Salud y beneficios

Medicaid is a joint state and federal program that pays for medical costs for people with low income. Medicaid cubre a los adultos de bajos ingresos, con o sin hijos. There are several different Medicaid programs, including:

• Ley de Cuidado de Salud a Bajo Precio Medicaid para Adultos,
• All Kids para niños de hasta 19 años,
• YouthCare for children whose care is subsidized by the Illinois Department of Children and Family Services (DCFS) or children served by DCFS through guardianship When a person is appointed by a judge to take care of a child or an adult with a disability and adoption When an adult becomes a child's legal parent assistance programs,
• Coverage for young adults under age 26 that were on Medicaid when they left DCFS foster care at age 18 or later
• Moms and Babies, for pregnant women (up to 12 months post-partum and babies
• AABD Medicaid para personas que tienen 65 años o más, son ciegas o están discapacitadas,
• Planes de salud familiar,
• Health Benefits for Immigrant Seniors who are 65 and older,
• Programas de Ahorro de Medicare, que ayudan con las primas de la Parte B de Medicare primas, Dinero que debe pagarse todos los meses, como para el seguro médico
• Las víctimas no ciudadanas de trata, tortura u otros crímenes graves,
• Programa de cáncer de mama y de cuello uterino,
• Beneficios de salud para trabajadores con discapacidades, y
• Atención para veteranos.

This is not a complete list of the available Medicaid programs in Illinois. The Illinois Department of Health and Family Services (IHFS) has a complete list on their website.

En Illinois, Medicaid está disponible para las personas que:

• Niños de 18 años o menos,
• Padres y cuidadores responsables de un niño de 18 años o menos,
• Adultos de bajos ingresos de 19 a 64 años,
• Más de 65 años,
• Discapacitado,
• Ciego,
• Pregnant, or
• Adultos jóvenes menores de 26 años que anteriormente estuvieron en cuidado de crianza temporal.

IDHS or HFS decides a person’s eligible for Medicaid.

Each group has different income and asset limits. They also have different rules about what kinds of income and assets Anything a person owns that has financial value will count toward these limits.

• For adult Any person 18 years old or over US citizens and eligible non-citizens under 65 and who do not have Medicare, the Medicaid income limit is 138% of the federal poverty level.
• For children, the income limit is 318% of the federal poverty level.
• For pregnant people, and those who have recently given birth, the income limit is 213% of the federal poverty level. They can keep this coverage for up to 12 months after giving birth.

For all of these categories, Illinois' Medicaid program will look at a household's size and income based on how many people file taxes or plan to file taxes together. This could include, for example, adult children who are living with their parents. It will then look at countable income from those household members. There is no asset limit for these Medicaid programs.

For adults who are disabled, blind, or age 65 or older (receiving Aged Blind and Disabled AABD benefits) and those who have Medicare benefits, there are different rules. Their countable income must be below 100% of the federal poverty level, and they must have no more than $17,500 of non-exempt resources. Exempt resources are typically assets like a person’s home, a single car, and their personal belongings, some life insurance policies, burial spaces, and more. If someone in this category is over the income or asset limit, they may still qualify for Medicaid with a spend-down. Read more about the income and asset rules for Aged Blind and Disabled (AABD) medical help.

If a person transfers certain kinds of property to someone else to qualify for Medicaid, they could be penalized. For example, if a person is applying for Medicaid coverage for long-term care services, HFS will look at whether they transferred any property in the last five years. If someone transferred property for less than fair market value The price that a normal buyer would pay during that time, they may not be eligible for Medicaid for long-term care for a certain period. Learn more about transferring property and Medicaid for long-term care.

Consulte con IDHS los límites de ingreso y recursos para su tipo de Medicaid. IDHS has the current standards that are in effect.

Only US citizens and certain non-citizens, such as refugees and people with lawful permanent resident status (LPR or green card) in the US for over five years, qualify for Medicaid.

Note: The non-citizen eligibility requirements for Medicaid will change in October 2026. After the change, some non-citizens who qualified for Medicaid before will no longer be eligible. Refugees, asylees, and victims of trafficking or domestic violence Harm by one household or family member against another household or family member. Harm may be an emotional, mental, or physical injury are losing non-emergency coverage effective October 2026. Medicaid eligibility will be limited to three specific categories of noncitizens: LPRs who have met a 5-year waiting period, Cuban and Haitian family reunification program entrants, and Citizens of the Freely Associated States (Micronesia, Marshall Islands, and Palau). 

In Illinois, these rules do not apply to children 18 years or younger, or to pregnant people.

Non-citizens 65 years or older may be eligible for Illinois' Health Benefits for Immigrant Seniors (HBIS) program. New enrollment is paused for the HBIS program. However, people can continue to receive benefits if they are already enrolled.

People who have applied for or obtained a U-Visa, T-Visa, asylum, or status under the Violence Against Women’s Act (VAWA) might also be eligible for state-funded medical assistance.

If someone cannot Medicaid because of their immigration status, they may be able to buy low-cost insurance. Some noncitizens might be able to get financial assistance through the Get Covered Illinois Marketplace.

Learn more about Government benefits for immigrants.

Medicaid cubre los servicios médicamente necesarios para personas elegibles. Medicaid para niños también cubre la atención preventiva, como chequeos regulares y vacunas. 

Illinois tiene diferentes programas médicos, y los requisitos de elegibilidad son distintos para cada programa. Algunos programas de salud cubren un conjunto limitado de servicios. La mayoría de las personas cubiertas por Medicaid tienen acceso a servicios integrales de atención médica, que incluyen:

• Odontólogos
• Visitas al médico,
• Servicios de emergencia,
• Cuidado ocular,
• Servicios y suministros de planificación familiar,
• Atención hospitalaria,
• cuidado de enfermos terminales,
• Servicios de atención a largo plazo, como atención especializada en residencias de ancianos,
• Equipos y suministros médicos,
• Cuidado de la salud mental,
• Medicamentos recetados,
• Servicios para el trastorno por consumo de sustancias,
• Servicios de telemedicina,
• Terapias, como la terapia del habla, terapia ocupacional o terapia física, y
• Transporte a los servicios de salud.  

Esta no es una lista completa. Además, algunos servicios pueden tener reglas o límites específicos. Por ejemplo, la atención dental es limitada para los adultos, pero es más completa para los niños.

Medicaid recipients can learn more about their specific medical program by:

• Calling the number on their medical card to ask about covered benefits,
• Llamar a la línea directa de beneficios de salud de Medicaid al (800) 226-0768, o
• Reviewing their member handbook, which can generally be found online.

Medicaid cubre los medicamentos recetados que son necesarios y algunos productos de venta libre. Some drugs require prior approval from HFS. Más información sobre la cobertura de medicamentos recetados de Illinois Medicaid en el sitio web de HFS.

HFS must approve medications after someone fills four prescriptions in 30 days. This limit generally applies to adults Medicaid recipients. Currently, prescriptions for children under age 19 won't be rejected because of this policy. Also, residents of Community Integrated Living Arrangements (CILAs) or Supportive Living Facilities (SLFs) won't be rejected if HFS has person's living arrangement recorded in their system 

Los siguientes tipos de drogas no requieren aprobación previa:

• Oncolytics, which are used to treat some cancers,
• Anti-retroviral agents, which are used to treat and prevent HIV,
• Anticonceptivos,
• Inmunosupresores,
• Medicamentos de venta libre, y
• Artículos no farmacológicos, como tiras reactivas de glucosa en sangre y monitores.

In certain situations, short-term approval will be granted. Cuando HFS no está disponible para procesar solicitudes, una farmacia puede proporcionar un suministro de emergencia de 72 horas.

Existen varias formas de verificar el estado de una solicitud:

• Patients may call the Health Benefits Hotline at (800) 266-0768 or (866) 675-8440 (TTY).
• If someone used Illinois Rx Portal to enter a prior approval request, they can check the status of the request in that system.

Learn more about the Four Prescription Policy.

Qualifying for a Medicaid program doesn't mean a person can go to any doctor for free. Algunos médicos no participan en Medicaid. Most people in Illinois on Medicaid are in managed care organizations, depending on where they live. This means they will probably need to choose a network of doctors and hospitals to see with their Medicaid card. Otherwise, they will choose a Primary Care Provider (PCP) who will help coordinate their care. Their PCP will refer them to specialists if they need to see one.

Recipients will receive an enrollment packet after starting Medicaid that explains the process of managed care. The enrollment packet will explain the choices of plans and doctors in their area. People should review the plans and pick the one that is best for them. Once they choose a plan, they might not be able to change plans until the annual open enrollment period. Learn more about managed care.

Some medical care requires prior approval when the patient has a Medicaid plan. Depending on the plan they are on, they may or may not need prior approval. If their plan requires prior approval, their doctor must explain the need for the treatment. Otherwise, their doctor will not receive payment.

Esto es común para la atención que no es rutinaria. Por ejemplo, equipos médicos o dispositivos de apoyo.

People may also need prior approval for prescription drugs. The specific Medicaid plan will state whether prior approval is needed for medical care or prescriptions.

People can apply online for Medicaid on the Illinois Application for Benefits Eligibility (ABE) website. They can also apply via mail, in person at an IDHS office, or over the phone. 

If someone is approved, they receive a letter in the mail with information about their medical benefits. Illinois Medicaid does not issue physical Medicaid cards. The approval letter is used to pay for doctor visits and hospital care. It is also used to pay for prescription drugs and other medical care. 

If someone needs to get a new copy of their letter, they can get one online through their Manage My Case account. Or they can visit their local DHS office to ask for another copy.

Learn more about applying for Medicaid.

People have a right to appeal A request to change a court's decision their denial of Medicaid. The deadline for appealing is 60 days after the date of the denial letter. Learn about appealing a Medicaid denial.

The State of Illinois and Cook County Health & Hospitals System (CCHHS) operate a Medicaid managed care program for uninsured adults in Cook County called CountyCare. Este es un programa Medicaid a través de la Ley de Cuidado de Salud a Bajo Precio (Ley de Cuidado de Salud a Bajo Precio). Recipients of CountyCare get medical care from providers in the CCHHS and others.

To qualify for CountyCare, a person must:

• Viva en el condado de Cook,
• Cumplir con los requisitos de ingreso, y
• Ser ciudadano de los Estados Unidos o cumplir con ciertos requisitos de inmigración.

Learn more about CountyCare.

Sitios web

The Illinois Department of Healthcare and Family Services (HFS) encourages people to apply for and manage their benefits online. There is no penalty for applying even if someone is found ineligible for benefits. People can use this online tool to:

• Check if they might be eligible for benefits,
• Solicitar beneficios,
• Check their application status,
• Ver detalles de los beneficios,
• Informar sobre un cambio,
• Renew their benefits,
• Cargar documentos, y
• Access the website to appeal A request to change a court's decision their benefits decision.

Information about other ways to apply for Medicaid benefits can be found on the IDHS website.

La página de atención al cliente de ABE ofrece recursos, incluyendo una Guía del Usuario de ABE, una Guía de Apelaciones de ABE, instrucciones sobre cómo configurar "Administrar mi caso", respuestas a preguntas frecuentes y más. 

For more information on the various Medicaid programs offered in Illinois, visit the HFS website.

Números de teléfono

HFS also offers a benefits hotline where people can get information about:

• Whether they qualify for Medicaid, or
• Si un proveedor de atención médica participa en Medicaid.

The hotline for most benefits programs is at:

• (866) ALL-KIDS (866-255-5437) gratuito, o
• (877) 204-1012 (TTY).

The DHS can help people locate their nearest DHS office or give them other information about health benefits. Se puede contactar con ellos en:

• (800) 843-6154,
• (866) 324-5553 (TTY), o
• A través de su oficina local.

Additional government websites

Administración del Seguro Social

Medicare

Medicaid

Departamento de Servicios de Salud y Familia de Illinois

Departamento de Servicios Humanos de Illinois