What Illinois Families Need to Know About Illinois Medicaid Changes Coming in 2027

Written by Everett Cowings

Nearly 1 in 4 Illinois residents relies on Medicaid for health coverage. Here is who qualifies, how much it costs, and what a new federal work requirement means for hundreds of thousands of adults starting in 2027.

More than 3.5 million people in Illinois get their health coverage through Medicaid — children, parents, pregnant women, seniors and people with disabilities among them. But for many families, the program remains confusing. Who qualifies? How much does it cost? How do I sign up?

The stakes are about to get higher. Under a new federal law, hundreds of thousands of adults on Illinois Medicaid will face a work requirement starting January 1, 2027, along with more frequent eligibility checks. State officials have already begun mailing notices.

Here is what Illinois residents need to know, from eligibility and cost to how the upcoming changes could affect coverage.

What Illinois Medicaid Covers

Medicaid is a joint federal and state health insurance program that provides free or low-cost coverage to people who qualify. In Illinois, it is run by the Department of Healthcare and Family Services, known as HFS, with help from the Department of Human Services, which processes applications. The program pays for doctor visits, hospital stays, prescriptions, preventive care, dental care, and mental health treatment.

Unlike many private insurance plans, Medicaid does not have an open enrollment period. Eligible residents can apply at any point during the year, and coverage in Illinois can begin as early as the month a person applies.

Who Qualifies for Medicaid in Illinois?

Eligibility comes down mostly to household size and income, measured against the federal poverty level, a threshold the U.S. government updates every year. Different groups face different limits.

Adults ages 19 to 64 can qualify for coverage through the ACA Adult group, or through FamilyCare if they are a parent or caretaker relative, as long as household income is at or below 138 percent of the poverty level — about $22,025 a year for one person, or $45,540 for a family of four.

Children 18 and younger qualify at much higher income levels through the All Kids program, which covers families earning up to 318 percent of the poverty level, or roughly $104,940 for a household of four, regardless of immigration status.

Pregnant women qualify up to 213 percent of the poverty level, with the unborn child counted as a household member. Coverage continues through pregnancy and for 12 months after birth, and babies remain covered through age one.

Seniors 65 and older, and people who are blind or have a disability, can qualify through the Aid to the Aged, Blind and Disabled program at up to 100 percent of the poverty level, though the program also limits countable assets to $2,000 for a single applicant.

Working adults with disabilities have a separate path: the Health Benefits for Workers with Disabilities program allows earnings up to 350 percent of the poverty level and assets up to $25,000, in exchange for a modest monthly premium.

How Much Does Illinois Medicaid Cost?

For most people who qualify, Illinois Medicaid costs little or nothing. Adults generally pay no monthly premium, though small copays of $2 to $3.90 can apply to some services.

Children’s coverage is free across the board. Illinois eliminated premiums and copays for All Kids in 2022, meaning every eligible child, regardless of family income tier, now receives coverage — including well-child visits and immunizations — at no cost.

Pregnant women and infants also pay nothing. Workers with disabilities pay a premium tied to income, along with modest copays: $2 for a generic prescription, and $3.90 for a brand-name prescription, an office visit or a hospital day.

Illinois Medicaid Work Requirements Begin in 2027

The biggest shift is still to come. A federal law known as H.R. 1 rewrites the rules for adults in the ACA Adult group — people ages 19 to 64 who generally do not have dependent children at home and are not on Medicare. HFS estimates roughly 700,000 Illinoisans fall into that category, and the agency began notifying them by mail on September 1.

HFS’s advice for the roughly 700,000 adults affected: make sure
the agency has your current mailing address, and watch your mail.
— Illinois Department of Healthcare and Family Services guidance

Starting January 1, 2027, those adults will need to show at least 80 hours a month of work, community service, school enrollment or another qualifying activity to keep their coverage, unless they qualify for an exemption — for example, if they are medically frail, caring for a family member, or pregnant. Current members will be checked at their next renewal; anyone applying for the first time after December 31, 2026, will need to meet the requirement before being approved.

Eligibility renewals for that group will also move from once a year to every six months, beginning with renewals processed on or after December 31, 2026. And starting October 1, 2026, the law narrows which immigrants can qualify for adult coverage. Children and pregnant women are not affected by the work requirement.

Advocates warn that even people who meet the new requirement could lose coverage over paperwork or reporting errors, so responding promptly to any notice from HFS will matter.

How to Apply for Medicaid in Illinois

Applying does not require a caseworker visit. The fastest option is the state’s online portal, ABE Illinois, which typically takes 30 to 45 minutes and can process applications for Medicaid, SNAP and other benefits together. Applicants will need photo identification, Social Security numbers for household members, proof of Illinois residency such as a utility bill or lease, proof of income, and documentation of citizenship or immigration status.

People who prefer not to apply online can call the ABE Customer Call Center at 1-800-843-6154 (TTY 1-866-324-5553), visit a local Department of Human Services office, or submit a paper application by mail. Free, one-on-one application help is also available through Get Covered Illinois and certified All Kids application agents.

Most applications are decided within 45 days; those involving a disability determination can take longer. Applicants can track their status by logging into ABE and opening “Manage My Case.” Once approved, most members select a health plan through HealthChoice Illinois.

Program rules and dollar figures change from year to year, and the final word belongs to HFS and DHS. Residents with questions about a specific case should contact the agency directly rather than rely on averages.