This article is a collection of the best answers to Illinois Medicaid’s most frequently asked questions.
Medicaid is a government-sponsored healthcare program for low-income families and individuals who fulfill specific income and resource requirements. Only the aged, blind, or disabled can access resources within the defined restrictions.
We have scoured the internet to provide all you need to know about the Illinois Medicaid Benefits.
You will learn everything you need to know about Illinois Medicaid in this article.
Table of Contents
What is Illinois Medicaid?
Medical assistance services are covered through Medicaid, a state and federal government program jointly funded.
Medicaid covers medical assistance for eligible children, parents, and caregivers of children, pregnant women, and people who are disabled, blind, or 65 years of age or older.
People previously in foster care services and adults aged 19 to 64 who do not have Medicare coverage and are not a parent or caregiver relative of a minor child. It also covers pregnant women and people who are 65 years of age or older.
The primary Medicaid-funded services are medical, hospital, and long-term care. Drugs, medical supplies, transportation, family planning, lab work, x-rays, and other medical services are also covered.
Who is eligible for Illinois Medicaid?
You must be a resident of Illinois, a national or citizen of the United States, a permanent resident, or a legal alien in need of health care or insurance help, and have a low income to qualify for Illinois Medicaid.
You must also be one of the following papers at the time of application submission:
- Pregnant, or
- Be in charge of a youngster who is younger than 18 years old or
- Have a disability yourself or a family member who is disabled.
- Be 65 years of age or older.
Annual Household Income Limits (before taxes)
| Household Size* | Maximum Income Level (Per Year) |
| 1 | $18,755 |
| 2 | $25,268 |
| 3 | $31,782 |
| 4 | $38,295 |
| 5 | $44,809 |
| 6 | $51,323 |
| 7 | $57,836 |
| 8 | $64,350 |
*For households with more than eight members, add $6,514 per additional person.
How do I contact Medicaid in Illinois?
Phone
1-800-843-6154
Website
Department of Healthcare and Family Services
What are the Medicaid plans in Illinois?
Illinois has contracts with a variety of health plans overall.
VMC is provided by Family Health Network, Harmony Health Plan, a local for-profit plan, and Harmony Health Plan, a nationwide for-profit plan (a national, non-profit plan). ICP is offered through several health plans servicing various counties throughout the state.
Cook County IlliniCare Health Plan, Blue Cross Blue Shield of Illinois, Cigna HealthSpring of Illinois, Community Care Alliance of Illinois (CCAI), Humana Health Plan, Meridian, and Aetna Better Health are some of the regional, for-profit affiliates of Centene Corporation (a national, for-profit plan).
Aetna Better Health and IlliniCare are available in DuPage, Kane, Kankakee, Lake, and Will Counties. Aetna, Community Care Alliance of Illinois (CCAIO), Knox, Peoria, Stark, and Tazewell Counties:
My Health Care Coordination (CCE), Meridian, and Molina. Boone, McHenry, and Winnebago Counties: Aetna.
Rock Island and Mercer Counties: IlliniCare and Precedence. Madison, Clinton and St. Clair Counties: Meridian and Molina.
- Voluntary Managed Care (VMC) program covers primary, acute, and specialty care, and behavioral health services on a voluntary basis to low-income children and families, pregnant women, and American Indians who live in certain counties.
- A medical home will coordinate acute, primary, and specialty care under Illinois Health Connect (IHC).
- In some counties in the state, older persons and adults with disabilities who are qualified for Medicaid but not Medicare are required to participate in the Integrated Care Program (ICP).
How do I apply for Illinois Medicaid?
Call the Health Benefits Hotline at 1-800-843-6154 for more information about applying for Medicaid.
TTY users can call 855-889-4326.
What is covered by Illinois Medicaid?
The following services are covered by Illinois Medicaid
| Alcohol and drug abuse services | Nursing home care |
| Chiropractic care | Physical therapy |
| Emergency dental services | Physician services |
| Family planning | Podiatric care for diabetics |
| Group care | Prescription drugs |
| Hospice care | Prosthetic devices |
| Hospital care | Psychiatric care |
| Lab and X-ray services | Renal dialysis |
| Medical equipment and supplies | Transportation for medical purposes |
| Nursing care | Vision services |
Copayments?
| Physician or clinic visit | $3.90 |
| Emergency visit for non-emergency | $3.90 |
| Over the counter medication | $3.90 |
| Brand name prescription | $3.90 |
| Inpatient hospital visits | $3.90 |
Who is not covered by Copay?
Copays do not apply to those who:
- Is pregnant (including 60 days postpartum)
- On a help case, is under the age of 19
- Is in a DCFS (category 98) case
- Receives hospice care;
- Lives in an institution
- Lives in a supportive living facility
- Lives in a sheltered care facility
- Is a patient undergoing treatment for Breast and Cervical Cancer (BCC)
- Is an American Indian or Alaskan Native
Even if they are given to an adult, the following services are provided without a copay:
- Family planning services
- Emergency services
- Services paid by Medicare
- Certain medications, including insulin, AIDS drugs, and chemotherapy drugs
Illinois Medicaid Waivers
The state’s request to implement a Managed Long Term Services and Supports program (MLTSS) waiver to serve its dual-eligible beneficiaries who wish to opt-out of the Medicare-Medicaid Alignment Initiative was authorized by the Center for Medicare and Medicaid Services in May 2014. (MMAI).
The program offers services on a mandatory basis to participants 21 years of age or older, eligible for benefits under Medicare Part A, and enrolled under Medicare Parts B and D.
Participants must reside in Greater Chicago or Central Illinois and meet all other eligibility requirements. To the participant’s need for nursing facility care, the program offers services to people getting long-term benefits.
The MLTSS waiver will also provide benefits to enrollees who participate in one of the five 1915 (c) waivers.
Can I have both Illinois Medicaid and Medicare?
The following people are eligible to sign up for the Medicare-Medicaid Alignment Initiative:
- Obtaining complete Medicaid and Medicare coverage (Medicare Parts A and B and Medicaid without a spend-down),
- Age 21 and older,
- Enrolled in the Medicaid category of aid for the elderly, blind, and disabled (AABD), and
- A resident of a county covered by the Medicare-Medicaid Alignment Initiative. Go here to find out if your county has a Medicare-Medicaid Alignment Initiative health plan.
What is the highest income to qualify for Medicaid in Illinois?
Individuals with incomes up to 138 percent of the federal poverty line ($1,366 for an individual and $1,845 for a couple) are eligible for coverage.
How much money can you have in the bank on Illinois Medicaid?
The asset limits depend on a few factors. You must have fewer than $2,000 in assets if you are single. It must be less than $3,000 total if you share housing with a dependent spouse or child.
The following categories have no asset limits:
- Non-disabled adults,
- Pregnant women, and
- People with a dependent child in their care.
Does the disabled person get Illinois Medicaid?
Suppose a person with a disability is a parent or caregiver relative of a minor kid living at home, and their income is at or below 138 percent of the federal poverty threshold for their family size. In that case, they may be eligible for Family Care.
Family Care does not have a resource (asset) test. The maximum monthly income for a household of four is $2,887. Disability is not a requirement for Family Care eligibility.
Aid to Aged, Blind and Disabled (AABD)
Those under 65 who are enrolled in Medicare may be eligible for Medicaid if they also have a low income due to their disability.
Illinois provides Medicaid coverage for those with disabilities whose income is up to 100 percent of the federal poverty threshold ($1,012 per month for an individual) and who have no assets that are not exempt and exceed $2,000 (for one person).
What documents do I need to apply for Medicaid?
You may need one or more of the following pieces of information to complete your application, whether you’re applying for the first time or renewing your benefits:
- Everyone requesting for benefits must provide proof of citizenship and identity.
- If you have non-U.S. citizens in your family, you’ll need Alien Registration Cards.
- Everyone should have a Social Security number, or proof that one has been applied for.
- Everyone who is claiming for benefits should have a copy of their birth certificate.
- The name, address, and daytime phone number of the landlord or neighbor
- A statement that verifies your residence as well as the names of all people who live with you. A non-relative who does not live with you must make the assertion. It must be signed, dated, and contain the person’s name, address, and phone number.
- Proof of ALL money your household got last month and this month from whatever source.
- Proof confirming your employment ended and that you were paid till the end of the month.
- Any other medical insurance must be verified.
What is the best Medicaid in Illinois?
With a score of 3.5, CountyCare tied for first place in Illinois. CountyCare had the best ratings in the state for treatment and prevention and tied for second place for customer satisfaction. CountyCare is a provider-led plan that puts members’ health before profits.
