Health Care: Medicaid
As of January 2014, Medicaid eligibility changed under the Affordable Care Act. You no longer have to be elderly, disabled, blind, or have dependent children to be eligible for Medicaid. Even if you do not qualify for Medicaid, you are eligible to buy affordable health insurance on the Illinois Health Insurance Marketplace.
How can Medicaid help me?
If you need help paying for your health care needs and your family’s health care needs, Medicaid may be able to provide you with limited insurance and payment for health care. The Illinois Department of Healthcare and Family Services (IHFS) runs the Medicaid program, but the Department of Human Services (IDHS) takes applications and determines eligibility.
Am I eligible?
The income limits for Medicaid coverage of adults varies with the categories of applicants. Medicaid will cover nearly all individuals with incomes up to 138% of the federal poverty level ($16,248 for an individual and $27,725 for a family of three in 2015). However, the resource limit varies with the type of Medicaid program. Contact IDHS at 1-800-843-6154 to obtain the specific income and resource limits for your type of Medicaid.
If your income is between 138% and 400% of the federal poverty level, you may be eligible for a premium subsidy under the Affordable Care Act. In addition, if your income is between 138% and 250% of the federal poverty level, you may be eligible for a cost sharing reduction. With the help of this federal financial aid you may purchase affordable health insurance on the Official Illinois Marketplace.
Immigration status. Adults must be U.S. citizens or eligible immigrants (see Special Information for Immigrants section). Children and pregnant women are eligible regardless of immigration status.
What services will Medicaid cover?
Covered services for adults include:
- Hospital and physician services, lab tests, and X-rays
- Prescription drugs
- Vision for children
- Home health care, long-term care, or hospice care
- Some medical and respiratory equipment and supplies
- Some substance abuse treatment
- Community mental health treatment
- Dental services for adults
- Some dental services for adults
- Podiatry services
New under ACA:
- Preventive services such as certain health screenings and vaccines
- Dental services for children and when necessary for the health of a pregnant woman
- Expanded coverage for contraception, reproductive health screenings (see this guide’s section on Women’s Health).
Medicaid will pay for services directly to your medical provider. Services are provided by your “medical home.” A medical home is a doctor’s office or clinic that knows you and your health care needs. You must choose a medical home or select a doctor or clinic you already have. Some services and items may require prior approval.
How do I apply?
You can find out if you are eligible for Medicaid or the Official Illinois Marketplace by visiting Get Covered Illinois and clicking on “see your options.” You will be asked questions about your family size and monthly income and then redirected either to the ABE portal for Medicaid benefits or the Marketplace (See section on Applying for SNAP, TANF, and Medical Assistance for more instructions about the ABE portal).
If you are approved, your Medicaid benefits usually begin the month you apply; however, the application can be backdated 3 calendar months from the month you apply. You will receive a medical card in the mail that you can use for your medical expenses. Coverage began January 1, 2014 for people who are newly eligible under Medicaid expansion. Medicaid enrollment is always open and ongoing.
If you apply for benefits from the Marketplace between the 1st and 15th of the month, your benefits will start at the beginning of the following month. If you apply between the 16th and the end of the month, your benefits will not start the following month but will begin the month after that. For example, if you apply on January 16th, your benefits will begin on the 1st of March. The Marketplace had a special enrollment period of November 15, 2014 to February 15, 2015. The next enrollment period will be November 1, 2015 to January 31, 2016.
Starting in 2014, everyone must have health insurance or an exemption. If you do not have insurance or an exemption, you will have to pay a fee. This is called the Individual Mandate.
More Information and Resources
For more information about applying for healthcare insurance, call (800) 318-2596 for assistance in 150 languages. For in person assistance, visit GetCoveredIllinois and type in your zip code to find an assister in your area, or call 1-866-311-1119.
If you need help finding a provider, call Illinois Health Connect at 1-877-912-1999 (TTY 1-866-565-8577).
You may also call the IHFS Health Benefits Hotline toll-free at 1-800-226-0768 (TTY 1-887-204-1012) to find out which doctors accept the Medicaid card, what benefits are covered, and what you may receive for general assistance. Also, visit IHFS online. You can also find a dental provider who accepts Medicaid (Adults who are not pregnant may get only emergency dental, but children may have regular dental visits. To find a dental provider who accepts Medicaid, visit DentaQuest).
Additional Related Programs
Supplemental Security Income (SSI) or Supplemental Security Disability Income (SSDI) may also help you pay for your medical expenses if you or your dependents are blind, disabled, or 65 or older and have little income. For more information, visit the Social Security Administration.
If you are 65 or older or have a disability, you may also be eligible for Medicare. For more information, visit Medicare.gov.
To find resources that can help you to reduce and manage your prescription medication costs, visit RxAssist.