Who is eligible
Children ages 0-18 with family income levels up to 142% of FPL. Pregnant women with family income up to 208% of FPL. Adults with family income up to 133% of FPL.
- healthinsurance.org contributor
- January 7, 2016
Medicaid is an important part of the Illinois healthcare system, covering more than 3 million of the state’s 12.9 million residents.
Compared to other states, Illinois Medicaid eligibility guidelines are more restrictive for children and about average for pregnant women and parents. Illinois did opt to expand Medicaid through the Affordable Care Act to other non-elderly adults, which contributed to a net increase of nearly 488,000 people in the Medicaid program in the first two years after expansion was implemented.
Eligibility guidelines for Illinois Medicaid
Federal law specifies mandatory and optional coverage groups for Medicaid. States must cover the mandatory groups to receive federal Medicaid funding, and they qualify for additional funding if they cover optional groups.
The federal government specifies minimum thresholds for eligibility for the various groups, for example, 133 percent of the federal poverty level. States can set their requirements at or above the minimum threshold. Illinois has established requirements that are near national averages.
Illinois’ eligibility standards for Medicaid are:
- Children ages 0-18 qualify with family income levels up to 142 of the federal poverty level (FPL); the Children’s Health Insurance Program covers children with family income up to 313 percent of FPL
- Pregnant women qualify with family income up to 208 percent of FPL
- Parents and other adults qualify with family income up to 133 percent of FPL (138 percent with the built-in 5 percent income disregard).
How to apply for Medicaid
You have several options for applying for Illinois Medicaid:
- Apply online using the Illinois wesbite or Healthcare.gov.
- Apply in person and get help from the Department of Human Services (DHS). Find the nearest Family Community Resource Center.
- Apply by mail or fax, or apply online or call at 1-800-843-6154 (TTY 1-800-447-6404) and ask DHS to mail you an application. Complete the application and mail or fax it back to the nearest Family Community Resource Center.
Medicaid expansion in Illinois was authorized in July 2013 and went into effect Jan. 1, 2014. Making Medicaid available to low-income, non-elderly adults is a key part of the Affordable Care Act’s strategy to reduce the nation’s uninsured rate. However, a Supreme Court ruling made Medicaid expansion optional, and as of early 2016, there are still 20 states that have not expanded Medicaid.
The federal government will pay 100 percent of the cost for the Medicaid expansion population through 2016. After that, the federal government’s portion will gradually decrease, reaching 90 percent by 2020, with Illinois covering the other 10 percent (it will remain at that level after 2020).
At the time Medicaid expansion was approved, Illinois officials estimated that 342,000 Illinois residents would qualify. According to a Chicago Tribune article, about 350,000 new enrollees had been approved as of June 2014.
By October 2015, enrollment in the Illinois Medicaid program had grown by nearly 488,000 people since the end of 2013, representing a 19 percent growth in net enrollment. Total enrollment in Illinois Medicaid as of October 2015 stood at 3,114,524.
More information about the Illinois Medicaid program
Medicaid was implemented in the state of Illinois in January 1966.
Individuals covered by Illinois Medicaid can choose either a fee-for-service plan or a managed care plan. The Illinois DHS site explains these options.
Illinois has been slower than many other states in moving beneficiaries to managed care plans. However, the state did pass a law in 2011 that requires expanding managed care to at least half the state’s Medicaid beneficiaries by Jan. 1, 2015.
In June 2014, Gov. Pat Quinn signed a Medicaid reform bill. The law restores adult dental care and podiatry services, aligns Illinois law with federal law to provide Medicaid coverage to children who have been without private insurance for three months, streamlines hospital and nursing-home reimbursement, and more.