This calculator provides an *estimated* eligibility for Illinois Medicaid based on income and household size. It does not guarantee eligibility.
Pregnant Women & Children
Adults (Age 21-64) – Non-Disabled
Disabled or Blind
Aged (65+) or Blind/Disabled
Medically Needy
Your estimated eligibility will appear here.
Understanding Illinois Medicaid Eligibility
Illinois Medicaid, administered by the Illinois Department of Healthcare and Family Services (HFS), provides essential health coverage to low-income individuals and families. Determining eligibility involves several factors, primarily household size and income relative to the Federal Poverty Level (FPL).
How Eligibility is Determined (Simplified):
Federal Poverty Level (FPL): Medicaid eligibility is often tied to a percentage of the FPL. Higher percentages of the FPL generally mean lower income limits for eligibility.
Household Size: The income threshold increases with each additional person in the household.
Categorical Eligibility: Eligibility often depends on meeting certain criteria, such as being pregnant, a child, disabled, blind, or aged 65 or older. Adults aged 19-64 who are not disabled or pregnant may qualify under the ACA expansion if their income is below 138% of the FPL.
Income Calculation: Generally, gross monthly income (income before taxes and deductions) is used. Some specific deductions may apply depending on the category.
Categories Covered by This Calculator (General Guidelines):
Pregnant Women & Children: Typically have higher income limits than other adult categories.
Adults (Age 21-64) – Non-Disabled: This category often refers to those qualifying under the ACA expansion, with eligibility up to 138% of the FPL.
Disabled or Blind: Individuals must meet Social Security Administration (SSA) disability or blindness criteria and income limits, often linked to SSI or specific Medicaid pathways.
Aged (65+) or Blind/Disabled: Eligibility for seniors and those with disabilities often follows specific pathways, sometimes with different asset tests (though this calculator focuses on income).
Medically Needy: For individuals whose income is too high for other categories but who have significant medical expenses that reduce their "countable" income to Medicaid levels. This is a more complex pathway.
Important Notes:
FPL percentages vary annually and by category. This calculator uses generalized thresholds for illustrative purposes. For exact figures, always refer to official Illinois HFS guidelines.
Asset Limits: Some Medicaid categories have asset limits (e.g., savings, property), which this calculator does not consider.
Other Factors: Citizenship/immigration status, residency in Illinois, and specific program rules can also affect eligibility.
This tool is an estimate. To confirm eligibility, you must apply through the official Illinois Department of Human Services (IDHS) portal or contact them directly.
Disclaimer: This calculator is for informational purposes only and is not a substitute for professional advice or an official eligibility determination. Data used is based on general guidelines and may not reflect the most current FPL percentages or specific program rules.
// Federal Poverty Level Guidelines (Approximate – these are example values and change annually)
// These are based on 2023/2024 general guidelines for illustrative purposes.
// Source: ASPE, HHS.gov – Actual thresholds vary slightly by year and specific program.
var fpl_guidelines = {
"1": {"100": 1458, "138": 2011, "133": 1941, "88": 1285, "75": 1093}, // For Household Size 1
"2": {"100": 1972, "138": 2720, "133": 2631, "88": 1734, "75": 1486}, // For Household Size 2
"3": {"100": 2486, "138": 3429, "133": 3321, "88": 2184, "75": 1879}, // For Household Size 3
"4": {"100": 3000, "138": 4138, "133": 4011, "88": 2634, "75": 2272}, // For Household Size 4
"5": {"100": 3514, "138": 4847, "133": 4701, "88": 3084, "75": 2665}, // For Household Size 5
"6": {"100": 4028, "138": 5556, "133": 5391, "88": 3534, "75": 3058}, // For Household Size 6
"7": {"100": 4542, "138": 6265, "133": 6081, "88": 3984, "75": 3451}, // For Household Size 7
"8": {"100": 5056, "138": 6974, "133": 6771, "88": 4434, "75": 3844} // For Household Size 8
// Add more sizes or adjust percentages as needed. For >8, add $514 for each additional person (100% FPL)
};
// Function to get FPL amount for a given household size and percentage
function getFPL(size, percentage) {
if (size 8) {
// For sizes larger than 8, calculate based on the difference from size 8
var baseFPL100 = fpl_guidelines["8"]["100"] || 1000; // Fallback if size 8 is missing
var additionalPerPerson = 514; // Approximate additional FPL per person for size > 8 (based on 2023 data for 100%)
var fpl100 = baseFPL100 + (size – 8) * additionalPerPerson;
if (percentage == "100") return Math.round(fpl100);
if (percentage == "138") return Math.round(fpl100 * 1.38);
if (percentage == "133") return Math.round(fpl100 * 1.33);
if (percentage == "88") return Math.round(fpl100 * 0.88);
if (percentage == "75") return Math.round(fpl100 * 0.75);
}
var guidelines = fpl_guidelines[size.toString()];
if (!guidelines) return null; // Size not found
return guidelines[percentage.toString()] || null;
}
function calculateMedicaidEligibility() {
var householdSize = parseInt(document.getElementById("householdSize").value);
var monthlyIncome = parseFloat(document.getElementById("monthlyIncome").value);
var category = document.getElementById("category").value;
var resultDiv = document.getElementById("result");
// Clear previous results and styling
resultDiv.innerHTML = "Your estimated eligibility will appear here.";
resultDiv.className = ""; // Reset classes
// Input validation
if (isNaN(householdSize) || householdSize <= 0) {
resultDiv.innerHTML = "Please enter a valid household size (1 or more).";
return;
}
if (isNaN(monthlyIncome) || monthlyIncome < 0) {
resultDiv.innerHTML = "Please enter a valid monthly income (0 or more).";
return;
}
var maxIncomeLimit = 0;
var eligibilityMessage = "";
var isEligible = false;
// Define income limits based on category and FPL percentage
// These are *generalized* limits. Actual limits can be more complex.
if (category === "pregnant-women-children") {
// Pregnant women and children often have higher limits, e.g., up to 208% FPL or higher depending on age/circumstance
maxIncomeLimit = getFPL(householdSize, "208"); // Example: Using 208% FPL
if (maxIncomeLimit === null) maxIncomeLimit = getFPL(householdSize, "100") * 2.08; // Fallback calculation
if (monthlyIncome <= maxIncomeLimit) {
isEligible = true;
eligibilityMessage = "Likely Eligible (Pregnant Women/Children)";
} else {
eligibilityMessage = "Likely Ineligible (Income too high for this category)";
}
} else if (category === "adults-21-64") {
// ACA Expansion group (Adults 19-64, non-disabled, non-pregnant) – typically up to 138% FPL
maxIncomeLimit = getFPL(householdSize, "138");
if (maxIncomeLimit === null) maxIncomeLimit = getFPL(householdSize, "100") * 1.38; // Fallback calculation
if (monthlyIncome <= maxIncomeLimit) {
isEligible = true;
eligibilityMessage = "Likely Eligible (Adult Expansion Group)";
} else {
eligibilityMessage = "Likely Ineligible (Income too high for Adult Expansion)";
}
} else if (category === "disabled-blind") {
// SSI-related disability often uses a threshold around 80-100% FPL, but can be complex
maxIncomeLimit = getFPL(householdSize, "88"); // Example: Using 88% FPL as a common reference
if (maxIncomeLimit === null) maxIncomeLimit = getFPL(householdSize, "100") * 0.88; // Fallback calculation
if (monthlyIncome <= maxIncomeLimit) {
isEligible = true;
eligibilityMessage = "Potentially Eligible (Disabled/Blind)";
} else {
eligibilityMessage = "Potentially Ineligible (Income may be too high)";
}
resultDiv.innerHTML += "Note: Requires meeting SSA disability/blindness criteria and potential asset limits.";
} else if (category === "aged-65-plus") {
// Aged 65+ often follows similar income guidelines to disability, potentially linked to SSI or specific state programs.
maxIncomeLimit = getFPL(householdSize, "88"); // Example: Using 88% FPL
if (maxIncomeLimit === null) maxIncomeLimit = getFPL(householdSize, "100") * 0.88; // Fallback calculation
if (monthlyIncome <= maxIncomeLimit) {
isEligible = true;
eligibilityMessage = "Potentially Eligible (Aged 65+)";
} else {
eligibilityMessage = "Potentially Ineligible (Income may be too high)";
}
resultDiv.innerHTML += "Note: May have asset limits.";
} else if (category === "medically-needy") {
// Medically Needy: Income is higher than standard limits, but medical expenses "spend down" income.
// This calculator cannot accurately determine Medically Needy eligibility without expense details.
// A general income threshold (e.g., 200% FPL) is often used as a starting point.
maxIncomeLimit = getFPL(householdSize, "200"); // Example threshold
if (maxIncomeLimit === null) maxIncomeLimit = getFPL(householdSize, "100") * 2.00; // Fallback calculation
if (monthlyIncome <= maxIncomeLimit) {
isEligible = true; // User *might* be eligible if they have high medical bills
eligibilityMessage = "Potentially Eligible (Medically Needy – requires high medical bills)";
} else {
isEligible = false;
eligibilityMessage = "Likely Ineligible (Income likely too high even with medical expenses)";
}
resultDiv.innerHTML += "Note: Requires verification of high medical expenses to 'spend down' income. Consult HFS for details.";
}
// Display result
if (isEligible) {
resultDiv.innerHTML = "Estimated Eligibility: " + eligibilityMessage + "Monthly Income Threshold (Approx.): $" + (maxIncomeLimit ? maxIncomeLimit.toFixed(2) : "N/A");
resultDiv.classList.add("result-eligible");
} else {
resultDiv.innerHTML = "Estimated Eligibility: " + eligibilityMessage + "Monthly Income Threshold (Approx.): $" + (maxIncomeLimit ? maxIncomeLimit.toFixed(2) : "N/A");
resultDiv.classList.add("result-ineligible");
}
}