Medicaid in Illinois is a health care program designed for low-income individuals and families, providing a comprehensive range of health benefits, including medical, prescription, dental, vision, and long-term care services.
Eligibility Criteria
To qualify for Medicaid in Illinois, you must meet specific criteria based on income, age, disability, and citizenship status.
Income Requirements
Medicaid eligibility in Illinois is largely based on the applicant’s Modified Adjusted Gross Income (MAGI), which includes a built-in 5% income disregard.
Children Ages 0-18: Family income up to 142% of the Federal Poverty Level (FPL)[1][2][4].
Pregnant Women: Family income up to 208% of FPL. Coverage extends for 12 months postpartum[1][2].
Adults Under 65: Family income up to 138% of FPL, thanks to the Affordable Care Act (ACA) Medicaid expansion[1][2][4].
Parents or Related Caregivers: Family income up to 133% of FPL[2].
Age Requirements
Children and Young Adults: Ages 0-18 are eligible with family income up to 142% of FPL.
Adults 19-64: Eligible if they meet income or disability requirements and are not receiving Medicare.
Seniors (65 and Older): Must have an income below $981 per month and countable assets below $2,000 to qualify for Medicaid. However, these limits are subject to change annually[2][3].
Citizenship Requirements
To be eligible for Illinois Medicaid, you must reside in Illinois and be a U.S. national, citizen, or permanent resident (Green Card holder) for at least five years. Children and pregnant women of any immigration status can qualify if they meet the income requirements[2][4].
Disability and Medical Need Requirements
For long-term care, applicants must also meet medical or functional need requirements. For example, nursing home care requires a nursing home level of care, while home and community-based services aim to delay nursing home admissions[3].
Applying for Medicaid in Illinois
There are several ways to apply for Medicaid in Illinois:
Online Application: Use the Illinois website or Healthcare.gov to apply online[1][2][4].
In-Person Application: Apply at the nearest Family Community Resource Center and get assistance from the Department of Human Services (DHS)[1][2].
Mail or Fax Application: Complete an application and return it by mail or fax to the nearest Family Community Resource Center[1][2].
Phone Application: Call 1-800-843-6154 (TTY 1-800-447-6404) to request an application or apply over the phone[1].
Long-Term Care Eligibility
For seniors, there are specific programs such as Institutional/Nursing Home Medicaid and Medicaid Waivers/Home and Community Based Services. The eligibility criteria include:
Income Limits: For example, in 2025, a single nursing home applicant must have an income under $1,215 per month[3].
Asset Limits: Assets must be under $17,500 for a single applicant[3].
Medically Needy Pathway: Allows seniors to become income-eligible by spending a significant portion of their income on medical expenses[3].
Important Facts About Illinois Medicaid Eligibility
Income Limits:
Children ages 0-18: Up to 142% of FPL.
Pregnant women: Up to 208% of FPL.
Adults under 65: Up to 138% of FPL[1][2][4].
Application Methods:
Online through Illinois website or Healthcare.gov.
In-person at Family Community Resource Centers.
By mail or fax.
Over the phone[1][2][4].
Citizenship Requirements:
Must be a U.S. national, citizen, or permanent resident for at least five years, except for children and pregnant women who can qualify regardless of immigration status[2][4].
Long-Term Care Eligibility:
Seniors must meet specific income and asset limits, and require a nursing home level of care or other medical needs[3].
Built-in Income Disregard:
A 5% income disregard is included in the MAGI-based eligibility rules[1][2].
Coverage Benefits:
Includes medical, prescription, dental, vision, and long-term care services[2].
By understanding these criteria and application methods, individuals can better determine their eligibility for Medicaid in Illinois and access the necessary health care services.
