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Rules & Restrictions for Medicaid in Illinois

Medicaid was created, along with Medicare, as part of the federal Social Security Act of 1965. The program is designed to assist low-income families and individuals afford proper health care. Unlike Medicare, which is managed mainly by the federal government, Medicaid programs are created and administered mainly by the states. Applications for Illinois' Medicaid program are accepted by the Department of Human Services, but Medicaid programs are regulated by the Department of Healthcare and Family Services.

  1. Applications

    • You must apply for Medicaid before you can be considered for benefits. You will need to show proof of your income, assets and medical condition. Illinois residents can apply for Medicaid, along with other social service programs, through either a traditional paper application or online. Paper applications can be downloaded from the Illinois Web Benefits site (see Resources) or picked up at Department of Human Services offices. You can return it to your local DHS office in-person or by mail or fax. The online Web Benefits site allows you to not only apply for Medicaid from any computer with Internet access, but also save your application for up to 15 days while you supply the proper information.

    Eligible Groups

    • Not everyone is eligible for Medicaid in Illinois. Groups who are primarily eligible for services are pregnant women, the disabled, the blind and the elderly. Illinois also has specialty programs for people with specific diseases and health troubles. Children are the majority users of Illinois Medicaid. According to the Department of Healthcare and Family Services, Illinois was the first state to offer health care to all children in the state.

    Income Thresholds

    • Most Illinois Medicaid programs have income limits. You cannot exceed the monthly income limit and still qualify for most programs. Children are an exception. The state allows all children to participate in the All Kids program, regardless of their family income. But Illinois does use income level to determine out-of-pocket costs and monthly premiums for All Kids. Parents can also participate through the FamilyCare program, as long as they make no more than 185 percent of the current federal poverty level. Working people with disabilities qualify for Health Benefits for Workers With Disabilities if they earn less than 200 percent of the FPL. Medicare cost sharing plans for the elderly, which help pay for Medicare's premiums, coinsurance and deductibles, are available to people who make less than 100 percent of the FPL.

    Specialty Programs

    • Illinois offers several programs, at little or no cost, specifically for people with certain health conditions. Pregnant women may be eligible for the Healthy Start program if they make less than 200 percent of the poverty level. Victims of sexual assault get their expenses covered through the State Sexual Assault Survivors Emergency Treatment Program. Individuals with kidney failure may use the Illinois State Chronic Renal Disease Program, and the State Hemophilia Program pays for the medical expenses for sufferers who do not qualify for any other kind of Medicaid offered by the Department of Healthcare and Family Services.

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