The Illinois Department of Healthcare and Family Services (HFS) is committed to improving the health of Illinois' families by providing access to quality healthcare. This mission is accomplished through HFS Medical Programs that pay for a wide range of health services, provided by thousands of medical providers throughout Illinois, to about two million Illinoisans each year. The primary medical programs are:
- Medical Assistance, as authorized under the Illinois Public Aid Code (305 ILCS 5/5 et seq.) and Title XIX of the Social Security Act, Medicaid; and
- Children’s Health Insurance, as authorized under the Illinois Insurance Code (215 ILCS 106/1 et seq.) and Title XXI of the Social Security Act, the State Children’s Health Insurance Program (SCHIP).
Necessary medical benefits, as well as preventive care for children, are covered for eligible persons when provided by a healthcare provider enrolled with HFS. Eligibility requirements vary by program. Most people who enroll are covered for comprehensive services, including, but not limited to; doctor visits and dental care, well-child care, immunizations for children, mental health and substance abuse services, hospital care, emergency services, prescription drugs and medical equipment and supplies. Some programs, however, cover a limited set of services.
ACA Adults – with the new Affordable Care Act (ACA), adults age 19-64 who were not previously eligible for coverage under Medicaid can now receive medical coverage beginning January 1, 2014. By applying now, individuals with income up to 138 percent of the federal poverty level (monthly income of $1,321/individual, $1,784/couple) can be covered starting in January 2014.
Aid to Aged Blind and Disabled (AABD) Medical covers seniors, persons who are blind and persons with disabilities with income up to 100 percent of the federal poverty level (FPL) and no more than $2,000 of non-exempt resources (one person). Federal matching funds are available under Medicaid for these individuals. More information on how to apply for these programs may be found on the Department of Human Services Website
Department of Children and Family Services (DCFS) – Coverage is provided to children whose care is subsidized by DCFS under Title IV-E (Child Welfare) of the Social Security Act as well as children served by DCFS through its subsidized guardianship and adoption assistance programs. Federal matching funds are available under Medicaid for nearly all of these children. More information on DCFS programs may be found on the DCFS Website.
Former Foster Care – covers young adults under age 26 who were on Medicaid when they left DCFS foster care at age 18 or later. This group is eligible for Medicaid regardless of income.
Family Health Plans
The All Kids and FamilyCare programs are comprised of six plans: FamilyCare/All Kids Assist; All Kids Share; All Kids Premium Level 1; All Kids Premium Level 2; All Kids Rebate and Moms and Babies. Children are eligible through 18 years of age. Adults must be either a parent or caretaker relative with a child under 19 years of age living in their home, or be a pregnant woman. For all plans, non-pregnant adults must live in Illinois and be U.S. citizens or legal permanent immigrants in the country for a minimum of five years. Children and pregnant women must live in Illinois and are eligible regardless of citizenship or immigration status. For more information visit the All Kids and FamilyCare Websites.
The All Kids Web site is maintained to provide easily accessible and current information about the program. Families may apply online through both an English and Spanish Web-based application. Both English and Spanish applications are also available for download by persons who want to apply for All Kids by mail. Those using the Website may also ask questions about the program. Information is provided about All Kids income guidelines/cost sharing, FamilyCare income guidelines and cost sharing, and All Kids Application Agents (AKAAs), who provide assistance to families when applying.
FamilyCare/All Kids Assist provides a full range of health benefits to eligible children 18 years of age and younger, and their parents or caretaker relatives. To be eligible, children must live in families with countable family income within 147 percent of the federal poverty level (FPL). The parents/caretaker relatives are eligible for coverage if the countable income is up to 138% FPL. Children covered under All Kids Assist have no co-payments or premiums. FamilyCare Assist parents have a co-payment per medical service or prescription received.
All Kids Share provides a full range of health benefits to eligible children. To be eligible children must have countable family income over 147 percent and at or below 157 percent of the FPL.
Children in All Kids Share have a co-payment for each medical service and prescription received, up to a maximum of $100 per family per year. There are no co-payments for well-child visits and immunizations.
Families with members who are American Indians or Alaska Natives do not pay premiums or co-payments.
All Kids Premium Level 1 provides a full range of health benefits to eligible children. For children to be eligible, families must have countable income over 157 percent and at or below 209 percent of the FPL.
Families eligible for All Kids Premium Level 1 pay monthly premiums based upon the number of children covered (ranging from one child to five or more). All Kids Premium Level 1 children have a co-payment for each medical service or prescription received, up to a maximum of $100 per family per year. There are no co-payments for well-child visits and immunizations. Families with children who are American Indians or Alaska Natives do not pay premiums or co-payments.
All Kids Premium Level 2 provides a full range of health benefits to eligible children in families with income above 209 percent and at or below 318 percent of the FPL. Monthly premiums are paid for one child and for two or more children. Co-payments vary by service.
Moms and Babies provides a full range of health benefits to eligible pregnant women and their babies up to one year of age. To be eligible, pregnant women must have countable family income at or below 200 percent of the FPL. Babies under one year of age are eligible at any income as long as Medicaid covered their mother at the time of the child’s birth. Moms and Babies enrollees have no co-payments or premiums and must live in Illinois.
Illinois Breast and Cervical Cancer Program (IBCCP) covers uninsured women at any income level who need treatment for breast or cervical cancer. Federal matching funds, at the enhanced rate of 65 percent, are available under Medicaid for women with income up to 200 percent of the FPL. Under the program, the Department of Public Health (DPH) provides screenings for breast and cervical cancer. HFS administers the treatment portion of the program. Individuals who are not enrolled in IBCCP should call the DPH Women’s Health Line at 1-888-522-1282 (1-800-547-0466 TTY). The Women’s Health Line will be able to walk women through the eligibility requirements and the screening process. Those who are already receiving coverage under the treatment portion of the program may call the HFS IBCCP Unit at 1-866-460-0913 (1-877-204-1012 TTY). Visit the IBCCP Website for more information.
Health Benefits for Workers with Disabilities (HBWD) covers persons with disabilities who work and have earnings up to 350 percent of the FPL who buy-in to Medicaid by paying a small monthly premium. Eligible people may have up to $25,000 in non-exempt resources. Retirement accounts and medical savings accounts are exempt. Federal matching funds are available under Medicaid for these benefits. Comprehensive program information, as well as a downloadable application can be found on the HBWD Website.
Illinois Healthy Women (IHW) Program is a special Medicaid waiver program that provides family planning (birth control) services to low-income women who qualify. This program does not cover a comprehensive array of health services. Federal matching funds are available at the 90 percent enhanced rate for family planning services. Individuals may learn more or download an application on the Illinois Healthy Women Website.
Medicare Cost Sharing covers the cost of Medicare Part B premiums, coinsurance, and deductibles for Qualified Medicare Beneficiaries (QMB) with incomes up to 100 percent of the FPL. Medicare cost sharing covers only the cost of Medicare Part B premiums only for persons with incomes over 100 percent of the FPL but less than 135 percent of the FPL under the Specified Low-Income Medicare Beneficiaries (SLIB) or Qualifying Individuals (QI) programs. Resources are limited to $7,080 for a single person and $10,620 for a couple. The federal government shares in the cost of this coverage. Additional information on the Medicare Cost Sharing program can be found on the HFS Medical Brochures page.
Pay-In Spenddown provides individuals whose income and/or assets are too high for regular Medicaid to enroll and pay their spenddown amount to the department, rather than having to accumulate bills and receipts of medical expenses on a monthly basis and provide them to the Department of Human Services, Family Community Resource Center (DHS FCRC). After enrolling in the Pay-In program, monthly statements of the spenddown amount are issued to the client providing the opportunity to meet spenddown through money order, cashier’s check, debit or credit card payment. Additional information on the Pay-In program can be found on the department’s Medical Brochures page.
State Hemophilia Program provides assistance to eligible patients to obtain antihemophilic factor, annual comprehensive visits and other outpatient medical expenses related to the disease. This program does not cover a comprehensive array of health services. Participants must complete a financial application each fiscal year. Some participants may be responsible for paying a participation fee prior to the program paying for eligible medications. Participation fees are determined by the individual’s family income and family size, and are similar to an annual insurance deductible. The program is always the payer of last resort, meaning that it only pays after other third party payers, such as private insurance or Medicare, have made a benefit determination. The program is available to any non-Medicaid eligible resident of Illinois with a bleeding or clotting disorder. Questions regarding applications or the eligibility of participants in the State Hemophilia Program should be directed to the HFS, Bureau of Comprehensive Health Services at 1-877-782-5565.
State Renal Dialysis Program covers the cost of renal dialysis services for eligible persons who have chronic renal failure and are not eligible for coverage under Medicaid or Medicare. This program does not cover a comprehensive array of health services. Eligibility for the program is reviewed and determined on an annual basis. Participants must be a resident of Illinois, and meet citizenship requirements. The program assists eligible patients who require lifesaving care and treatment for chronic renal disease, but who are unable to pay for the necessary services on a continuing basis. The program covers treatment in a dialysis facility, treatment in an outpatient hospital setting and home dialysis, including patients residing in a long-term care facility. Individuals determined eligible for the program may be responsible for paying a monthly participation fee based on family income, medical expenses and liabilities, family members, and other contributing factors. All participation fees are paid directly to the dialysis center that provided the treatment. These benefits are financed entirely with state funds. Individuals may learn more or download an application at State Renal Dialysis Program
State Sexual Assault Survivors Emergency Treatment Program pays emergency outpatient medical expenses and 90 days of related follow-up medical care for survivors of sexual assault. This program does not cover a comprehensive array of health services. The program will reimburse an Illinois hospital for a patient’s initial emergency room (ER) visit and for related follow-up care for 90 days following the initial ER visit. If the patient receives a voucher at the hospital for the program’s follow-up program, then the patient can seek their 90 days of follow-up care from the community providers of their choosing. HFS maintains an online registry for hospitals to register the sexual assault survivor in order to produce a voucher that allows the survivor to obtain needed follow-up care outside of an Illinois hospital. The program is always the payer of last resort, meaning that it only pays after other third party payers, such as private insurance or Medicare, have made a benefit determination. Participants currently eligible for Medicaid are not eligible to receive benefits under this program.
Veterans Care provides comprehensive healthcare to uninsured veterans under age 65 who were not dishonorably discharged from the military, are income eligible, and are not eligible for federal healthcare through the U.S Veterans Administration. Eligible individuals pay a monthly premium of either $40 or $70 depending on their income. Veterans may apply for Veterans Care by either downloading an application from the Web site, or by going to their local Illinois Department of Veterans Affairs Office. The Department of Healthcare and Family Services determines eligibility, notifies the Veteran and handles the premium payments. Individuals may learn more about this program on the Illinois Veterans Care Web site.
Refugee Program covers persons who are not citizens and who are not otherwise qualified aliens, but who are admitted to the U.S. as refugees, asylees or conditional entrants; resident non-citizens who were formerly refugees; certain Amerasian immigrants from Vietnam; certain Cubans and Haitians; or victims of human trafficking.
Medical Assistance for Asylum Applicants and Torture Victims provides up to 24 months coverage for persons who are not qualified immigrants but who are applicants for asylum in the U.S. or who are non-citizen victims of torture receiving treatment at a federal funded torture treatment center. Such person must meet all other eligibility criteria.
For information about where to apply for medical benefits call: 1-800-843-6154
For Persons Using TTY: 1-800-447-6404
Or go to a DHS Family Community Resource Center
For more information about medical benefits, call the Health Benefits Hotline:
In Illinois: 1-866-468-7543
Outside of Illinois: 1-217-785-8036
Persons Using TTY: 1-877-204-1012