Medicaid Income Limits in Illinois in 2024

In Illinois, the Medicaid income limits for 2024 are designed to provide access to healthcare for various groups, including the Affordable Care Act (ACA) expansion adults, families, pregnant women, children, and individuals with disabilities. For ACA adults between the ages of 19-64, the income cap is set at 138% of the Federal Poverty Level (FPL), translating to an annual income of $17,774 for a household of one. For families and children, the All Kids Assist program extends eligibility up to 318% of the FPL, allowing a monthly income of $3,500 for a two-person household. The FamilyCare Assist program offers coverage for parents and caregiver relatives with incomes up to 138% of the FPL, equivalent to a monthly income of $1,481 for individuals. These income thresholds are critical for qualifying for Medicaid in Illinois, with specific programs offering flexibility for those with unique needs or higher medical expenses.

Two Medicaid Eligibility Categories in Illinois

There are two primary categories to be aware of when determining Medicaid eligibility:

1. ACA Adults: Individuals aged 19-64 who were not previously eligible for coverage and who have incomes up to 138% of the Federal Poverty Level (FPL) can now receive medical coverage. This is part of the Affordable Care Act's Medicaid expansion and includes parents and other adults without dependent children.
2. Family Health Plans: These include programs like All Kids, FamilyCare, and Moms & Babies, which cover families, children, and pregnant women at varying income levels.

General Eligibility for Medicaid in Illinois

Below is an overview of the general criteria you need to meet to qualify for Medicaid in Illinois:

• Residency: You must be a resident of the state of Illinois.
• Citizenship: You need to be a U.S. citizen or have a qualifying immigration status.
• Income: Your total household income must fall within the limits set by the various Medicaid programs. These limits are often expressed as a percentage of the Federal Poverty Level (FPL).
• Household Size: The number of individuals in your household impacts the income threshold for eligibility.

Besides the basic qualifications mentioned above, Illinois Medicaid covers several groups under different categories:

• Children and Pregnant Women: Programs like All Kids and Moms & Babies offer comprehensive care. They have higher income eligibility limits to ensure broader coverage for children and expectant mothers.
• Adults Under the Affordable Care Act (ACA): Also known as the Medicaid expansion, it extends coverage to adults without dependent children who meet certain income requirements.
• Seniors and Individuals with Disabilities: The Aid to Aged, Blind, and Disabled (AABD) program provides benefits to people who meet the age, income, and medical criteria.
• Families: The FamilyCare program extends benefits to low-income parents and caretaker relatives living with children under 19 years of age.
• Special Programs: Illinois offers several special programs tailored to distinct needs, such as coverage for breast and cervical cancer treatment, services for former foster care individuals, and healthcare for immigrant seniors who may not qualify for standard Medicaid.
• Medicare Beneficiaries: Eligible individuals who already receive Medicare benefits can receive assistance with Medicare premiums, coinsurance, and deductibles through the Medicare Savings Programs.

Illinois Medicaid Income Limits in 2024

ACA Adults Income Limits

Under the Affordable Care Act, Medicaid is available to adults without dependent children and parents/caretaker relatives with income up to 138% of the FPL.

Note: For each additional person, add $6,265 annually or $522 monthly.

For Family Health Plans

Family Health Plans are designed for parents with children under 19 years of age, relatives caring for children, and pregnant women. Income limits vary based on specific programs.

All Kids Assist Program Income Limits

This program is for children up to age 18. The income limits are based on 318% of the FPL:

Note: For each additional person, add $912 monthly.

FamilyCare Assist Program Income Limits

Designed for parents/caretaker relatives. The income limits for FamilyCare Assist are up to 138% of the FPL:

Note: For each additional person, add $522 monthly.

My Income Exceeds The Medicaid Limits in IL, What Do I Do?

• Spend-Down Program: Illinois operates a Medical Spend-Down program that allows those with higher incomes to qualify for Medicaid by offsetting their excess income with medical expenses. If you have ongoing medical costs, this program can help you "spend down" to the Medicaid eligibility level.
• Health Benefits for Workers with Disabilities (HBWD): If you have a disability and are working, the HBWD program allows you to receive Medicaid coverage by paying a monthly premium based on your income.
• Family Health Spenddown: For individuals with incomes too high for regular Medicaid, you can apply for this program. Enrollment allows you to spend your excess income on medical bills, which can make you eligible for Medicaid.
• Check for Illinois-Specific Programs: Look into state-funded programs like the Illinois Breast and Cervical Cancer Program or the All Kids program that could provide healthcare coverage opportunities without strict income limits.
• Consider a High-Deductible Health Plan: These plans typically have lower premiums and can be paired with Health Savings Accounts (HSAs), allowing you to set aside money before taxes for medical expenses.

Illinois Medicaid FAQs - Complex Questions Answered

Can owning property disqualify me from Medicaid eligibility in Illinois?

Generally, owning a primary residence does not disqualify you from Medicaid, but other property assets may count towards your eligibility limit. However, there are exceptions and specific rules about how property is counted. It's advisable to consult with a Medicaid planning expert to understand how your real estate holdings might affect your eligibility.

How do I navigate Medicaid eligibility if I have a fluctuating income due to freelance work?

Illinois considers your current monthly income and not your annual income when determining Medicaid eligibility. If you are a freelancer with a fluctuating income, you should report your income monthly. Keep detailed records and consider averaging your income over the months, if that option is available.

What if my income is over the limit due to a one-time windfall?

One-time windfalls can temporarily affect your Medicaid eligibility. If this happens, you might lose eligibility for the month during which you received the additional income but could re-qualify in subsequent months once your income falls back within the eligibility range.

Can enrollees in HBWD (Health Benefits for Workers with Disabilities) earn too much to qualify for Medicaid?

The HBWD program allows workers with disabilities to earn more than traditional Medicaid limits while still receiving benefits, provided they pay a premium based on their income. There's a maximum income cap for HBWD, but it's substantially higher than regular Medicaid.

What happens to my Medicaid if I move out of Illinois or spend part of the year in another state?

Medicaid is administered by each state individually, and you must be a resident of Illinois to receive Medicaid benefits from Illinois. If you move out of state or are no longer considered a permanent resident, you would need to apply for Medicaid in your new state of residency.

Does enrolling in a college or educational program affect Medicaid eligibility?

Enrollment in a college or educational program itself does not directly impact Medicaid eligibility. However, any income (like a work-study program), changes in residence, or student health insurance could affect your eligibility status.

How does retirement affect my Medicaid eligibility if I have a pension?

If you retire and have income from a pension, this income will count towards your Medicaid eligibility determination. However, certain retirement-related assets, like some IRAs or 401(k)s, might not be counted as part of your financial resources.

Is there a special provision for Medicaid eligibility for individuals with high medical expenses in Illinois?

Illinois Medicaid has a spend-down program for individuals whose income is too high to qualify for standard Medicaid. Under this program, qualifying medical expenses can be subtracted from your income, potentially making you eligible. This program is particularly useful for individuals with high ongoing medical costs.

How does divorce or separation affect Medicaid eligibility in Illinois?

A change in marital status can affect Medicaid eligibility by altering your household size and income. You must report any change in marital status to the Department of Human Services as it may increase or decrease your eligibility for Medicaid.

If I am eligible for Veterans Affairs (VA) benefits, can I also receive Medicaid?

Yes, you can be eligible for both VA benefits and Medicaid. However, the services covered by VA may not be billed to Medicaid. Coordination between the two programs ensures that your healthcare needs are met cost-effectively.