Medicaid Legislative Reforms and Budget 

HFS Budget - FY2014

• Fiscal Year 2014 Budget Overview (pdf)
• Program Area Appropriations Comparison (pdf)

HFS Medicaid Reforms and Budget - FY2013

The FY 2013 state budget required significant spending reductions and new revenues to fill a $2.7 billion budget hole in the Medicaid Program. This will mean numberous changes for both medical providers and for Medicaid clients. You can view copies of new laws, rules, fact sheets, as well as notices to Medicaid recipients and providers that will implement the package of new laws.

General Budget Information

• SMART Act Implementation Report March 19, 2013 (pdf)
• SB 2840 PA 097-0689 Final Version – SMART Act (pdf)
• Administrative Rules to Implement Package of New Laws
• Final SB 2840 Budget Action Worksheet (pdf)
• SB 2194 PA 097--0688 Final Version – cigarette tax (pdf)
• HB 5007 PA 097-0687 Final Version – Cook County Waiver (pdf)
• SB 3397 PA 097-0691 Final Version – Section 25 (pdf)
• Fact Sheet on the Final Medicaid Legislative Package (pdf)
• Medicaid 101 (pdf)
• Menu of Possible Options for Medicaid Liability and Spending Reductions (pdf)
• HFS Appropriations Status Report, FY 2013 (pdf)
• FY2013 Medicaid Pharmacy Program (pdf)

Information for Recipients

• Changes to Your Medical Benefits (pdf)
• Dental Beneficiary FAQs (pdf version) 
• Notice of Eligibility Changes in FamilyCare Coverage for Adults (pdf)
• Notice of Termination of Illinois Cares Rx Benefit (pdf)
• Notice of Termination of Illinois Cares Rx Benefit (Spanish)(pdf)
• Medicaid Program for Technology Dependent Children Fact Sheet (pdf)
• Questions and Answers on the Medicaid Program For Medically Fragile and Technology Dependent Children (pdf version)
• Extension Request for Medically Fragile Technology Dependent Waiver Renewal (pdf)

Information for Providers

Provider Notices

• $12 Dispensing Fee for 340B Purchased Drugs (pdf) (html)
• 180 Day Time Limits for Claim Submittal (pdf) (html)
• All Kids Application Agent - Alert (pdf) (html)
• Bed Reserve Coverage Changes Resulting from the Save Medicaid Access and Resources Together (SMART) Act (pdf) (html)
• Billing and Payment Changes for Occupational, Physical, and Speech Therapy Services (pdf) (html)
• Category of Risk (pdf) (html)
• Change in Adult Dental Benefits (pdf) (html)
• Change to Adult Eyeglasses Benefit Effective July 1, 2012 (pdf) (html)
• Change to Group Psychotherapy Effective July 1, 2012 (pdf) (html)
• Changes for Physical, Occupational and Speech Therapy Services (pdf) (html)
• Changes to Utilization Reviews/Inpatient Detoxification Readmissions (pdf) (html)
• Chapter H-200, Handbook for Hospital Services (pdf) (html)
• Chapter O-200, Handbook for Providers of Optometric Services Eyeglasses Limitation for Adults 21 Years of Age and Older (pdf) (html)
• Clotting Factor Dispensing April 1, 2013 (pdf) (html)
• Clotting Factor Dispensing August 1, 2012 (pdf) (html)
• Concurrent Palliative and Curative Care for Children Receiving the Hospice Benefit (pdf) (html)
• DME Supplies to be Billed Through Pharmacy System Effective July 1, 2012 (pdf) (html)
• Dental Provider FAQs (pdf version) 
• Elimination of Chiropractic Services for Participants 21 Years of Age and Older (pdf) (html)
• Elimination of the Illinois Cares Rx Program (pdf) (html)
• Elimination of Time Limited Provider Agreements (pdf) (html)
• Enrollment in the 340B Program (pdf) (html)
• Four Prescription Limit (pdf) (html)
• Hospital Inpatient and Outpatient Reimbursement Systems (pdf) (html)
• Incontinence Supplies Changes (pdf) (html)
• Increase in Prevention of Spousal Impoverishment Standards (pdf) (html)
• Inpatient Utilization Review Change Mandated by P.A. 097-0689, the Save Medicaid Access and Resources Together (SMART) Act (pdf) (html)
• Institutional Provider Rate Reductions Effective July 1, 2012 (pdf) (html)
• Long Term Care Residents Restricted to 14-Day Supplies of Certain Medications (pdf) (html)
• LTC Coverage Changes Resulting from the Save Medicaid Access and Resources Together (SMART) Act (pdf) (html)
• 08-31-12 Limitations on Podiatric Services (pdf) (html)
• 07-23-12 Limitations on Podiatric Services (pdf) (html)
• Limitations on Podiatric Services (Revised) (pdf) (html)
• No Hospice Rate Reductions Effective July 1, 2012 (pdf) (html)
• Non-Coverage of Specified Services for Hospice-Enrolled Participants (pdf) (html)
• Over-The-Counter Drug Co-payment Clarification (pdf) (html)
• Participant Co-payments Effective July 1, 2012 (pdf) (html)
• Pharmacy Reimbursement Changes Effective July 1, 2012 (pdf) (html)
• Pharmacy Utilization Controls, Including Prior Approval, for Specialty Drugs, Oncolytic Drugs, Drugs for the Treatment of HIV Or AIDS, Immunosuppressant Drugs, and Biological Products in Order to Maximize Savings on these Drugs.
• Prior Approval for Certain Drugs (pdf) (html)
• Prior Approval for Surgeries for Morbid Obesity (pdf) (html)
• Prior Approval Required for All Wheelchair and Power-Operated Vehicle (POV) Repairs Effective June 1, 2013 (pdf) (html)
• Prior Approval Requirements for Clotting Factor (pdf) (html)
• Provider Rate Reductions Effective July 1, 2012 (pdf) (html)
• Provider Self Disclosure Protocol (pdf) (html)
• Reimbursement Changes to the Illinois Hemophilia Program (pdf) (html)
• Reimbursement Changes to the Sexual Assault Emergency Treatment Program (pdf) (html)
• SLF Coverage Changes Resulting from the Save Medicaid Access and Resources Together (SMART) Act (pdf) (html)
• (SMART) Act Changes and its Effect on DCFS Children (pdf) (html)
• (SMART) Act Changes and its Affect on Managed Care Organizations (pdf) (html)
• Third Party Liability (pdf) (html)
• Update to Therapy Services Provided by Hospitals and APL Policy Change (pdf) (html)

Fee Schedules

• Audiology (pdf)
• Chiropractor (pdf)
• Optometric (pdf) 
• Podiatry (pdf)
• Therapy (pdf)
• DME
• Practitioner

Proposed Rules

• 89 Ill. Adm. 101 (pdf)

• 89 Ill. Adm. 104 (pdf)

• 89 Ill. Adm. 110 (pdf)

• 89 Ill. Adm. 118 (pdf)

• 89 Ill. Adm. 119 (pdf)

• 89 Ill. Adm. 120 (pdf)

• 89 Ill. Adm. 125 (pdf)

• 89 Ill. Adm. 140 (pdf)

• 89 Ill. Adm. 148 (pdf)
• 89 Ill. Adm. 152 (pdf)
• 89 Ill. Adm. 153 (pdf)

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Illinois Department of Healthcare
and Family Services
201 South Grand Avenue East
Springfield, IL 62763-0001
Phone: 217-782-1200
TTY: 1-800-526-5812