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Elizabeth M. Whitehorn, Director

Going to the Doctor

When you or a family member needs medical help, you should call your Primary Care Provider (PCP) first. Your PCP will make an appointment to see you or your family member, or will refer you to a specialist for additional services if needed. You can also call your health plan’s member services number, found on your health plan member ID card, for assistance.

Emergencies

If you have an emergency, you should go to the closest emergency room or call 911. You may go to any emergency room. You do not need to ask your doctor.

An emergency is a health problem that is life threatening or one that will seriously hurt your health if it is not treated right away. Go to the emergency room only if your problem is serious. If it is not serious, make an appointment to see your PCP.

Medical Emergencies May Include

  • Chest or serious stomach pains

  • High fever

  • Bleeding that won't stop

  • Passing out or trouble breathing

  • Seizures

  • A broken bone

  • Serious burns

  • Damage to the eyes

  • Any medical problem you think is serious

Your Illinois HFS Medical Card

When you go to your doctor’s appointment or to the pharmacy, you must bring your State of Illinois photo ID and you should also bring your Healthcare and Family Services (HFS) Medical Card. If you do not have these items, the doctor’s office or the pharmacist can check the with the State to confirm your eligibility.  The doctor’s office can use your HFS Recipient Identification Number (RIN) or your name, social security number, and date of birth to check your eligibility.  Individuals enrolled in a health plan will also receive a separate member ID card.  If you receive a health plan member ID card, you should bring that card to your doctor’s appointments too.  

You should also bring your HFS Medical Card and your health plan member ID card, if you have one, to the pharmacy when you fill a prescription.  The pharmacist will need the information on the cards to fill your prescriptions.

If you have questions about your benefits or coverage, call your health plan at the member services toll-free number on your health plan member ID card. If you are not enrolled with a health plan, or your health plan hasn’t taken effect yet, call the toll-free number on your HFS Medical Card: 1-855-828-4995.  

Referrals

In most cases, your Primary Care Provider (PCP) manages your health care. If you need to see a specialist, your PCP will refer you to a network provider, who works with your PCP's hospital or medical group.

Health plans and PCPs generally require a referral to see a specialist. It is important that you get a referral from your health plan or PCP before you go to a specialist. If you do not get a referral from your health plan or PCP, you might have to pay all of the costs of the specialist appointment. All referrals must meet the requirements of the state and your health plan, if you are enrolled in a health plan.

You can call your health plan or Primary Care Provider (PCP) to check on the status of a referral. Once the referral is approved, the specialist can order any necessary treatment until the referral expires. If the specialist recommends that you see another specialist, they will need to contact your health plan or PCP for a new referral for that specialist.

An Exception to Referrals

Women don't need a referral to see an OB/GYN in their network for routine services such as Pap tests, annual well-woman visits, and obstetrical care.

In most cases, your Primary Care Provider (PCP) manages your health care. If you need to see a specialist, your PCP will refer you to a network provider, who works with your PCP's hospital or medical group.

Health plans and PCPs generally require a referral to see a specialist. It is important that you get a referral from your health plan or PCP before you go to a specialist. If you do not get a referral from your health plan or PCP, you might have to pay all of the costs of the specialist appointment. All referrals must meet the requirements of the state and your health plan, if you are enrolled in a health plan.

You can call your health plan or Primary Care Provider (PCP) to check on the status of a referral. Once the referral is approved, the specialist can order any necessary treatment until the referral expires. If the specialist recommends that you see another specialist, they will need to contact your health plan or PCP for a new referral for that specialist.

Covered Medical Services

Medicaid covers services similar to private health insurance plans. Care Provider (PCP) to check on the status of a referral. Once the referral is approved, the specialist can order any necessary treatment until the referral expires. If the specialist recommends that you see another specialist, they will need to contact your health plan or PCP for a new referral for that specialist.

Covered services include:

  • Ambulatory services, such as:

    • Office visits

    • Outpatient hospital services

    • Family planning services and supplies

    • Diagnostic services

    • Services from rural health clinics and federally qualified health centers

  • Emergency room services

  • Emergency transportation

  • Inpatient hospital care

  • Maternity and newborn care, including:

    • Services during and after pregnancy

    • Inpatient hospital

    • Nurse-midwife services

    • Free-standing birth center services

    • Help to quit smoking for pregnant women

  • Mental health and substance use services, such as:

    • Mental health rehabilitation services at community mental health centers

    • Alcohol and substance abuse services

    • Detox services

    • Inpatient hospital services

  • Prescription drugs

  • Rehabilitative and habilitative services, including:

    • Skilled nursing facilities

    • Physical therapy

    • Occupational therapy

    • Speech, hearing, and language therapy

    • Medical supplies and equipment

    • Prosthetic devices

    • Eyeglasses and other optical materials

  • Lab and x-ray services

  • Preventive and wellness services, including many recommended screenings and vaccinations

  • A range of pediatric services for children up to the age of 20, including all medically necessary dental care.

 

Medicaid also covers many additional services, such as long term care, limited dental services for adults, hospice care, certain home health services, and non-emergency transportation.

Not all health care services are covered in all situations.  Many health care services have limits or pre-approval requirements that can be hard to understand.  If you are in a health plan, the health plan will help you get the covered services you need from its network of health care providers, and help you understand which services have limits or pre-approval requirements.  You can also work with your PCP to get help understanding your coverage for the services you need.

Have questions about your medical coverage and you are NOT enrolled with a health plan, or your health plan hasn't started yet?

Call the HFS Health Benefits Hotline at 1-866-226-0768

 

Have Questions about your medical coverage?

Please call your PCP or health plan.

They can tell your what services or medications are covered, and assist you with