Although you may not yet realize it, there is a very good chance that you will eventually need to qualify for Medicaid benefits, most likely when you are a senior. The need for Medicaid eligibility frequently occurs as a result of the high cost of long-term care coupled with the fact that neither private health insurance policies nor Medicare will cover those costs. Because we are aware of the complicated nature of the Illinois Medicaid application and approval process, as well as the difficulty people often have locating helpful information regarding Medicaid eligibility, we have put together some resources to assist you if you are in a position where qualifying for Medicaid may be necessary.
Illinois Medicaid Basics
Medicaid is a healthcare program that is predominantly funded by the United States federal government; however, the individual states may also provide supplemental funding and each state administers their own Medicaid program. Medicaid provides medical services for children and their caretakers, pregnant women, and persons who are disabled, blind or 65 years of age or older.
Illinois Medicaid Benefits
The Affordable Care Act (ACA) requires state Medicaid programs, including the Illinois Medicaid program, to provide certain benefits, collectively known as “Essential Health Benefits (EHB).” The ten categories of EHB that all Illinois Medicaid recipients must receive include:
- Outpatient (Ambulatory) services
- Emergency services
- Hospitalization
- Maternity and Newborn care
- Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment
- Prescription Drugs
- Programs such as physical and occupational therapy (known as Rehabilitative & Habilitative Services) and devices
- Laboratory services
- Preventive and wellness services & chronic disease management
- Children’s (Pediatric) services, including oral and vision care.
Depending on the category of Medicaid you are enrolled in, you could receive benefits in addition to the EHB benefits; however, you must receive at least the above-referenced EHB benefits if you qualify for Illinois Medicaid.
Illinois Medicaid – Basic Eligibility
Because of the diverse groups that Medicaid potentially services, there are several categories under which an applicant could qualify, with each having its own eligibility guidelines. There are, however, some basic eligibility guidelines for all applicants, including:
- Resident of the State of Illinois
- A U.S. national, citizen, permanent resident, or legal alien
- Need healthcare services
- Be considered low income
Medicaid Programs
Illinois Medicaid programs service a wide range of individuals and families. Information on all of the various programs for which you might qualify can be found on the Illinois Department of Healthcare and Family Services Website (IDHFS). Examples of some of the programs available include:
- Aid to Aged Blind and Disabled (AABD) Medical – covers seniors, persons who are blind and persons with disabilities with income up to 100 percent of the federal poverty level (FPL) and no more than $2,000 of non-exempt resources (one person).
- Department of Children and Family Services (DCFS) – Coverage is provided to children whose care is subsidized by DCFS under Title IV-E (Child Welfare) of the Social Security Act as well as children served by DCFS through its subsidized guardianship and adoption assistance programs.
- Moms and Babies – provides a full range of health benefits to eligible pregnant women and their babies up to one year of age.
- Pay-In Spend down – provides individuals whose income and/or assets are too high for regular Medicaid to enroll and pay their spend down amount to the department, rather than having to accumulate bills and receipts of medical expenses on a monthly basis and provide them to the Department of Human Services,
Medicaid Income Guidelines
Medicaid is intended to provide healthcare services to individuals and families who are considered low income. As such, the Illinois Medicaid income guidelines apply to all applicants. The income limits are directly tied to the Federal Poverty Level (FPL), meaning the limits are subject to change when the FPL changes each year. The current income standards can be found here.
Medicaid Services for Seniors
Like many people, you may make it through your entire working years without the need to qualify for Medicaid benefits thanks to employer sponsored and/or privately funded health insurance coverage. During your “Golden Years,” however, you may find that the high cost of long-term care (LTC) causes you to turn to Medicaid for help. Fortunately, Illinois Medicaid does cover LTC expenses for seniors who qualify for benefits. In fact, Illinois Medicaid currently covers LTC costs for 55,000 seniors in 738 nursing facilities across the state. You can find out more about the long-term care program on the IDHFS website.
Illinois Medicaid also offers assistance to seniors who wish to remain in their homes but who need healthcare services above and beyond that which their loved ones can provide. The Home and Community Based Service Waiver Program is designed to help with the costs of care for a senior who wishes to remain at home or in a community setting in lieu of a nursing home.
Medicaid for Veterans
Illinois Medicaid also has a special program for veterans who are in need of healthcare services. In fact, Illinois was the first state in the nation to create a Medicaid program specifically for veterans. Under the Veterans Care Program, veterans pay a small monthly premium ($40-$70 depending on income) and receive medical, limited dental, and vision care.
Applying for Illinois Medicaid
If you are in need of healthcare services and believe you may qualify for Illinois Medicaid, or you wish to find out if you qualify, you may apply online through the Application for Benefits Eligibility (ABE) website.
Contact a Knowledgeable Medicaid Planning Lawyer Today
For additional assistance with elder law issues in the State of Illinois, contact the experienced Illinois elder law attorneys at Nash, Nash, Bean & Ford, LLP by calling 309-944-2188 to schedule your appointment today.
