Medicaid is a government health insurance program that helps people with low income get health care services at a lower cost. There are different Medicaid programs in Illinois for different groups, including those who are older (age 65+), blind, or living with a disability.

What does Illinois Medicaid cover?

Medicaid pays for routine and acute health care services. This includes:

• Visits to health care providers (including physicians and nurse practitioners)
• Inpatient and outpatient hospital services
• Early and periodic screening, diagnostic, and treatment services
• Preventive care (e.g., vaccinations)
• Lab tests and X-rays
• Dialysis services
• Mental health services
• Substance use treatment
• Rural health clinic services
• Medical transportation
• Long-term care (e.g., nursing facility care, home health services)

Most states also cover optional services such as:

• Physical, respiratory, and occupational therapy
• Home- and community-based care
• Case management
• Prescription drugs
• Dental and vision care

In Illinois, Medicaid is administered by the Department of Health Care and Family Services (HFS). To get coverage once you are enrolled, you must go to health care providers that take part in the Medicaid program.

Since the program serves those with limited income and resources, people with Medicaid benefits pay few to no out-of-pocket costs. To learn more about the coverages provided, find your nearest local Department of Human Services Family Community Resource Center (FCRC) by using this office locator tool.

How do I know if I qualify for Medicaid in Illinois?

In general, to be eligible, you must:

• Be an Illinois resident
• Be a U.S. citizen or a qualified non-citizen
• Meet the income and/or asset limit for your coverage group

If you need help with your health care coverage and costs, you should apply for Medicaid even if you think you are over the income limit or your assets are too high. This is because:

• Not all types of income are counted toward the income limit.
• You may qualify for a different form of health care assistance. For example, if you have Medicare, you may qualify for a Medicare Savings Program (MSP).

If you are over the income limit, but you have very high medical costs, you may be able to qualify for the Spend-Down Program.

What are the different Medicaid programs in Illinois?

You may be able to get health coverage if you fall into one of the following categories:

Healthcare and Family Services (HFS) Medical Benefits

This Medicaid program is for people who are older (age 65+), blind, or living with a disability. It may also be called Aid to the Aged, Blind, or Disabled (AABD) medical benefits.

Nursing Home Medicaid

Nursing Home Medicaid covers health care and support services in a nursing home or other medical facility. You can get these services if you have limited income and resources. You must also have a medical condition that requires the skills of a licensed nurse on a regular basis.

CountyCare

CountyCare is a Medicaid program that is part of the Affordable Care Act (Healthcare Reform) offered by the State of Illinois and Cook County Health & Hospitals System. This program provides affordable health insurance coverage to you if you cannot get insurance through regular Medicaid or private insurance. You may get help from this program if you have limited income and live in Cook County. You must also be between 19 and 64 years of age and not have any health insurance coverage.

Health Benefits for Workers With Disabilities (HBWD)

If you're a worker who has a disability and limited income and resources, the HBWD program can provide you with health care benefits. This program lets you work, keep more in your savings, and still get health care coverage. You can take part in this program if you are a paid worker (part-time or full-time) between the ages of 16 and 64.

Medically Needy Program (Medicaid Spend-Down)

If your income puts you over the limit to qualify for Medicaid in Illinois, you may still be able to get coverage if you have very high medical expenses. You would be required to “spend down” your income until it is below a special limit called the “medically needy” income limit. The income must be spent on medical expenses.

With the Illinois Medicaid Spend-Down Program, you can only use medical expenses that you are responsible for paying. You cannot use expenses covered by other insurance or Medicare. Examples of health care-related expenses to spend down your income on include:

• Medications
• Paid medical bills
• Unpaid medical bills (if they were outstanding 3 months prior to the date of your Medicaid application)
• Nursing home care
• Health-related home renovations, such as wheelchair ramps or chair lifts
• Transportation to medical appointments

How do Medicare and Medicaid work together?

Medicaid pays for some services not covered by Medicare. If you get Medicare, you may also be able to get help from Illinois Medicaid. Millions of Americans have both Medicare and Medicaid coverage. This is called being "dual eligible."

If you have Medicare and qualify for full Medicaid coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums. Depending on the level of Medicaid you qualify for, the state might also pay for:

• Your share of Medicare costs, like deductibles, coinsurance, and copayments
• Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage

In addition, if you are dual-eligible for Medicare and Medicaid:

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.
• You may be able to get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, visit the Medicare website or call 1-800-633-4227 or 1-877-486-2048 (TTY).

How do I prepare to apply for Illinois Medicaid?

When you apply for Medicaid, you’ll be asked for important information to help determine if you qualify for benefits. Before you start, gather some basic information to make your application process easier: 

• A document that shows your age, such as your birth certificate or driver’s license
• Your Social Security card
• Pay stubs for anyone in your household who has earned income
• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)
• Information about your financial assets, such as bank account or investment account statements

How do I apply for Medicaid in Illinois?

There are a few different ways you can apply for Medicaid in Illinois. Read below to learn more about which option might be right for you.

The quickest and easiest way to apply for AABD Medicaid in Illinois is online through the ABE (Application for Benefits Eligibility) portal . All your personal information is kept 100% confidential and protected by special security technology.

Apply Online

You can download and print a benefits application, complete it, and mail it to your nearest DHS office. You can also drop your application off in person. 

How can I get help with my application?

There are a few ways to get help filling out your Medicaid application:

• Contact your local DHS office directly or call  1-833-234-6343 .
• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.
• NCOA also has a HelpLine you can call to get free support. To get started today, call 1-800-794-6559.