Important information for families and adults who rely upon Medicaid for their health care and prescription drugs. Please share this with other advocates.
Our Family to Family Health Information Center is here to assist families to navigate the changes to All Kids and Medicaid because of the cuts passed by the Illinois General Assembly. 


Due To A New Law In Illinois, TheSave Medicaid Access
And Resources Together Act (SMART Act). . .

  • On July 1, 2012, your prescription drug benefits will be changed.
  • Only 4 (four) prescriptions per month will be covered by Medicaid.
  • If you need more than 4 prescriptions per month, you must first obtain prior approval before they can be filled.

Here is link to information from the Illinois Department of Healthcare and Family Services about the SMART Act and changes in your benefits:
 What is prior approval and how do I get it?

  • Prior approval means that your doctor(s) must complete forms stating the reason why your prescription(s) are “medically necessary” and submit them to HFS (or to your HMO, if you are participating in the Integrated Care Program) and get permission for your prescription(s).
  • The first step to securing prior approval is to let all of your doctors, medical providers and pharmacists know about this change in coverage.
  • Make sure that you have all needed prescriptions refilled in June.
  • Check the refill dates now and get ready to request refills on the correct date.
  • Let your providers know right away if you are concerned about running out of medications and/or supplies.
  • We are waiting to get more information from HFS regarding how the new prior approval system will work.
  • We do not yet know if you will need to request new prior approvals each month.
  • The Arc of Illinois will send out additional consumer education alerts when information is available.

The pharmacy is not allowed to fill your prescription and bill Medicaid (or your HMO) until the prior approval process is complete.  Your “options” are to wait for the prior approval process OR to pay for the prescription yourself if you are able to do so. This is called “self-pay”.
How can I get more information about this new regulation?

  • Here is a link to the current HFS Pharmacy Prior Approval Form:
  • Medicaid enrollees, parents, guardians, case managers and service provider agencies can contact the Pharmacy Unit at (217) 782-5565 option 7, or visit the Medicaid Pharmacy Unit website:
  • Medical providers can call the HFS Drug Prior Approval hotline1-800-252-8942.
  • Medicaid enrollees participating in the Integrated Care Program should contact their managed care company representative:

1.    Aetna Better Health: Call Member Services toll free at 1-866-212-2851 or visit  
2.    IlliniCare: CallMember Servicesat (866) 329-4701 or TDD/TTY (866) 811-2452 from 8 a.m. – 5 p.m. (Central Time) or visit

For more information, contact The Arc of Illinois Family to Family Health Information Center
20901 S. LaGrange Road #209
Frankfort, IL 60423
 815-464-8247 (direct)
708-560-6703 (mobile)

Tony Paulauski
Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423
815-464-1832 (OFFICE)
815-464-1832 (CELL)