Some services require prior authorization.
Your provider will submit any needed prior authorizations.
CountyCare covers all medically necessary Medicaid covered services, along with some additional benefits for our members. We cover these services at no cost to you.
Some services require prior authorization.
- Abortion services are covered by Medicaid (not CountyCare) by using your HFS Medical Card
- Advanced practice nurse services, including Certified Nurse-Midwives for maternity and women’s health care
- Ambulatory surgical treatment center services
- Assistive/augmentative communication devices
- Audiology services
- Blood work, blood components, and the administration thereof
- Chiropractic services for enrollees under age 21
- Coverage for one or more vendors procured by Chicago Public Schools (CPS) to manufacture eyeglasses for children in CPS
- Dental services: Exams (1 every six months for members under age 21)
- Dental services: Fluoride treatments (1 per year for members under age 21)
- Dental services: Oral surgeons for enrollees under age 21 and dental cleanings two (2) times per year
- Dental services: Eligible adults (age 21 and over) will be able to get limited and comprehensive exams; restorations; dentures; extractions; and sedation
- Dental services: Eligible pregnant women can get these additional dental services PRIOR to the birth of their babies: periodic oral examination teeth cleaning and periodontal work
- Durable medical equipment (DME)
- Emergency dental services
- Renal dialysis services
- Respiratory equipment and supplies
- Services to prevent illness and promote health
- Subacute alcoholism and substance use services, residential day treatment, and detox day treatment
- Transplants using transplant provider certified by HFS
- Transportation to get to covered services
- EPSDT services for enrollees under age 21 (excluding shift nursing for enrollees in the MFTD HCBS waiver for individuals who are medically fragile and technology dependent (MFTD))
- Family planning (birth control) services and supplies
- Federally Qualified Heath Centers (FQHCs), Rural Health Clinics (RHCs), and other encounter rate clinic visits
- Genetic radiology services
- Genetic counseling and testing
- Hearing tests
- Home health agency visits
- Hospital emergency room visits
- Hospital inpatient services
- Hospital ambulatory services
- Laboratory and x-ray services
- Maternity care before, during and after childbirth, including free-standing birth center services
- Medical supplies, equipment, prostheses and orthoses, and respiratory equipment and supplies
- Mental health services provided under the Medicaid clinic option, Medicaid rehabilitation option, and targeted case management option
- Nursing care for enrollees under age 21 not in the HCBS waiver for individuals who are MFTD
- Nursing care for the purpose of transitioning children from a hospital to home placement or other appropriate setting for enrollees under age 21
- Nursing facility services
- Vision care services and supplies
- Optometrist services
- Palliative and hospice services
- Pharmacy services (drugs used in the treatment of hepatitis C are covered only if dispensed in accordance with coverage criteria approved by the Illinois Department of Healthcare and Family Services, HFS)
- Physical, occupational, and speech therapy services
- Physician services
- Podiatry services (foot and ankle care)
- Post-stabilization services
- Practice visits for enrollees with special needs
CountyCare provides free dental coverage for members, including free exams and cleanings every six months. All members are covered for emergency dental services.
Dental benefits for members 21 years of age and older:
- CountyCare covers some routine and medically necessary dental services, including x-rays, fillings, crowns, root canals (front teeth only), oral surgery, extractions, dentures and denture repairs for members 21 years of age and older.
- Pregnant women get regular check-ups, cleanings and periodontal work (deep cleaning and tooth scaling).
- As an added benefit, CountyCare also covers regular exams and cleanings every six months for members 21 years of age and older. All members are covered for emergency dental services.
You must go to an in-network provider to receive dental services.
If you have questions about dental benefits, please call 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
Dental benefits for members 20 years of age and younger:
- CountyCare covers one dental exam and one cleaning every six months.
- CountyCare covers x-rays, sealants, fillings, oral surgery, crowns (caps), root canals, dentures and extractions (pulling teeth).
CountyCare has a robust network of vision providers. We offer exams to all members. You have the choice between glasses or contact lenses.
- One eye exam from our network of optometrists and ophthalmologists every year.
- Your choice from our standard selection of frames or you can choose a $100 allowance toward the retail value of frames. If the frames cost more than $100, you are responsible to pay for the difference in price. You are eligible for new glasses every two years.
- If certain prescription requirements are met, single vision and bifocal lenses for your glasses are fully covered.
- You can choose contact lenses instead of eyeglasses, the fitting fee is fully covered, and you get a $100 allowance toward the cost of your contact lenses. If the cost of your contact lenses is above $100, you are responsible to pay for the difference in price.
You must go to an in-network provider to receive vision services.
If you have questions about vision benefits, please call 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
Extra vision benefits and rewards:
- Free LASIK Eye Surgery – Members between the ages of 21 and 50 who meet the qualifications can receive LASIK eye surgery at no cost to them. Click here for more information about free LASIK eye surgery for CountyCare members.
Vision for kids:
- Your children’s pediatrician or nurse will test their vision during a routine check-up. If you or your child’s doctor have any concerns about your child’s vision you can take them to an eye doctor. Children receive the same vision benefits as adults.
Do you feel anxious, lonely, sad, or need someone to talk to during the COVID-19 pandemic?
You can get free counseling services through CountyCare’s partnership with Aunt Martha’s Health & Wellness. CountyCare provides no-cost telehealth counseling services to help you cope during the pandemic. Telehealth lets you talk to a therapist from your own home using video chat or phone call.
CountyCare has other in-network providers that provide telehealth counseling and psychiatry services. Please click here to find a full list of providers.
If you feel that you would like to talk to someone, call 877-MY-AUNT-M (877-692-8686) and select “option 2” to schedule an appointment. Representatives are available from 7:00 a.m.-7:00 p.m. Monday-Friday, and Saturday from 8:00 a.m.-4:00 p.m.
CountyCare provides pharmacy coverage for members through our vendor, MedImpact. Your prescription drugs are provided at no cost to you when you have your prescriptions filled at an in-network pharmacy.
Is my medication covered?
You may also download a print-friendly Preferred Drug List or request a paper copy by calling Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
If you need a medication that does not appear on the Preferred Drug List, your provider can ask for a prior authorization formulary request.
If you are new to CountyCare, you can continue any medication you currently use for your first 90 days with us, even if it is not part of the CountyCare Preferred Drug List. You will be told how you and your provider can ask for a prior authorization Preferred Drug List request.
CountyCare also covers over-the-counter medications. You will need a prescription from your provider to have the over-the-counter drug covered.
Medications not covered by Medicaid:
- Weight loss drugs
- Fertility drugs
- Experimental or investigational drugs
- Certain vitamins and minerals
- Cosmetic drugs
- Erectile dysfunction drugs
- Drugs classified as ineffective
Where can I get my prescriptions?
You must have a prescription written by your provider to get your medication. You can take your prescription to one of our in-network pharmacies, including national retail chains such as CVS, Kmart, Kroger, Walgreens, Target, Osco and Walmart. Make sure you have your CountyCare member ID card to show at the pharmacy.
Many pharmacies are now offering free medication delivery (including Walgreens, CVS, Jewel-Osco and others). The CountyCare Pharmacy Help Desk is available 24 hours a day, 7 days a week at 1-888-402-1982 to help you access your medications.
CountyCare members who would like to use MedImpact’s mail order pharmacy should follow the steps outlined here.
If you see a Cook County Health provider, you may also use the Cook County Health pharmacies. You can also get prescriptions mailed to your home. Call the Cook County Mail Order Pharmacy 24 hours a day at 800-458-0501.
If your PCP is part of a community health center, you may be able to use his/her pharmacy to get your prescription.
Log in to the MedImpact portal to check the status of your prior authorizations, get information on the medications you are taking or to print out a list of your medications.
On the MedImpact portal, you can also do the following:
We provide transportation to and from scheduled appointments. You can:
- Request public transportation passes (CTA and Pace) 2 weeks before your appointment by calling Member Services at 312-864-8200/ 855-444-1661 (toll-free)/ 711 (TDD/TTY).
- Schedule a ride through First Transit at least 72 hours (3 days) before your appointment.
- Review these tips about transportation services available to you.
If you are having a medical emergency, call 911. CountyCare covers ambulance service for emergency care. We may also cover this service at other times; however, you must have prior approval for a non-emergency ambulance trip.
Behavioral Health and Substance Use Services
If you have a life-threatening emergency, please call 911 or go to the nearest hospital emergency department.
CountyCare wants to help you stay healthy in mind as well as body. We offer behavioral health services to treat mental health and substance use disorders. Behavioral health services are available for both children and adult members.
To learn more about behavioral health and substance use services, please call 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
Our network of providers offer treatment for:
- Bipolar disorder
- Substance use disorders (such as drug and/or alcohol use)
- Other mental or behavioral health conditions
Covered behavioral health services include but are not limited to:
- Medication assisted treatment for substance use disorder, like Methadone, Suboxone and Vivitrol
- Crisis stabilization services
- Medication management
- Mental health assessments
- Case management
- Individual, group, and family therapy
- Psychological testing
- Community support
- Partial hospitalization
- Inpatient psychiatric care
- Electroconvulsive Therapy (ECT)
- Withdrawal management
- Residential rehabilitation
If you need these services speak with your PCP, your care coordinator, or call Member Services at 312-864-8200/ 855-444-1661 (toll-free) / 711 (TDD/TTY).
You must go to an in-network provider to receive behavioral health services.
Mobile Crisis Response Services - CARES
CARES or Crisis and Referral Entry Services is a telephone response service that handles mental health crisis calls for children and adults in Illinois. CountyCare members can use the 24-hour Crisis and Referral Entry Services (CARES) line to talk to a behavioral health professional. You can call if you or your child is a risk to themselves or others, having a mental health crisis or if you would like a referral to services.
Call the CARES line at 1-800-345-9049 (TTY: 1-773-523-4504).
Family Planning Services
CountyCare offers family planning services through our network of family planning providers. You can get services from any qualified family planning provider, and they do not have to be a network provider. You also do not need a referral from your PCP or permission from CountyCare to get these services.
- All contraceptive methods, including birth control devices and the fitting or insertion of the device (such as IUDs or implants).
- Over the counter and prescription emergency contraception.
- Permanent contraceptive methods, including vasectomies and tubal ligations
Pregnancy & Maternity Services
- Outpatient health care provider services, including prenatal and postpartum check-ups, laboratory screenings and ultrasound and care for problems or complications of pregnancy or childbirth.
- Inpatient hospital services in a participating hospital, out-of-hospital birth center care and out of-network emergency labor and delivery services.
- Prenatal diagnostic procedures, including genetic testing, are covered if you have a high-risk pregnancy.
- Double-electric breast pumps ordered by your provider.
You may stay at the hospital for at least 48 hours after a normal vaginal delivery and at least 96 hours after a cesarean section delivery.
Sometimes mothers want to leave sooner. You can leave sooner if, after talking to you, your doctor approves your discharge and makes an outpatient appointment for you and the baby within 48 hours.
You can choose a Certified Nurse-Midwife to deliver your baby. Click here to find a Certified Nurse-Midwife under “Specialty Provider.” You do not need CountyCare’s approval to see a Certified Nurse-Midwife
Long-Term Care (LTC)
Long-term care sometimes goes by different names such as nursing home, nursing facility, long-term care facility or skilled nursing facility.
These facilities have services that help both the medical and nonmedical needs of residents who need assistance and support to care for themselves due to a chronic illness or disability.
If you are living in a long-term care facility, CountyCare has supports in place to ensure you are getting the care you need. If you are able, we have resources to assist in transitioning you back to living independently in the community.
Contact your care coordinator if you would like to talk about long-term care or living in the community.
Covered Home and Community Based Services (HCBS or "Waiver Services")
CountyCare operates Waiver Programs through the Illinois Department of Healthcare and Family Services for individuals who qualify.
A waiver program provides services that allow individuals to remain in their own homes or live in a community setting, instead of living in an institution or a nursing facility. These HCBS waiver services are available in addition to medical and behavioral health benefits. The five (5) HCBS Waiver Programs currently operated by CountyCare include:
- Aging Waiver
- Persons with Disabilities Waiver
- Persons Living with HIV/AIDS
- Persons with Brain Injury Waiver
- Supportive Living Program Waiver
The State of Illinois determines who can receive waiver services. Contact Member Services if you think you may qualify for a waiver program. We can help you apply.
CountyCare members in a waiver program may be eligible for additional services such as:
- Adult Day Service
- Adult Day Service Transportation
- Assisted Living
- Automated Medication Dispenser
- Behavioral Services
- Day Habilitation
- Environmental Accessibility Adaptions-Home
- Home Delivered Meals
- Home Health Aide
- Long-Term Services and Supports (LTSS)
- Nurse Intermittent
- Nursing Skilled
- Occupational, Physical and Speech Therapy
- Prevocational Services
- Personal Assistant
- Personal Emergency Response System (PERS)
- Supported Employment
- Specialized Medical Equipment and Supplies
Managed Long-Term Services & Supports (MLTSS)
MLTSS is a program for members who have full Medicaid and Medicare benefits, who live in a nursing facility or receive HCBS (Waiver Services).
MLTSS covered services include:
- Some mental health services
- Some alcohol and substance use services
- Non-emergency transportation services to appointments
- Long Term Care services in skilled and intermediate facilities
- All Home and Community Based Waiver Services