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Illinois Medicaid and the new work rules
Illinois Medicaid — "ACA Adults" is run by Illinois Department of Healthcare and Family Services (HFS), with the Department of Human Services (IDHS) handling applications and the helpline. Illinois expanded Medicaid on January 1, 2014, which is why the new federal work requirement reaches this state — and why what you do before January 1, 2027 matters.
From January 1, 2027, most adults have to show 80 hours a month
The requirement applies to adults aged 19 to 64 covered through Medicaid expansion — around 635,344 people in Illinois. It is not only about paid work: study, job training, volunteering and a mix of them all count , and earning at least $580 a month satisfies it on its own.
HFS's FAQ does not yet spell out its specific data-matching sources; it only confirms that compliance is assessed at application (for new applicants after the Dec 31, 2026 cutoff) and at each ACA Adult's first 2027 redetermination.
If your hours swing from month to month, say so. The rule is written per month, which is the wrong shape for farm and fishing work, construction, tourism and seasonal retail — a good month and a dead month average out to a living, but the dead month is the one that fails. Federal law has a provision for exactly this: a seasonal worker can satisfy the requirement using their average monthly income over the previous six months instead of hours worked in the month being checked. It is at 42 CFR 435.552(a)(7), and the law defines who counts as seasonal by pointing at the tax code rather than listing jobs, so do not decide for yourself that it misses you. If your work is seasonal or your hours are irregular, tell the state that when you report, and ask for the six-month average to be used.
That is the range the state itself published.
HFS's own estimate, reported on September 30, 2026. The state published a range rather than a single figure, which is itself telling: even the agency administering the change does not know how many people it will remove.
Most of that is expected to be paperwork rather than people becoming ineligible. Which is the whole reason to sort out your address and your proof now rather than at the last minute.
You do not have to prove anything if any of these describe you
Exemptions are meant to be applied by the state automatically from records it already holds, but records are imperfect. If one of these fits you and you still get asked to report hours, say so and ask them to check — don't assume the notice is right.
What you can earn and still qualify
Monthly income, before tax, for the whole household. These are the state's own published figures, which is what its caseworkers actually apply. If you are close to a line, apply anyway — some income does not count, and only the agency can run the calculation for your situation.
Adults 19 to 64138% of the poverty line
- 1 person
- $1,835
- 2 people
- $2,488
- 3 people
- $3,141
- 4 people
- $3,795
- 5 people
- $4,448
- 6 people
- $5,101
- 7 people
- $5,754
- 8 people
- $6,407
- 9 people
- $7,061
- 10 people
- $7,714
Parents and caretakers138% of the poverty line
- 1 person
- $1,835
- 2 people
- $2,488
- 3 people
- $3,141
- 4 people
- $3,795
- 5 people
- $4,448
- 6 people
- $5,101
Source: IDHS WAG 25-03-02(2) Medical Assistance Income Standards (caseworker reference), effective October 1, 2026, cross-checked against Get Covered Illinois's 2026 FPL chart (GCI.FPL.Chart.pdf). A note on precision: HFS's own general overview page, hfs. We publish the state figure.
Two other changes land on the same day
Renewals get more frequent, and back-dated coverage gets shorter.
P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.
Illinois has a law that would end expansion automatically
Coverage here is tied by statute to how much the federal government pays.
305 ILCS 5/5-2, paragraph (18). If Illinois' federal medical assistance percentage (FMAP) is reduced below 90% for persons eligible for medical assistance under this paragraph 18, eligibility under this paragraph 18 shall cease no later than the end of the third month following the month in which the reduction in FMAP takes effect.
This ties continued expansion coverage for over 600,000 ACA Adults directly to the federal match rate — if it ever drops below 90%, expansion eligibility ends automatically within about three months, with no new legislative action required.
The trigger remains fully on the books and unmodified as of this research date; the repeal bill has not passed.
This is not a reason to delay applying. It is a reason to keep your contact details current, open everything the state sends, and not assume coverage renews itself.
Do this now
Update your address and phone number first. Everything about the new rules arrives by mail, and a stale address is the most common reason people lose coverage they are still entitled to. Then check whether an exemption applies to you.
About the phone numbers: ABE's own application and notices are only available in English and Spanish; ask for an interpreter or request Polish, Mandarin, or Ukrainian if that's your preferred language (see languagesNote).
Deaf, hard of hearing or speech-impaired: 1-866-324-5553.
ABE and Manage My Case offer English and Spanish fully, and added Polish, Mandarin, and Ukrainian as spoken and written options in 2025 under state law PA 103-0723. Not every notice has been converted into the new languages yet, so caseworkers can also arrange an interpreter — tell them your preferred language when you apply or call the helpline.
Most people who lose coverage lose it over paperwork, not eligibility
Nationally, most people who lose Medicaid lose it over paperwork rather than because they stopped qualifying. From January 1, 2027 that matters more, not less.
NOTICE OF ELIGIBILITY DETERMINATION
Case number: ███████
Date of this notice: 1January 12, 2027
Our records do not show that you met the community engagement requirement for the reporting period.
2If you believe this is incorrect, or if an exemption applies to you, contact us on or before February 11, 2027.
3Coverage for other members of your household is not affected by this notice.
What the federal data says about coverage here
Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what those numbers mean if you are the person enrolled.
Provider supply here is around the national middle.
Book an appointment before you need one, not when you do.
Coverage here runs through private health plans rather than the state paying providers directly. You pick a plan, and your plan decides your network.
Check your doctor is in the plan before you choose it.
Questions people ask about this
Do the new Medicaid work rules apply to me in Illinois?
How many hours a month do I have to work?
Who is exempt from the work requirement in Illinois?
When do the Illinois work rules start?
What is the income limit for Illinois Medicaid?
How do I apply for Illinois Medicaid — "ACA Adults"?
How often do I have to renew Illinois Medicaid?
Guides for neighboring states
The rules change completely at the state line. If you moved recently, or you're helping family somewhere else, start with their state rather than this one.
Starting today, October 1, 2026, Illinois narrows who qualifies for full-scope Medicaid by immigration status — refugees, asylees, trafficking survivors, and humanitarian parolees without a green card generally lose coverage unless they're a child, pregnant, or already enrolled in a state-funded program like HBIS or AATV.
If this might affect you, call the DHS Helpline now to find out whether you still qualify, and ask about Emergency Medicaid or a federally qualified health center if you don't.
Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.
Go to ABE — Application for Benefits Eligibility (abe.illinois.gov) →