- Illinois expanded Medicaid in 2014, and nearly 790,000 people have gained coverage as a result.
- Approved waiver allows Illinois to pilot new mental health and substance abuse treatment approaches.
- Illinois Medicaid has expanded coverage for Hepatitis C medication.
ACA’s Medicaid eligibility expansion in Illinois
Medicaid is an important part of overall health insurance enrollment and coverage in Illinois, with Medicaid and CHIP covering about 20% of the state’s 12.5 million residents. About 20% of those covered are eligible for Medicaid due to the state’s expansion of Medicaid under the Affordable Care Act (ACA). The Illinois Department of Healthcare and Family Services maintains a running update of total enrollment numbers; as of August 2021, there were 789,974Illinois residents covered under expanded Medicaid.
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Total Medicaid enrollment includes people who are eligible under the ACA’s expansion of Medicaid to low-income adults, as well as people who were already in one of the traditional Medicaid groups (low-income people who are also either pregnant, children, parents of minor children, aged, blind, or disabled residents). Most Illinois Medicaid enrollees are in one of those traditional eligibility groups, although enrollment in those groups has declined while enrollment in expanded Medicaid has grown. As of June 2021, total Medicaid enrollment in Illinois stood at more than 3.3million people — up from 2.62 million in 2013.
There has been a significant increase in Medicaid enrollment during the COVID pandemic, due to the widespread job and income losses. Under the Families First Coronavirus Response Act, enacted in the early days of the pandemic, states are receiving additional federal Medicaid funding, but on the condition that they not disenroll anyone from their Medicaid programs (unless the person moves out of state or requests a disenrollment). So Medicaid enrollment has generally just trended upward since early 2020, without the normal fluctuations we’d tend to see as people transition in and out of Medicaid.
Medicaid funding for enhanced mental health care
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 whoneed 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.
Hepatitis C drug coverage expanded in stages, now available to anyone with the disease
In the past few years, drugs that can cure Hepatitis C have burst onto the medical scene, 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 have been 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, the state 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.
Illinois has accepted federal Medicaid expansion
- 3,342,166 – Number of Illinoisans covered by Medicaid/CHIP as of June 2021
- 715,223– Increase in the number of Illinoisans covered by Medicaid/CHIP fall 2013 to May 2021
- 46% – Reduction in the uninsured rate from 2010 to 2019
- 27% – Increase in total Medicaid/CHIP enrollment in Illinois since Medicaid expansion took effect
Who is eligible for Medicaid in Illinois?
Federal law specifies mandatory and optional coverage groups for Medicaid. States must cover the mandatory groups to receive federal Medicaid funding, and they qualify for additional funding if they cover optional groups.
The federal government specifies minimum thresholds for eligibility for the various groups, and states can set their requirements at or above the minimum threshold. Illinois has established requirements that are near national averages.
Illinois’ eligibility standards for Medicaid are:
- Children ages 0-18 qualify with family income levels up to 147% of the federal poverty level (FPL); the Children’s Health Insurance Program covers children with family income up to 318% of FPL
- Someone who is pregnant will qualify with family income up to 213% of FPL
- Parents and other adults qualify with family income up to 138% of FPL
Note that all of those limits include a built-in 5% income disregard, which is part of the MAGI-based eligibility rules used to determine Medicaid eligibility for Medicaid expansion, pregnant people, and children.
How does Medicaid provide assistance to Medicare beneficiaries in Illinois?
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.
How do I enroll in Medicaid in Illinois?
You have several options to enroll in Medicaid in Illinois:
- Apply online using theIllinois websiteor 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 applyonlineor 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.
Illinois Medicaid history
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 2021, 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 2022, there were still 12 states that had not expanded Medicaid.
The federal government paid 100% of the cost for the Medicaid expansion population through 2016. After that, the federal government’s portion gradually decreased, reaching 90% by 2020, with Illinois covering the other 10% (it will remain at that level going forward).
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 to606,670 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. By August 2021, nearly 790,000 people were enrolled in expanded Medicaid in Illinois.
By May 2021, total enrollment in Medicaid and CHIP in Illinois stood at more than 3.3 million, and was 27% higher than it had been at the end of 2013. The total CHIP/Medicaid population includes people who were already enrolled in Medicaid pre-2014, people who were eligible but not yet enrolled at that point, and people who gained eligibility as a result of the ACA’s expansion of Medicaid.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
Individuals with income up to 138 percent of the federal poverty level (monthly income of $1,366/individual, $1,845/couple) can be covered.What is Illinois Medicaid changing in 2023? ›
The enhanced federal match of 6.2 percentage points for the continuous coverage continues through March 2023, and will phase down to: 5 percentage points April – June 2023. 2.5 percentage points July – September 2023 and. 1.5 percentage points October – December 2023.What is ACA Medicaid in Illinois? ›
This means Illinois Medicaid now provides health coverage for low income individuals who are seniors, persons with disabilities, parents/caretakers of dependent children, “ACA adults,” pregnant women and children (under the All Kids program).What is the highest income to qualify for Medicaid 2022? ›
Parents of Dependent Children: Eligibility levels for parents are presented as a percentage of the 2022 FPL for a family of three, which is $23,030. Other Adults: Eligibility limits for other adults are presented as a percentage of the 2022 FPL for an individual, which is $13,590.What is the income cut off for Medicaid in Illinois? ›
Effective April 2022 – March 2023, the Medically Needy Income Limit (MNIL) in IL is $1,133 / month for an individual and $1,526 / month for a couple.What is the highest income to qualify for Medicaid in Illinois? ›
Adults with income under 133% of the federal poverty level are eligible for Medicaid. Sometimes the number used is 138% of the federal poverty level. This is because there is a 5% income disregard that effectively brings the level up to 138%. Children and pregnant women have higher income limits.
For 2023, the Part A deductible will be $1,600 per stay, an increase of $44 from 2022. For those people who have not worked long enough to qualify for premium-free Part A, the monthly premium will also rise. The full Part A premium will be $506 a month in 2023, a $7 increase.Do you have to reapply for Medicaid every year in Illinois? ›
To keep getting care through HealthChoice Illinois, you are asked to renew your Medicaid coverage every year. It is a simple process just to make sure you are still qualified to receive benefits. You may also know this annual renewal as “redetermination.”Does Illinois have expanded Medicaid coverage? ›
Illinois expanded Medicaid in 2014, and more than 914,000 people have gained coverage as a result. Illinois Medicaid disenrollments resume in July 2023, after three years of pandemic-related continuous coverage. Approved waiver allows Illinois to pilot new mental health and substance abuse treatment approaches.What is the difference between ACA and Medicaid? ›
Medicaid is designed to offer either free, or low cost health care coverage to those in need. While the ACA is done through the federal government, Medicaid is handled by the state, meaning the laws and regulations depend on your location.
Illinois offers Medicaid coverage for people with disabilities with income up to 100% of the federal poverty level (monthly income of $1,012 for an individual) and non-exempt resources (assets) of no more than $2,000 (for one person).What is the highest income to qualify for Medicaid 2023? ›
In approximately half of the states, ABD Medicaid's income limit is $914 / month for a single applicant and $1,371 for a couple. In the remaining states, the income limit is generally $1,215 / month for a single applicant and $1,643 / month for a couple.What is the highest income to qualify for Medicaid? ›
Income Limit in Most States
Most states — 38 and Washington, D.C. — have the same income limit of $2,523 per month for a single person for most types of Medicaid services. For a married couple, the limit increases to $5,046 in most cases.
|Number of People in Your Household||Maximum Gross Monthly Income||Maximum Gross Monthly Income (Age 60 and Over or Disabled)|
|1||$ 1,869||$ 2,265|
|2||$ 2,518||$ 3,052|
|3||$ 3,167||$ 3,838|
|4||$ 3,816||$ 4,625|
If you are 65 or older, you are eligible for Medicaid if you have income below $973 a month and countable assets below $2,000. People on SSI or SSDI or who are disabled according to the Social Security definition of disability are also eligible for Medicaid.