Medical programs are called Family Health Plans (FHP), Affordable Care Act (ACA) Adults, Aid to the Aged, Blind and Disabled (AABD), Health Benefits for Persons with Disabilities (HBWD), Health Benefits for Persons with Breast or Cervical Cancer (BCC), Former Foster Care, Veterans Care (VC), Medical Benefits for Asylum Applicants and Torture Victims (AATV), and Medicare Savings Programs (MSP). There are several FHP programs; i.e., Family Assist, All Kids/FamilyCare Assist, Moms & Babies, All Kids Share, All Kids Premium and Family Health Spenddown.

Persons who qualify for TANF or AABD cash automatically qualify for medical benefits.

Persons on most HFS medical programs cases get an HFS medical card. The HFS medical card lists each eligible person. When someone needs medical service, they show the medical card to the doctor, hospital, drug store, clinic, etc. A medical provider who is approved to participate in the medical program has agreed to accept payment from HFS and send the bill to HFS.

Medical Programs

new text Financial eligibility and the applicable income limits are linked for each of the medical programs listed below.  See WAG 25-03-02 for a chart showing the monthly income limits based on the current federal poverty level (FPL) for medical programs. Unless otherwise noted, the income limits for the medical programs increase every year if the federal poverty level increases. When the federal poverty level increases, the eligibility system is updated each year in the spring with the new income limits and are retroactive to the first of the year. 

Family Health Plans

  • revised textFamily Assist: medical benefits for families whose income is at or below the TANF Cash Payment Level. Once the family's income rises above the Family Assist income limit, the family unit may be eligible for up to a year of extended medical coverage. The Family Assist income limit is in PM 15-06-01-a. Because the income limit is the same as the TANF Cash Payment Level, the income limit does not change annually.
  • revised textAll Kids Assist: medical benefits for children under age 19 whose income is above the Family Assist income limit, but equal to or less than 147% of the FPL. Children are guaranteed financial eligibility for 12 continuous months of medical coverage, dating from the last eligibility determination. The All Kids Assist income limit is in PM 15-06-01-d.
  • revised textFamilyCare Assist: medical benefits for the parent or caretaker relative (and their spouse) of dependent children under age 18, with countable income greater than the Family Assist limit, but equal to or less than 138% of the FPL. The FamilyCare Assist income limit is in PM 15-06-01-c.
  • revised textAll Kids Share: medical benefits for children under age 19 with income greater than the All Kids Assist limit, but equal to or less than 157% of the FPL. Children are guaranteed financial eligibility for 12 months from the first month of approval or last renewal. The All Kids Share income limit is in PM 06-08-02-b.
  • revised textAll Kids Premium Level 1: medical benefits for persons under 19 with income greater than the All Kids Share limit, but equal to or less than 209% of the FPL. Children are guaranteed financial eligibility for 12 months from the first month of approval or last renewal. The All Kids Premium Level 1 income limit is in PM 06-08-02-b.
  • revised textAll Kids Premium Level 2: medical benefits for persons under 19 with income greater than the Premium Level 1 limit, but equal to or less than 318% of the FPL. Children are guaranteed financial eligibility for 12 months from the first month of approval or last renewal. Only uninsured children can receive All Kids Premium Level 2.  The All Kids Premium Level 2 income limit is in PM 06-08-02-b.
  • revised textMoms & Babies: medical benefits for pregnant women and infants under 12 months of age who are born to eligible women whose income is above the Family Assist limit, but equal to or less than 213% of the FPL. This program covers both inpatient and outpatient health care for women while they are pregnant and for 60 days after the baby is born regardless of changes in income.  new text The Moms & Babies income limit is in PM 06-09-03.
  • revised textFamily Health Spenddown: medical benefits for children with income above the All Kids Assist limit and pregnant women with income above the Moms & Babies limit. A benefit unit must incur medical expenses that equal or exceed  the monthly spenddown amount before medical coverage is provided for a month. The spenddown amount is the difference between a benefit unit's countable income and the Family Health Spenddown standard. The income limit for Family Health Spenddown is in PM 15-06-01-e. The income limit does not change annually.
  • revised textMedicaid Presumptive Eligibility (MPE): offers immediate, temporary coverage for outpatient health care for pregnant women. If eligible, MPE covers the customer for pregnancy care starting on the date of application until the Moms & Babies application is approved. MPE eligibility is determined by an MPE provider. The income limit for MPE is in WAG 06-10-05.

ACA Adults

A person age 19-64 who does not qualify for FHPs or Former Foster Care, and who has countable income equal to or less than 138% of the FPL. A person who is blind or has a disability and does not have Medicare may qualify for the ACA Adult program whether living in the community or in a long term care facility. revised textThe income limit for ACA Adult is in PM 15-06-01-b.

AABD Medical

revised textA person who is aged (at least 65 years old) or blind or has a disability may qualify for AABD Medical whether living in the community or in a long term care facility. A person with countable income and resources that are equal to or less than the AABD Medical income limit and AABD Medical resource limit may qualify for AABD Medical benefits without a spenddown obligation. The AABD community income limit is in PM 15-06-02-a. The AABD income limit for residents of long term care facilities is in PM 15-06-02-b.

DCFS Related

Medical benefits are also provided to the following groups:

  • revised textFoster care/adoption care children from other states who live in Illinois and qualify for the All Kids Assist program. deleted text FCRCs do not handle these cases. The Bureau of Local Office Transaction and Support Service, Springfield, approves and maintains them.
  • revised textFoster care/KinGap/subsidized adoption assistance cases administered by DCFS.
  • revised textThe child of a youth in foster care through DCFS is eligible for Medicaid as a 'child of ward' (newborn up to age one) based on the mother's receipt of Medicaid through DCFS.

Former Foster Care

Medical coverage is provided to persons age 19 through 25 under the Former Foster Care program. Eligible individuals must have received foster care services through the Illinois Department of Children and Family Services (DCFS) and lost related Medicaid coverage when they aged out of the foster care program at age 18 or older. There is no income or resource test for these individuals.

Health Benefits for Persons with Breast or Cervical Cancer (BCC)

Revised text A person who needs treatment for breast or cervical cancer or a precancerous condition receives benefits through the Health Benefits for Persons with Breast or Cervical Cancer (BCC) program administered by the central BCC Unit. There is no income limit or resource test for BCC.

Health Benefits for Workers with Disabilities (HBWD)

revised textA person who meets the SSA definition of disabled and is employed receives benefits through the Health Benefits for Workers with Disabilities (HBWD) program administered by the central HBWD Unit. The income limit for HBWD is in WAG 06-24-04. The resource limit for HBWD is in WAG 06-24-05.

Medical Benefits for Asylum Applicants and Torture Victims (AATV)

revised textA person who has an application for asylum pending with the U.S. Bureau of Citizenship and Immigration Services (BCIS), or who receives services from a federally funded torture treatment center may receive benefits through the Medical Benefits for Asylum Applicants and Torture Victims program. The income and resource limits for AATV is in PM 06-21-01

Medicare Savings Program

new textPersons enrolled in Medicare Part A (hospital insurance) or Parts A and B (supplementary medical insurance) may qualify for help with Medicare premiums, coinsurance and deductibles. The amount of help available depends on the level of household income.

  • Qualified Medicare Beneficiary (QMB)-Coverage includes coinsurance, deductibles and payment of Medicare Part A premiums (if any) and Medicare Part B premiums. The income limit for QMB is in PM 06-12-01-b.  The resource limit for QMB is in PM 06-12-01-a.
  • Specified Low Income Beneficiary (SLIB)-includes payment of Medicare Part B premiums. The income limit for SLIB is in PM 06-13-01-b.  The resource limit for SLIB is in PM 06-13-01-a
  • Qualified Individual-1 (QI-1)-includes payment of Medicare Part B premiums. The income limit for QI-1 is in PM 06-14-01-b.  The resource limit for QI-1 is in PM 06-14-01-a.

Incarcerated Individuals

revised textA person who applied for help and was determined eligible before being arrested and jailed by a peace officer from a county or unit of local government qualifies, even if they didn't get help before they were jailed. This special coverage pays for qualifying medical bills over the first $500.

A person who is incarcerated in an Illinois Department of Corrections (IDOC) facility may apply for medical coverage in advance of their release date.  A person may also qualify for medical coverage while in an IDOC facility if they receive inpatient hospital services during their incarceration.  The income limit depends on the type of medical coverage for which they qualify.

Veterans Care (VC)

revised textA person who is an uninsured veteran and does not qualify under any other program listed here may receive benefits under the Veterans Care program administered by the central Veterans Care Unit.  Note: as of March 2016, new applications for Veterans Care are no longer being accepted due to funding.