Medicaid Regulations in Illinois

The Illinois Medicaid program is a joint state and federal medical assistance program for certain categories of persons and those with very low income. You apply for Medicaid and have your eligibility determined through the Illinois Department of Human Service. If you are Medicaid eligible, your benefits will be obtained through programs run by the Illinois Department of Healthcare and Family Services. Both the departments follow Medicaid regulations established by the state and federal government.

Eligible Persons

• As a rule, Medicaid benefits are available if you require health care and have limited resources and low income. However, you are required to be part of a Medicaid eligible group. In Illinois, the groups designated as eligible include pregnant women, the elderly, blind and disabled persons, as well as families and children. Although the primary regulations specify that you meet both the low income and group requirement, Illinois does permit persons meeting the group requirement that have income or resources above the established limits to spend-down the excess income or resources in order to receive Medicaid benefits.

Applying for Benefits

• You must submit an application to the Illinois Department of Human Service in order to be considered for Medicaid benefits. Because Illinois has several medical assistance programs, a unified application process is used so that only one application per person is required to be considered for all programs. Illinois regulations require Department of Healthcare and Family Services personnel to actively assist persons seeking Medicaid with the application process, including assistance to obtain documents supporting eligibility. It is best to apply at the Department of Human Service office nearest you, but an application will be mailed to you upon request.

Eligibility Determination

• Illinois regulations require the Department of Human Service to determine an applicant's eligibility for medical benefits within 45 days of applying. If disability is an issue, the deadline is extended to 60 days. If your application is denied, you can appeal the decision within 60 days of the denial. You can submit your appeal in writing to a Department of Human Service office or appeal by telephone. The appeal regulations entitle you to be represented by an advocate of your choice during the appeal process and hearing.

Medicaid and Medicare

• The Medicaid program, which is a form of welfare, is often mistaken for Medicare, a form of medical insurance coverage. If you are over 65 or disabled, you qualify for Medicare -- no income requirements exist. However, like other forms of medical insurance, Medicare involves premiums, co-payments and other out-of-pocket expenses. If you qualify for Medicare and your income and resource are within Medicaid limits, you can use Medicaid to pay for the expenses not covered by Medicare.