Illinois Form IL444-2304, Verification of Pregnancy, is a one-page document you use to prove pregnancy when applying for Medicaid programs like Moms & Babies. You fill in the identifying information at the top, your healthcare provider completes and signs the medical section, and you return the form to your local Family Community Resource Center (FCRC). It moves fastest when the provider fills it out completely at your visit and you submit it through the ABE portal the same day.
Where to Get the Form
You have three practical options. Download the printable PDF from the IDHS forms library and take it to your prenatal appointment.1Illinois Department of Human Services. IDHS: Forms Pick one up in person at any Family Community Resource Center, which is the local IDHS office handling medical benefits, cash assistance, SNAP, and job services.2Illinois Department of Human Services. Office Locator – IDHS Or wait for the Verification Checklist your caseworker generates after you apply; the pregnancy verification is often listed there as a required proof.3Illinois Department of Human Services. WAG 02-07-02: Obtaining Verifications
What You Fill In
The top section asks for your full name, mailing address (street, city, state, ZIP), and date of birth. If you already have an open case with IDHS, write your case number in the space provided so the caseworker can match the form to your file quickly. Sign and date the form on the lines at the bottom, and have a witness sign where indicated.4Illinois Department of Human Services. Verification of Pregnancy Form IL444-2304
The form does not ask for your Social Security Number. The only identifying fields are name, address, date of birth, and case number.
What Your Provider Fills In
Your doctor, nurse practitioner, or midwife completes the clinical portion. They confirm whether you are pregnant, record your expected date of delivery, and note how many babies are expected if a multiple birth is anticipated.4Illinois Department of Human Services. Verification of Pregnancy Form IL444-2304 Then they sign, print their title, and date the form.
The number of expected children is not a formality. Illinois counts a pregnant applicant as herself plus the number of children she is expected to deliver when calculating household size, and household size sets your income ceiling. Someone expecting twins is treated as a household of three rather than two, which can be the difference between qualifying and not. Confirm the number is correct before you leave the appointment.
There is no field for a medical license number or an office stamp. If a receptionist tells you the form isn’t complete without one, it is; the signature and title are all IDHS requires from the medical side.
How to Submit the Completed Form
The form instructs you to return it to the local office named at the top, and your assigned FCRC’s name, address, phone, and fax are typically pre-printed there.4Illinois Department of Human Services. Verification of Pregnancy Form IL444-2304 Four ways to get it there:
- Upload through ABE. Log into abe.illinois.gov, open Manage My Case, and upload a scan or clear photo. Select the correct person and document type, keep each file under 2 MB, and submit. This is the fastest option and gives you an electronic receipt.5Illinois Department of Human Services. Uploading Documents – IDHS
- Fax it to the number on the form or the fax number listed for your FCRC in the office locator. IDHS accepts faxed copies as valid verification.3Illinois Department of Human Services. WAG 02-07-02: Obtaining Verifications
- Hand-deliver it to your FCRC and ask for a date-stamped receipt. Use the IDHS Office Locator and select “Family Community Resource Center” to find the nearest one.2Illinois Department of Human Services. Office Locator – IDHS
- Mail the original to the FCRC address on the form. This is the slowest channel; if your processing clock is running, choose upload or fax.
Keep a copy of the signed form for yourself. If anyone later asks what was submitted or when, your copy settles it.
What Happens After You Submit
A caseworker reviews the pregnancy verification alongside the rest of your application, including income and residency proofs. Illinois has 45 days to process medical assistance applications that do not involve a disability determination. If the state misses that deadline and you have provided everything requested, you should receive a notice about possible entitlement to temporary medical assistance.6Illinois Department of Human Services. Temporary Medical Assistance
If you need care before the full application is decided, ask a Medicaid Presumptive Eligibility (MPE) provider to screen you. If your income falls below 200 percent of the Federal Poverty Level, you can receive outpatient care immediately under presumptive eligibility. It ends when the state issues a formal decision, or at the end of the month following the screening month if you never file a full application.7Illinois General Assembly. Section 120.66 Medicaid Presumptive Eligibility for Pregnant Women
The Form Confirms Pregnancy, Not Eligibility
Filing IL444-2304 proves you are pregnant. It does not by itself qualify you for Moms & Babies. Your monthly household income must also be at or below 213 percent of the Federal Poverty Level (208 percent plus a standard 5-percent income disregard).8Illinois Department of Human Services. PM 06-09-03: Income Requirements For a household of two, the current limit is $3,628 per month; for a household of three, it is $4,583.9Illinois Department of Healthcare and Family Services. Moms and Babies Because Illinois counts the unborn child or children in household size, an accurate entry from your provider on the “number expected” line directly affects which ceiling applies to you.