Alyssa Lane
Illinois' Medicaid program, commonly known as the Medical Assistance Program, is a state-administered, state- and federally funded health care program for low-income individuals of all ages. It covers about 30% of the state's 12.8 million residents, including low-income adults, children, pregnant women, and people who are disabled, blind, or elderly. Eligibility is determined by the Illinois Department of Human Services (IDHS), and enrollment can be done online, in person, by mail, or by fax. Illinois has also expanded Medicaid under the Affordable Care Act (ACA), providing new options for uninsured Illinoisans to obtain health coverage through the state's Medicaid program or the Federal Health Insurance Marketplace.
| Characteristics | Values |
|---|---|
| Name | Medicaid |
| Administered by | Illinois Department of Healthcare and Family Services |
| Eligibility determined by | Illinois Department of Human Services |
| Eligibility | U.S. citizens or qualified non-citizens; low-income individuals and families; children; pregnant women; young adults under 26 who were formerly in foster care; adults under 65; seniors 65+ |
| Income limits | Children (0-18): up to 147% of the federal poverty level (FPL); Children's Health Insurance Program: up to 318% of FPL; Pregnant women: up to 213% of FPL; Adults under 65: up to 138% of FPL; Seniors 65+ (varies) |
| Coverage | Doctor visits, dental care, well-child care, immunizations, mental health services, substance abuse services, hospital care, emergency services, prescription drugs, medical equipment, nursing home care, non-medical support services, transportation, home modifications, assistance with daily living activities, adult day care, assisted living services, memory care services, etc. |
| Enrollment options | Apply online, in person, by mail, or by fax |
| Additional notes | Illinois is running ten pilot projects that provide coverage for services not previously covered by Medicaid, including substance abuse treatment and recovery support, home health visits for new babies, job coaching, and more. |
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What You'll Learn
Illinois Medicaid eligibility and enrollment
Illinois's Medicaid program provides coverage for a significant portion of the state's residents, with about 30% of the state's 12.8 million residents covered as of September 2023. The program is especially crucial for low-income individuals and families, covering medical costs for those who meet eligibility requirements.
Eligibility Requirements:
To be eligible for Medicaid in Illinois, you must meet specific income and citizenship requirements. Firstly, you must be a U.S. citizen or fall within certain categories of non-citizens, such as refugees or persons lawfully present in the U.S. for over five years. Additionally, Illinois has established income thresholds for different groups:
- Children aged 0-18: Family income up to 142%-147% of the Federal Poverty Level (FPL).
- Pregnant women: Family income up to 208%-213% of FPL. Coverage extends up to 12 months after giving birth.
- Adults under 65: Family income up to 138% of FPL.
- Children with higher family incomes (up to 318% of FPL) may be covered under the Children's Health Insurance Program (CHIP).
- Adults who are disabled, blind, or aged 65 or older have different income limit rules.
- Young adults under 26 who were formerly in foster care may also be eligible.
Enrollment Process:
Illinois offers several options for enrolling in Medicaid:
- Apply online using the Illinois website or Healthcare.gov (for non-disabled adults under 65).
- Apply in person at the nearest Family Community Resource Center or with the Department of Human Services (DHS).
- Apply by mail or fax, or call to request an application and return it by mail or fax.
- Visit the Get Covered Illinois website or help desk for information on coverage options and assistance with enrollment.
- Create an account with the Health Insurance Marketplace, fill out an application, and your information will be sent to the state agency for enrollment processing.
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Income and asset limits
Illinois' Medicaid eligibility standards are based on income and asset rules that vary for each group. Income limits are determined as a percentage of the federal poverty level (FPL). For instance, children aged 0-18 qualify with family incomes up to 147% of the FPL, while adults under 65 qualify with incomes up to 138% of the FPL. Children from families with incomes up to 318% of the FPL are covered under the Children's Health Insurance Program, and pregnant women with incomes up to 213% of the FPL are covered for 12 months after birth. Adults who are disabled, blind, or 65 and older must have an income below 100% of the FPL and no more than $17,500 in non-exempt resources.
The asset limit for Illinois Medicaid was recently increased from $2,000 to $17,500. This limit includes countable assets such as cash, stocks, bonds, investments, bank accounts, and real estate that is not a primary residence. IRAs are also counted in Illinois. Exempt assets include personal belongings, household furnishings, automobiles, and generally, one's primary home. Burial spaces and ABLE accounts or tax-exempt savings accounts for disability-related expenses are also exempt. Seniors with assets exceeding the limit can reduce their countable assets by spending on non-countable assets, such as home modifications, prepaying funeral expenses, or paying off debt. However, assets cannot be gifted or sold under fair market value, as this violates the Medicaid Look-Back Rule.
Medicaid eligibility is also based on citizenship or qualified non-citizen status, such as refugees or persons lawfully present in the U.S. for over five years. Non-citizens who are 65 or older and do not qualify for Medicaid due to their immigration status may be eligible for Illinois' Health Benefits for Immigrant Seniors program.
Illinois offers multiple pathways towards Medicaid eligibility, and income limits change annually. As of 2025, a single Nursing Home Medicaid applicant must have an income under $1,304.17 per month and assets under $17,500.
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Healthcare coverage options
Illinois offers a range of healthcare coverage options for its residents, including government-funded programs and private insurance plans. Here is an overview of some of the key options:
Medicaid
Medicaid is a government-funded health insurance program that provides coverage for low-income individuals and families in Illinois. The program is administered by the state under federally set parameters and is an important part of the state's overall health insurance coverage. As of September 2023, about 3.93 million people in Illinois were covered by Medicaid, which is nearly a quarter of the state's population. Eligibility for Medicaid in Illinois is determined by the Illinois Department of Human Services (IDHS) and is based on income, age, and other factors. For example, children aged 0-18 qualify with family incomes up to 147% of the federal poverty level (FPL), while adults under 65 qualify with family incomes up to 138% of the FPL. Pregnant women and children have higher income limits, and there are also special provisions for young adults under 26 who were formerly in foster care. Illinois also offers several pilot projects that provide coverage for services that were not previously covered by Medicaid, such as short-term inpatient substance abuse treatment and job coaching services.
Children's Health Insurance Program (CHIP)
CHIP, also known as the State Children's Health Insurance Program (SCHIP) in Illinois, provides necessary medical benefits and preventive care for children who may not be eligible for Medicaid. The program is administered by the Illinois Department of Healthcare and Family Services (HFS) and covers comprehensive services, including doctor visits, dental care, immunizations, mental health services, prescription drugs, and more.
Private Insurance Plans
For residents who do not qualify for Medicaid or other government-funded programs, private insurance plans are also available in Illinois. The state has an online marketplace called the Illinois Health Insurance Marketplace, where residents can compare plans and prices from different insurance providers. Financial assistance is also available through the Get Covered Illinois program to help pay for insurance costs.
Special Programs
Illinois also offers several special programs to provide medical assistance to specific populations. These include the State Hemophilia Program, which provides assistance with medical expenses related to the disease, and the Coverage for Immigrant Seniors program, which offers healthcare benefits to seniors aged 65 and older who are not eligible for Medicaid due to their immigration status.
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Medicaid long-term care
In Illinois, Medicaid is available to US citizens or those within qualified categories of non-citizens, such as refugees and persons lawfully present in the US for over five years. The state's Medicaid program covers about 30% of its 12.8 million residents.
Medicaid is a common funding source for long-term care for those who are eligible. To be eligible for long-term care Medicaid assistance, applicants must meet the following basic criteria: they must be an Illinois resident, a US citizen, or have proper immigration status.
The Illinois Medicaid rules underwent significant changes in 2012. The federal Deficit Reduction Act (DRA), which became law in 2006, was implemented in Illinois on January 1, 2012. The DRA altered the eligibility rules for Aged and Blind Disabled (AABD) Medicaid long-term care coverage. It increased the look-back period to five years, introduced stricter asset transfer penalties, restricted annuities, and implemented a homestead equity cap.
In July 2012, Illinois enacted the SMART Act, which aimed to cut $1.6 billion from various medical assistance programs. The SMART Act further restricted Medicaid eligibility and altered some of the DRA provisions. As of January 1, 2012, the homestead exemption was $750,000, but the SMART Act reduced this to the federal minimum.
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Medicaid coverage for immigrant seniors
In Illinois, Medicaid is available to people who are: young adults under 26 who were formerly in foster care, children with family incomes up to 318% of the federal poverty level, pregnant women with incomes up to 213% of the federal poverty level, and adults under 65 with family incomes up to 138% of the federal poverty level.
To be eligible for Medicaid, one must be a U.S. citizen or fall within one of the qualified categories of non-citizens, such as refugees and persons lawfully present in the U.S. for over five years. If you are above 65 years old and are not eligible for Medicaid due to your immigration status, you may be eligible for Illinois' Health Benefits for Immigrant Seniors program. This program provides comprehensive healthcare coverage without premiums and covers doctor and hospital care, lab tests, rehabilitative services, mental health and substance use disorder services, dental and vision services, and prescriptions.
Enrollment in the Health Benefits for Immigrant Seniors program has been paused. However, you can contact the Immigrant Family Resource Program at 1-855-437-7669 or 312-793-7120 to learn more about your eligibility and how to enroll. Additionally, you can reach out to the Office of Welcoming Centers for Refugee and Immigrant Services, DHS Bureau of Refugee and Immigrant Services, at (312) 793-7120 or [email protected].
It is important to note that co-payments and cost-sharing are applicable for certain non-emergency procedures and services under the Health Benefits for Immigrant Seniors program. For instance, a $250 co-payment is charged per non-emergency inpatient hospitalization, while non-emergency hospital outpatient services incur a 10% co-payment based on what HFS would pay the provider. Nevertheless, no co-payment or cost-sharing is charged for emergency services needed to evaluate or stabilize an emergency medical condition.
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Frequently asked questions
Medicaid is a state and federal program that helps with healthcare costs for people with low incomes.
Eligibility for Illinois Medicaid is determined by the Illinois Department of Human Services (IDHS). To be eligible, you must be a U.S. citizen or fall into one of the qualified categories of non-citizens. Eligibility also depends on income and assets.
You can enrol in Illinois Medicaid by applying online, in person, by mail, or by fax.
Illinois Medicaid covers doctor visits, dental care, immunizations, mental health services, hospital care, emergency services, prescription drugs, and medical equipment. It also covers non-medical support services for seniors.
For those who are not eligible for Illinois Medicaid, there is the option to buy low-cost insurance through the Illinois Health Insurance Marketplace.
