Provider Notice issued 09/25/2026

2027 Critical Access Pharmacy (CAP) Program

In accordance with Public Act 104-0027, the Department of Healthcare and Family Services (HFS) is required to make enhanced dispensing fee payments to pharmacies defined as Critical Access Pharmacies.

Annual Eligibility Criteria

Independent pharmacies must meet all of the following criteria to qualify:

• The owner(s) have an ownership or control interest in fewer than 10 pharmacies. 
• The pharmacy is located in Illinois, is a brick‑and‑mortar location open to the public, and HFS customers must present in person to fill prescriptions. The pharmacy must not be owned or operated by a hospital nor located within a hospital. 
• At least 51% of the pharmacy’s prescriptions are not mail‑order and are not delivered to residential facilities. 

Pharmacies must also meet one of the following criteria:

• The pharmacy is physically located in a county with a population under 50,000; or 
• The pharmacy is located within a Medically Underserved Area (MUA) as designated by the Health Resources and Services Administration (HRSA)

Attestation Procedures and Annual Enrollment

To participate in the CAP program, pharmacies that determine they meet the eligibility criteria must complete the online attestation form attestation form. Please ensure the form is completed in full to prevent delays or disqualification.

For eligibility in Calendar Year 2027, all documentation must be submitted between October 1, 2026, and October 31, 2026. Submissions will not be accepted before October 1 or after October 31. Newly opened pharmacies participating in the Illinois Medicaid program after October 31 that determine they meet all eligibility requirements should email the Department at HFS.CriticalAccessPharmacy@illinois.gov. These requests will be reviewed on a case‑by‑case basis.

The MUA designation will be reviewed and applied as of November 2, 2026 for the Calendar Year 2027 eligibility determination. Changes to the MUA designation made after November 2026 will not be considered for Calendar Year 2027 eligibility. The eligibility list for Calendar Year 2027 will be announced and posted on the HFS website no later than December 1.

Pharmacies wishing to appeal their eligibility determination must submit their appeal, along with supporting documentation, to HFS.CriticalAccessPharmacy@illinois.gov by December 10. Appeal decisions will be communicated directly to providers, and updates to the eligibility list will be finalized before January 1, 2027.

Laura Phelan, Administrator
Division of Medical Programs