Services: A range of services for children up to age 20, including all medically necessary dental care.‍
• Additional Services: Long-term care, limited adult dental services, hospice care, certain home health services, and non-emergency transportation.

Many services have limits or require pre-approval. If you are in a health plan, the plan will guide you in accessing covered services from its network and help you understand any limitations or pre-approval requirements. Your Primary Care Provider (PCP) can also assist in understanding coverage for needed services.

If you have questions about your medical coverage and are not enrolled in a health plan, or your health plan has yet to start, call the HFS Health Benefits Hotline at 1-866-226-0768 for assistance.

Remember, while Medicaid provides broad coverage, understanding the specifics of your plan, especially regarding service limits and pre-approval, is crucial for accessing the full range of benefits.

Eligibility for Medicaid in Illinois is determined based on several criteria, including income and immigration status. Here's a summary of the key requirements:

Income Requirements

• To qualify, your income must be below the Medicaid income limit for your household size.
• Household size includes you, your spouse (if living together), children and stepchildren under 19 years old living with you, the child's parents if they live with you and the child is under 19, and any dependents you plan to claim on your taxes regardless of their residence.
• Income sources include wages, self-employment income, Social Security benefits, retirement payments, rental income, daycare or babysitting earnings, and other income or support.

Immigration Status

• Medicaid eligibility also depends on your U.S. citizenship or immigration status.
• Adults (other than children under 19 or pregnant women) must be U.S. citizens or immigrants with lawful permanent resident status for at least five years to be eligible.
• Refugees, asylees, and other immigrants with special status may be eligible immediately.
• Children can be applied for even if the parents are not U.S. Citizens or haven't had lawful permanent resident status for five years.
• Lawful permanent residents not meeting the five-year requirement might be eligible for financial assistance to purchase private insurance via the Health Insurance Marketplace.

The information provided in a Medicaid application is confidential and won't be shared with U.S. Immigration and Customs Enforcement. Applying for Medicaid does not impact your ability to become a U.S. citizen.

Applying for Medicaid in Illinois can be done in four different ways:

Online

• Apply at ABE.Illinois.gov.
• Create a secure account to keep track of your application.
• The application process takes about 30 to 45 minutes. Use the "Save and Exit" button to pause and continue later.
• After submitting, you'll receive a tracking number ("T-number"), which should be noted and kept safely.
• The same website can be used to apply for SNAP (Food Stamps), Cash Assistance (TANF, Refugee Cash Assistance), and the Medicare Savings Program. Select the benefits you wish to receive while filling out the application.

Over the Phone

• Call the DHS Help Line at 1-800-843-6154.
• A representative will assist with the application. Remember to request and note down the case number.

In Person

• Apply at Family Community Resource Centers (FCRC). Locate the nearest FCRC using the online DHS Office Locator at www.dhs.state.il.us.
• Some hospitals, health centers, and community organizations also offer assistance with Medicaid applications.
• Schedule an appointment for in-person help by calling Get Covered Illinois at 1-866-311-1119.

With a Paper Application

• Download the application form from here.
• Fill out the form (either online or by printing it) and sign it.
• Submit the completed form by carrying, mailing, or faxing it to your local Family Community Resource Center. Locate the center using the DHS Office Locator.

Call the DHS helpline at 1-800-843-6154 (TTY: 1-800-447-6404).

Maintaining Medicaid in Illinois involves reporting changes and undergoing a yearly redetermination process. Here's a summary of what you need to know:

Reporting Changes

It's crucial to inform the state of any changes in your circumstances within ten days of the change.

Changes to report include:

• Changes in your name, address, and phone number.
• Changes in household size.
• Changes in income for anyone in your household.
• Changes in other health insurance.
• Changes in assets (for those receiving AABD).

Also, inform your medical plan and Primary Care Provider (PCP) about these changes.

How to Report Changes

• Call the DHS helpline at 1-800-843-6154.
• For address changes only, use the DHS website.

Medicaid Redetermination

• Redetermination is required annually to review your eligibility.
• The State will check income, household size, and other information. Most verification is done electronically.
• A redetermination form will be sent to you if additional information is needed. Please return the form with the required documents by the specified date to avoid loss of benefits.

Process for Redetermination

• For those with Medicaid and other benefits like SNAP: You'll receive a letter from DHS to update your information every six months.
• For those with only Medicaid: Annually, or if your Medicaid coverage group changes, you'll receive a form from the Illinois Medicaid Redetermination Project (IMRP).
• Return the form with necessary changes and supporting documents by the due date.
• The form and documents can be returned via a secure website, fax, or mail.

If You're No Longer Eligible

• If you lose eligibility, you may qualify for financial assistance on the Health Insurance Marketplace.
• Losing Medicaid coverage triggers a 60-day Special Enrollment Period to sign up for health coverage on the Marketplace. If you miss this period, you must wait for the Annual Open Enrollment or another Special Enrollment Period.

For questions or to check the status of your Medicaid-only redetermination, call 1-866-255-5437. Visit GetCoveredIllinois.gov or call 1-866-311-1119 through the Health Insurance Marketplace for more information about health coverage options.