Illinois Medicaid Application Information

Illinois Medicaid, which is an initiative by the state of Illinois and the federal government, caters for a range of medical related fees incurred by its beneficiaries. Illinois Medicaid mainly targets families and individuals with low income, providing them with a range of affordable services. These services are divided into primary services and other additional medical services, which are highlighted below:

The program provides support for regular medical checkup of children, making sure that they are able to stay healthy by preventive measures. If your child needs to go to a dentist or a doctor, you won't have to worry about paying extra-ordinary costs. Once your child is enrolled in the program, all such expenses will be covered by the program.

Primary Services

  • Physician Fees
  • Hospital Charges
  • Long-term Care

Other Services

  • Drugs
  • Transportation fees
  • Medical equipment
  • Laboratory tests
  • Family planning

In order to qualify for Illinois Medicaid, one needs to meet a set of eligibility requirements. The Illinois Medicaid only covers US citizens, or legally approved permanent residents. This means that those individuals residing in the country through visas are not covered. Some of these requirements include, being a resident of the state of Illinois, a Us citizen and other specific requirements.

Under Medicaid most of the eligible individuals and families are placed under managed care plans. Under the managed care plan, members are enrolled to a private health care plan, which is provided by an independent insurance provider. In return the insurance provider is given monthly premiums by the state of Illinois as payments for services offered.

It should be noted that not all members of the Illinois Medicaid are placed in a managed plan, some mostly the disabled and aged members are retained in the traditional fee for service structure. Illinois Medicaid provides early and Periodic Screening, Diagnostic and treatment (EPSDT) as a mandatory service for children. In the event that a medical condition is identified during screening then the state immediately becomes responsible for the treatment of the condition.

From the above it can be concluded that Illinois Medicaid has proven to be an important healthcare tool for the residents of the state.

Eligibility Requirements

Illinois Medicaid has general and more specific eligibility requirements. First, to be eligible for the Illinois Medicaid program you must fall within the following groups:

  • Children
  • Pregnant women
  • Senior citizens (aged 65 and above)
  • Individuals with disabilities

Once you are among the above groups you will be subject to a set of eligibility requirements which are basically related to residence, immigration status, and documentation of citizenship.

General Eligibility Requirements

  • One must be a resident of Illinois
  • Us citizen or what is termed as a "legal alien"
  • Senior citizens (aged 65 and above)
  • Your financial resources should fall within the categories characterized as low income or very low income (see financial requirements here: aspe.hhs.gov/poverty/figures-fed-reg.shtml)

Illinois Medicaid Retroactive Eligibility Requirement

This simply means that coverage starts retroactively prior to the date of applications. This retroactive period is usually 3 months, which means that coverage becomes null and void in the period which the individual no longer meets the eligibility requirements.

Medicaid Application Instructions

There are several ways to apply for Illinois Medicaid. You can apply online, in person and via phone.

Apply Online

You can make an online application for Illinois Medicaid by visiting the following web link:
www.hfs.illinois.gov/medical/apply.html.

By visiting this link you will, fill an online form which is the equivalent of a formal application. This method is much more convenient as it gives you the flexibility to make an application, anywhere any time. Also if you do not finish filling the application in one go, you always have the option of saving your work, and resuming it before 15 days.

Most people find this appropriate as it saves them the time spent in making a trip to the Illinois department of Human services.

Apply in Person

You can decide to apply in person by visiting the Illinois Department of Human services (DHS), where you will get assistance from the staff on how to submit an application. This might prove resourceful as the staff at the DHS, has experience dealing with applications.

Apply Via Phone

Since the Illinois Medicaid deals with people with disabilities, it provides a telephone application option. This means that if you are not able to visit the DHS offices due to health or other reasons you have the option of calling and asking for the application forms to be sent to you.

The Department of Human services uses the following toll free numbers: 1-800-843-6154 or 1-800-447-6404.

Applications are also available at hospitals and may be completed at the hospital. Also pregnant women and minors under the age of 19 can be enrolled through Illinois All Kids agents, who are available in all parts of the state of Illinois.

Payment Options and Service Plans

There are several payment options available for Medicaid members.

The Fee for Service Plan

You can choose the fee-for-service program, which will require you to find your own doctor or clinic that accepts Medicaid members. The choice of a doctor and hospital are tied, in the sense that if you want to be treated in a certain hospital, you must make sure that your doctor has made the requisite arrangements with the hospital.

The Managed Care Plan

Here you will receive basic medical care through a doctor that is associated with a specified managed care plan. Your families Medicaid will be managed by the specified managed care plan, meaning that the doctors, hospitals, and pharmacies that you visit will be associated with that specific managed health care plan that you have chosen.