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Rules for Medicaid in Illinois

Illinois provides health insurance coverage through the state-operated, federal- and state-funded Medicaid program to low-income elderly or disabled individuals, pregnant women and children. Obtaining and maintaining Medicaid coverage in Illinois requires adhering to specific Medicaid guidelines.

  1. Application Process

    • You must complete an application at your nearest Illinois Department of Human Services (DHS) office in order to be considered for Medicaid coverage. If you are unable to go to your local DHS office due to poor health, you may call your local DHS office and ask for an application to be mailed to you. After your application is received, DHS will contact you to complete an interview via phone.

    Managed Care vs. Fee-For-Service Plans

    • If you are enrolled in a fee-for-service program, you are responsible for locating on your own a primary care physician that accepts Medicaid. If you are enrolled in a managed care program, DHS will assign you a primary care physician.

    Income & Assets

    • You must meet specific income requirements to qualify for Medicaid. The income limits vary depending on your family size and the specific Medicaid program that you are enrolled in. You must also meet resource limits, which are typically $2,000 for individuals and $3,000 for couples. However, the resource limit may vary depending upon the type of Medicaid program you are enrolled in. Contact DHS at 800-843-6154 to obtain the specific income and resource limits for your type of Medicaid.

    Spenddown

    • If you exceed the income or resource limit to qualify for Medicaid, you may qualify for the Medicaid spend-down program. Each month, you will have to pay a specified amount of your medical bills prior to Medicaid paying for your medical expenses. If you fail to meet your spend-down for three or more consecutive months, your Medicaid coverage may be canceled.

    Appeals

    • If you disagree with a decision by DHS regarding your Medicaid, you have the right to appeal. You must file an appeal by writing a letter to the Bureau of Administrative Hearings at 401 S. Clinton Street, Chicago, IL 60607, calling 800-435-0774 or completing an appeal form at your local DHS office.

    Changes

    • You must report any changes in your income or assets, living arrangements and residency within 10 days of the change. Failure to report changes may result in termination of Medicaid benefits.

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