Illinois Medicaid Eligibility Requirements and Income Limits

To meet Illinois Medicaid eligibility requirements, you need to live in Illinois, be a U.S. citizen or qualified noncitizen, and have household income under the limit for your category — 138% of the federal poverty level for most adults, higher for children and pregnant women, and 100% of FPL with an asset test if you are 65 or older, blind, or disabled. The rules branch from there based on your age, household, and whether you need long-term care.

Income Limits for 2026

Illinois sets different income ceilings for different groups, all pegged to the 2026 federal poverty level.¹

Adults ages 19 to 64 without a disability: 138% of FPL, roughly $1,835 a month for a single person or $22,025 a year, and about $3,795 a month for a family of four.²
Children through All Kids Assist: 318% of FPL for free coverage, with subsidized tiers reaching well above that.²
Pregnant women through Moms and Babies: 213% of FPL, with full benefits through pregnancy and the baby’s first year.³
Aged, blind, or disabled (AABD): 100% of FPL, or $1,330 a month for one person, plus an asset test.²

The 138% adult figure comes from a 133% income standard combined with a 5% income disregard that federal rules build in. The state applies that disregard automatically, so you do not have to calculate it.⁴

Do Your Assets Count?

Illinois uses two different financial tests, and which one applies decides whether your savings matter.

MAGI Applicants: Income Only

Most non-disabled adults, parents, children, and pregnant women are evaluated using Modified Adjusted Gross Income. That is essentially your federal tax income: wages, self-employment earnings, Social Security, and other taxable sources. Assets are not part of the calculation. Your bank balance, retirement accounts, and property holdings do not factor into the decision. If your income comes in under the threshold for your household size, you qualify.

AABD Applicants: Income and Assets

If you are 65 or older, blind, or have a qualifying disability, Illinois looks at both. Income has to fall at or below 100% of FPL, and countable assets have to stay below $17,500.⁵ That $17,500 limit applies regardless of household size.

Not everything counts. Your primary home, one vehicle, personal belongings, and burial funds up to set limits are typically excluded. The state is looking at cash, bank accounts, stocks, bonds, and real estate beyond your home. Illinois also runs a federally mandated electronic Asset Verification System that pulls financial institution records directly, so the state may already have your account balances before you send anything in.⁶

Residency and Citizenship

You have to physically live in Illinois and intend to stay. There is no minimum length of residence. The state looks for evidence you have settled here, like a lease, utility bills, or a state ID.⁷

Federal law also requires that you be a U.S. citizen or a “qualified noncitizen” for full Medicaid benefits. Qualified noncitizens include lawful permanent residents, refugees, asylees, trafficking victims, individuals granted withholding of deportation, and several other statuses.⁸ Most qualified noncitizens face a five-year waiting period after obtaining that status before they can access standard Medicaid.⁹

Lawfully present children and pregnant women are the major exception. Illinois has opted into a federal provision that lets them receive Medicaid regardless of how long they have been in the country.⁹

If Your Income Is Too High: Spend-Down

Income above the standard limit does not automatically end the conversation. Illinois runs a spend-down program that works like a monthly deductible. The state calculates the amount by which your income exceeds the limit, and that overage becomes your monthly spend-down. Once you accumulate medical bills or receipts equal to that amount in a given month, you get a Medicaid card for the rest of that month.¹⁰

The list of qualifying expenses is broad: doctor and hospital bills, prescriptions, dental work, eyeglasses, therapy, health insurance premiums including Medicare, medical transportation, and co-payments you have already paid. Unpaid bills can be applied as long as the bill was dated no earlier than six months before the month you use it. Receipts for bills you have already paid apply in the month you paid and for six months afterward.¹⁰

You can also use the Pay-In Spenddown, sending your spend-down amount directly to the Department of Healthcare and Family Services each month rather than gathering bills. Both approaches can be combined.

Long-Term Care Applicants: Extra Rules

If you are applying for nursing home coverage or home and community-based services, two additional rules matter.

Illinois protects the spouse who stays home. The Community Spouse Resource Allowance is $143,172 for 2026, meaning the at-home spouse can keep up to that amount in countable assets while the applicant spouse qualifies for coverage. The at-home spouse can also keep a monthly income allowance of up to $4,066.50 in 2026, and if their own income falls below that floor, part of the nursing home spouse’s income can be redirected to bring them up. The resource allowance is determined once, at application or initial long-term care determination, and is not recalculated in later years.¹¹

Illinois also reviews the past 60 months of your financial transactions. Assets you gave away or sold below fair market value during that window can trigger a penalty period during which Medicaid will not pay for long-term care. The penalty length is the total value transferred divided by the average monthly cost of nursing home care in Illinois, which was $7,012 in 2025. The clock does not start on the transfer date. It begins on the later of the transfer date, the date you entered a nursing home and were otherwise Medicaid-eligible, or the day after any prior penalty period expires. Giving away $70,000 four years before applying does not mean the penalty has already run.

Documents You Will Need

Everyone provides the basics: Social Security numbers for all household members seeking coverage, proof of Illinois residency such as a utility bill, lease, or official mail, and proof of identity.

For income, gather at least 30 days of recent pay stubs or your most recent federal tax return. If you receive Social Security, unemployment compensation, child support, or other non-wage income, bring documentation for those too. The state cross-checks reported income against employment records, so report what you know and let the state flag any discrepancies.

AABD applicants document more. Because assets count, you will need recent bank statements covering several months along with records for retirement accounts, life insurance policies with cash value, and any real estate other than your home. The state’s Asset Verification System runs its own check, but supplying your own documentation upfront moves the case along.⁶

How to Apply

Illinois takes applications through three channels.¹²

Online at abe.illinois.gov, the Application for Benefits Eligibility portal. The form takes roughly 30 to 45 minutes, saves your progress, and gives you a tracking number after submission.
On paper, downloaded from the HFS website, then delivered, mailed, or faxed to your local DHS Family Community Resource Center.
By phone with a representative at your local Family Community Resource Center.

List every household member who lives with you and shares financial responsibilities, and include all income sources even ones you think might not count. Over-reporting and letting the state sort it out beats leaving something off and triggering a delay.

How Long the Decision Takes

Illinois has to process standard medical applications within 45 days of receipt. Applications that involve a disability determination for AABD get 60 days.¹³ The written decision arrives by mail, and if the state needs more documentation the notice will tell you what is missing.

Coverage requires annual renewal. The state contacts you when it is time to verify continued eligibility. If you do not respond, coverage ends automatically, even if you still qualify. Watch your mail around your renewal date, and update your address through the ABE portal if you move.¹⁴

If You Are Denied

You have 60 days from the date on the notice to file an appeal. You can submit a Notice of Appeal through the ABE portal, by mail or fax to the Bureau of Hearings at 69 W. Washington, 4th Floor, Chicago, IL 60602, by email to DHS.BAH@illinois.gov, or by phone at 1-800-435-0774.

If you already have Medicaid and want benefits to continue during the appeal, timing tightens. You must file before the “Date of Change” listed on the notice or within 10 calendar days of the notice date, whichever comes first. Miss that window and benefits stop while the appeal runs. If you lose after keeping benefits running, the state may require you to repay the cost of services received during that period.¹⁵

A pre-hearing conference should happen within 10 days of filing. If that does not resolve the issue, a formal fair hearing is scheduled before a hearing officer. Federal rules require a final decision within 90 days of the appeal request.¹⁶ If the ruling goes against you, you have 35 days from the date the decision was mailed to file for judicial review in an Illinois Circuit Court.

1
ASPE. 2026 Poverty Guidelines
2
Illinois Department of Human Services. WAG 25-03-02 Medical FPLs
3
Illinois Department of Healthcare and Family Services. Medical Programs
4
Medicaid.gov. MAGI Conversion and the 5% Disregard
5
Illinois Department of Human Services. PM 07-02-01 Asset Limits
6
Medicaid.gov. Financial Eligibility Verification Requirements and Flexibilities
7
Illinois General Assembly. Illinois Code 305 ILCS 5/5-2
8
Medicaid.gov. SHO 26-001 – Medicaid and CHIP Coverage for Qualified Non-Citizens
9
Medicaid.gov. Eligibility for Non-Citizens in Medicaid and CHIP
10
Illinois Department of Healthcare and Family Services. HFS 591SP Medicaid Spenddown
11
Illinois Department of Healthcare and Family Services. Provider Notice – 2026 Impoverishment Standards
12
Illinois Department of Healthcare and Family Services. Applying for Medicaid
13
Illinois Department of Human Services. Frequently Asked Questions – Medical Assistance
14
Illinois Department of Healthcare and Family Services. Renewing My Medicaid
15
Medicaid.gov. Understanding Medicaid Fair Hearings
16
eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries