Medicaid eligibility and enrollment in Illinois

You have several options to enroll in Medicaid in Illinois:

• Apply online using the Illinois website or Healthcare.gov (for non-disabled adults under age 65).
• Apply in person and get help from the Department of Human Services (DHS). Find the nearest Family Community Resource Center.
• Apply by mail or fax, or apply online or call at 1-800-843-6154 (TTY 1-800-447-6404) and ask DHS to mail you an application. Complete the application and mail or fax it back to the nearest Family Community Resource Center.

Many Medicare beneficiaries also receive assistance through Medicaid. This includes help with Medicare premiums, cost sharing, prescription drug costs, and services not covered by Medicare – such as long-term care expenses.

Our guide to financial resources for Medicare beneficiaries in Illinois describes these programs, including Medicare Savings Programs, Medicaid long-term care benefits, and guidelines for eligibility.

During the COVID pandemic, states were prohibited from disenrolling people from Medicaid, even if they no longer met the eligibility guidelines. This rule was in use for three years, from March 2020 through March 2023. But states have since resumed regular eligibility redeterminations and disenrollments.

States had some flexibility on the timing of the return to normal procedures, and Illinois opted to delay this as long as possible. The state began sending renewal notices in late April, for people whose Medicaid was due to renew in June. The first round of disenrollments came on July 1 — three months after the earliest possible date allowed by the federal government.

Total Medicaid enrollment in Illinois peaked in July, with 3,969,148 people covered. By September, total enrollment had dropped to 3,932,604, for a decline of 36,544 people (note that this does not represent the total number of people disenrolled, as new people join the Medicaid rolls each month too, and the Illinois enrollment page shows total enrollment).

Illinois is using enrollees’ regularly scheduled renewal date, which enrollees can find at abe.illinois.gov. Renewals are available via that website starting one month before they’re due, and enrollees can renew online once their renewal is available. The state will automatically renew benefits when they have enough information to do that (they expect to be able to auto-renew about a third of enrollees), but will otherwise notify the enrollee that their renewal needs to be completed, either online or with a paper form. The state is encouraging people to use the online renewal whenever possible.

Enrollment in Illinois Medicaid grew by about one million people during the pandemic, from 2.9 million to 3.9 million (as noted above, it peaked at about 3.97 million in July 2023). The state expects about 32,000 people to lose their coverage during each month of the 12-month “unwinding” period, with about 384,000 people losing coverage once all of the eligibility redeterminations are processed.

Most of these people will be eligible for employer-sponsored health coverage or for a subsidized plan through the Illinois exchange/marketplace (getcoveredillinois.gov, which uses the HealthCare.gov enrollment platform). Enrollment windows for employer-sponsored coverage are time-limited. And although HealthCare.gov is offering an extended 16-month enrollment window for people who lose Medicaid during the “unwinding” period, it’s still important to sign up prior to the date that Medicaid terminates, in order to avoid a gap in coverage. There is also a special enrollment period during which people can transition from Medicaid to Medicare without late enrollment penalties, if they’re now eligible for Medicare.

In September 2016, Illinois officials requested permission from the federal government to use existing Medicaid funds (with no changes to eligibility or funding) to test different approaches to treating Medicaid enrollees who need mental health and/or substance abuse treatment. The state had planned to implement the changes in July 2017, but CMS didn’t approve the waiver proposal until May 2018.

The idea is to focus more on preventive care, supportive housing services, and community-based care, rather than institutional care. The state notes that while 25% of Illinois Medicaid enrollees have mental health and/or substance abuse diagnoses, their treatment accounts for 56% of the Medicaid program’s total cost.

Under the terms of the approved waiver, Illinois is running ten pilot projects that provide coverage for services that weren’t previously covered by Medicaid, including short-term inpatient substance abuse treatment, services to help people manage withdrawals during substance abuse recovery, home health visits for new babies and for children born to opioid-addicted mothers, and job coaching and transportation services designed to help people obtain and keep employment.

Drugs that can cure Hepatitis C burst onto the medical scene several years ago, heralded as miracles. But they can also be a strain on budgets, as the pill initially could cost more than $1,000 per day, and the treatment course lasts 12 weeks. Medicaid programs across the country grappled with how to handle the situation, and Illinois announced in September 2016 that they would loosen their guidelines in terms of when Hepatitis C drugs would be covered.

Rather than restricting coverage only to the sickest patients, Illinois Medicaid began to cover Hepatitis C drugs for people with stage 3 and 4 liver scarring, rather than just 4. Advocates cheered the new rules, but cautioned that there was still no coverage for treatment in people with chronic Hepatitis C that hadn’t progressed as far as stage 3 liver scarring, and urged the state to continue to consider the issue.

By 2018, the price of Hepatitis C medications had declined, and a generic version was set to hit the market in early 2019, priced at $24,000 for the full treatment course (as opposed to $90,000 in the early years that the drug was available). And in October 2018, Illinois eliminated the restrictions on access to Hepatitis C drugs, allowing several thousand Illinois residents to obtain Hepatitis C medication through Medicaid, regardless of the stage of their disease and without having to prove sobriety.

Medicaid was implemented in the state of Illinois in January 1966.

Individuals covered by Medicaid in Illinois can choose either a fee-for-service plan or a managed care plan. The Illinois DHS site explains these options.

Illinois has been slower than many other states in moving beneficiaries to managed care plans. However, the state did pass a law in 2011 that required expanding managed care to at least half the state’s Medicaid beneficiaries by Jan. 1, 2015. As of 2022, more than 80% of Illinois Medicaid enrollees were covered under Medicaid managed care plans.

In June 2014, then-Governor Pat Quinn signed a Medicaid reform bill. The law restored adult dental care and podiatry services, aligns Illinois law with federal law to provide Medicaid coverage to children who have been without private insurance for three months, streamlines hospital and nursing-home reimbursement, and more.

Illinois opted to expand Medicaid eligibility, as allowed by the ACA, in July 2013 for a January 1, 2014 effective date. Making Medicaid available to low-income, non-elderly adults is a key part of the Affordable Care Act’s strategy to reduce the nation’s uninsured rate. However, a Supreme Court ruling made Medicaid expansion optional, and as of the fall of 2023, there were still 11 states that had not expanded Medicaid (North Carolina will expand Medicaid in December 2023, reducing the number of non-expansion states to ten).

At the time Medicaid expansion was approved, Illinois officials estimated that 342,000 Illinois residents would qualify. But according to the Chicago Tribune, about 350,000 new enrollees were approved in just the first several months, by June 2014. And a little over a year later, by August 2016, total enrollment in the state’s Medicaid expansion program had exceeded 646,000. But enrollment had dropped to 606,670 people as of July 2018, and remained at a very similar level (607,404) as of April 2020. That was still far higher than the state had initially projected, but lower than it had been a few years earlier.

However, the COVID pandemic pushed Medicaid enrollment (including Medicaid expansion enrollment) much higher in Illinois, as was the case nationwide. By July 2023 (when total Medicaid enrollment peaked in Illinois, before starting to decline due to post-pandemic disenrollments), there were nearly 906,000 people covered under Medicaid expansion in Illinois. That number is expected to decrease somewhat through mid-2024, due to the return to normal eligibility redeterminations and disenrollments after the pandemic (details above).