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How to use or fill out Request for medical benefits for another family member(s) - dhs state il

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name as it appears on the MediPlan or All Kids/FamilyCare ID Card, along with your address and phone number.
Fill in the case number from your MediPlan or All Kids/FamilyCare ID Card. If known, include the CSID on the MediPlan card.
List the names of the individuals you are requesting benefits for, including their sex, birth date, and Social Security Number.
Indicate your relationship to each person and whether they are an Alaska Native or American Indian. For those under 19, provide parental names.
Answer questions regarding previous medical care received in the last three months and any current insurance coverage details.
Complete income-related sections if applicable, providing necessary documentation such as pay stubs or proof of other income sources.
Finally, review all entered information for accuracy before signing and dating the form at the bottom.

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What is the family income limit for Medicaid in Illinois?

If your familys income is at or under 138% of the Federal Poverty Guidelines (FPG) ($21,597 per year for an individual; $44,367 for a family of four), you may qualify. If you are 18 or younger and your familys income is at or under 318% of FPG ($102,237 per year for a family of four), you may qualify for All Kids.

How do I apply for benefits in Illinois?

Apply for Benefits Portal (ABE.Illinois.gov) To apply for healthcare, food and cash assistance benefits, click the blue Apply for Benefits button. You will need to set up an account, log in and fill out the online application. Supporting documents can also be uploaded after the application is signed and submitted.

What is family assist Medicaid Illinois?

Family Assist: medical benefits for families whose income is at or below the TANF Cash Payment Level. Once the familys income rises above the Family Assist income limit, the family unit may be eligible for up to a year of extended medical coverage.

How to apply to be a caregiver for a family member in Illinois?

If youre interested in becoming a paid caregiver in Illinois, contact your local Department on Aging or a Medicaid-certified home care agency like Paid. care. We can help you navigate the Illinois Caregiver Application process and ensure youre receiving the support you deserve while caring for your loved one.