Illinois Medicaid

CHIP

  • 1,503,250 children were enrolled in Illinois Medicaid/CHIP in October 2014.
  • Children accounted for 49.1% of total IL Medicaid/CHIP enrollees in October 2014.

Costs Covered

  • In the 2012 fiscal year, the distribution of Illinois Medicaid spending by service was as follows: acute care (67.1%), long-term care (29.6%) and disproportionate share hospital payments (3.3%).
  • In 2012, the federal government and the state of Illinois shared the cost of Medicaid equally at 50-50.

Conditions

  • Illinois Medicaid spending by enrollment group in 2011 was as follows: the aged (17%), the disabled (40%), the adults (18%) and children (25%).

Medicaid Expansion

  • Illinois is one of the 28 states (including the District of Columbia) to accept the Medicaid expansion in 2014.
  • Before the Affordable Care Act, Illinois monthly Medicaid enrollment was 2,626,943.
  • After the ACA’s Medicaid expansion, the monthly IL Medicaid enrollment average rose by 16.6% to 3,062,543.

1) What is Medicaid?

Medicaid is a program that is funded by both the state and federal governments to provide low-income Americans with free or low-cost health insurance. Because the United States government now requires that all Americans have health coverage, due to the individual mandate, Medicaid has become more important than ever. Any individual or family that is covered by the medical assistance program meets the individual mandate requirement of the Affordable Care Act. Those who do not qualify for Medicaid will have to obtain health insurance by another means, such as the Health Insurance Marketplace.

To obtain the medical benefits of the program in Illinois, you must file an IL Medicaid application and have your candidacy be accepted by the Department of Healthcare and Family Services. Those parents who are accepted into the program will also be able to provide these benefits to their children. Children of individuals who meet the requirements of the program will enjoy all of the following and more:

  • Immunizations
  • Treatment
  • Screenings
  • Doctor visits
  • Preventive care

The most important thing to know about the Illinois Medicaid program is that eligibility is largely based on income. Very rarely will an individual be accepted into the medical assistance system if they make more money than the posted limit.

2) How do I apply for Medicaid in Illinois?

Anyone interested in applying for medical assistance in the state of Illinois should learn how to apply for Medicaid in the different methods that are available to them. They can go through the application in one of three ways:

  • Online
  • In person
  • By mail

For those who would like to submit their Illinois Medicaid application in person, you must locate your nearest Department of Human Services office and meet a representative. To find out where the nearest office is to your home, call 1-800-843-6154, and the DHS will be able to provide you with a few options close to you.

If you cannot go to the DHS office for a reason concerning your health, you have the option of calling the help line and having an IL Medicaid application mailed to you. Once you finish and mail the form, you will be contacted by phone for an interview.

The most convenient option of the three is to apply for Medicaid online. All that you are required to do is follow the prompts provided by the Department of Human Services offices. After you answer the questions, you will see if you are eligible to receive the medical benefits. To begin the process and apply online today, click here.

3) What does IL Medicaid cover?

Due to the Affordable Care Act’s individual mandate, it is more important than ever to be aware of the services, treatments and supplies that are included in Medicaid programs around the country. If you want to apply for Medicaid in Illinois, you will enjoy all of the following medical benefits if accepted:

  • Hospital stays (inpatient)
  • Outpatient services provided by clinics
  • Prescription medication
  • Doctor visits
  • Emergency services to treat an injury or an illness
  • Durable medical equipment, also known as DME
  • Medical supplies
  • Maternity care for pregnant women and newborn care for their infants
  • Lab tests
  • X-rays
  • Eye exams and eyeglasses
  • Dental care for children
  • Dental care for adults in emergencies
  • Pediatric services
  • Family planning services (birth control)
  • Physical therapy
  • Speech therapy
  • Occupational therapy
  • Mental health services
  • Substance abuse treatment

Applicants should also remember that certain treatments, surgeries and services will not be covered by the Medicaid program of Illinois. If members of Illinois Medicaid choose to go through with procedures that are not considered medically necessary, they will have to pay the amount out of pocket, unless they have obtain health insurance that covers such services. If the above services represent a great deal of your medical expenses, apply for Medicaid here.

4) Who is eligible for Illinois Medicaid?

When an individual or a family goes to submit their IL Medicaid application, they must do so with the understanding of the various factors that go into determining eligibility. Some of the groups of people that typically receive medical assistance from the state of Illinois and other parts of the country include:

  • Women who are pregnant.
  • Children under the age of 19.
  • Women with breast cancer.
  • Women with cervical cancer.
  • Foster children.
  • Parents or relatives of children who have a parent that is absent.
  • Individuals who are blind.
  • Those who are disabled.
  • The aged.

Nevertheless, just because you are part of one of the above groups does not mean that you immediately qualify for medical assistance. The main aspect of a person’s situation that determines whether or not they are eligible to receive the benefits of Medicaid IL is their income. If you make above a certain amount of money per month or per year, you will not be considered eligible and will have to look elsewhere for health insurance. Fortunately, the income limit varies depending on household size. Households with more children are allowed to earn more income and still be eligible to receive medical benefits from the state’s Medicaid program.

Review the 2015 Illinois Medicaid income requirements below:

  • 1 person = $11,770
  • 2 family members = $15,930
  • 3 family members = $20,090
  • 4 family members = $24,250
  • 5 family members = $28,410
  • 6 family members = $32,570
  • 7 family members = $36,730
  • 8 family members = $40,890
  • Add $4,160 for each additional person for families with more than eight family members.

5) What is the Medicaid expansion, and did Illinois accept the Medicaid expansion in 2014?

One of the biggest pieces of the Affordable Care Act was the Medicaid expansion. In 2014, all of the states in the country were offered the chance to augment their medical assistance program with federal funds. The states would not have to pay anything for this expansion of the state and federal Medicaid program until the year 2016. In 2016, states would have to start paying a percentage of the expansion costs, which would begin at 10 percent and increase slightly in future years.

Illinois was one of 28 states, including the District of Columbia, to expand their Medicaid IL program. By doing so, they allow individuals and families with an income of up to 133 percent of the federal poverty level to receive medical benefits for a very low cost. In many cases, the care is free, and it includes everything from immunizations to surgery and other services.

In the states that chose not to expand Medicaid, thousands, even millions of people are missing out on access to free or low-cost health insurance. The numbers vary from state to state, as Florida and Texas would have seen an immense increase in Medicaid enrollment while states like Alaska and South Dakota would have seen smaller increases in enrollees.

6) How do I contact Illinois Medicaid?

There are a few different reasons why you would have to get in contact with an Illinois Medicaid office in the state of Illinois. Some common situations where you would have to call include:

  • If you are having issues with your Medicaid application.
  • In the event you are uncertain about your eligibility.
  • If you want to know about your application status.
  • If you would like to have a Medicaid form mailed to your residence.

Fortunately, regardless of the reason why you want to get in touch with a Medicaid representative, there are a few simple ways that you can do so. Your first option is to locate a Department of Human Services office and pay them a visit in person. If that interests you, click here to access the office locator.

Your second option when trying to get in contact with a DHS representative is to call their IL Medicaid phone number at 1-800-843-6154. This help line will connect you with a professional who is well equipped to work with you and resolve your Medicaid-related issue. If neither of these options interests you, residents of Illinois also have the option of contacting the Department of Human Services by email at DHS.WEBBITS@ILLINOIS.GOV.

Close Bitnami banner
Bitnami