This fact sheet was developed by our Family to Family Health Information Center.

Update:  Changes to Medicaid eligibility for adults age 19 and older with disabilities in

Before the Affordable Care Act (ACA) kicked in on 1/1/14, adults in Illinois could qualify
for Medicaid only if they met appropriate residency and citizenship status, were
financially eligible,  and:

  1. Pregnant or the parent/caretaker relative of a child under age 18 (called
    FamilyCare or Moms and Babies)
  2. Those with adjudicated disability status using the SSA criteria (referred to as SSI
    , or SSDI), or those whose disability has been determined by the state Client
    Assistance Unit (CAU), using the same criteria as SSA.
  3. Seniors over age 65 (AABD or SPD) or legally blind.

With the ACA, a big change took place for uninsured, low-income adults, ages 19 – 64.
For the first time ever, an adult could be determined to be eligible for Medicaid based
on income and residency and citizenship status, without the additional requirement to
be included in one of the above categories.  This means that many more people are
eligible for Medicaid health coverage now.  Medicaid coverage also continues for
people in the “old” eligibility groups listed above.

This new eligibility category is called the “new Medicaid expansion” or “ACA Adult
program”. One of the “new Medicaid” components is a change to the household
income counting rules, called MAGI or Modified Adjusted Gross Income. This new
MAGI process takes into consideration the applicant’s tax filing status. It asks if the
individual is a tax filer or claimed as a tax dependent by another member of the

When a person with a disability applies for Medicaid for the first time, they will initially
be assessed using the MAGI budgeting rules like everyone else. This includes people
who have been determined eligible for and receive SSI and those who are tax
dependents.  If they are income ineligible using MAGI, they will be reviewed again using
the AABD, or Aid to the Aged, Blind, and Disabled, budgeting methodology. This
methodology is applied internally by the Illinois Department of Human Services (DHS)
when they get a new Medicaid application. If you or your family member with a disability
is asked for family financial information during this process, it will speed up the process
if you provide the information promptly. All financial information is verified by the IRS
(Internal Revenue Service) and the Illinois Department of Revenue.


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)