Covered Services

Some services require prior authorization. Your provider will submit any needed prior authorizations.

Need care away from home? For urgent or routine care away from home, you must get approval for CountyCare to go to an out of state or out-of-network provider. Call Member Services at 312-864-8200, 711 (TTY/TDD) to get this approval.

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 with no copays or deductibles.

  • 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 over the age of 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

Dental Care

You should visit your dentist regularly to prevent cavities and other problems. You must go to an in-network provider to receive dental services. You can find a CountyCare dental provider by going on our website or by calling CountyCare Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
Please refer to CountyCare’s dental benefits here. If you have questions about specific services, please call Member Services.

Dental benefits for members 21 years of age and older:

  • X-rays, fillings, crowns (caps), oral surgery, extractions (pulling teeth), dentures and denture repairs, emergency dental services
  • As an added benefit, CountyCare also covers:
    • Dental exams and cleanings (1 every 6 months)
    • Root canals for all teeth and retreatment of root canals
    • Adjustment and removal of braces that were applied under age 21
    • Partial dentures
    • Pregnant members get regular checkups, cleanings and periodontal work (deep cleaning and tooth scaling)

You must go to an in-network provider to receive dental services. Please refer to CountyCare’s dental benefits here.

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:

  • Dental exam and cleaning (1 every 6 months)
  • Medically necessary braces
  • Fluoride treatment, oral surgery, X-rays, sealants, fillings, oral surgery, crowns (caps), root canals, dentures and denture repairs, extractions (pulling teeth), emergency dental services

As an added benefit, CountyCare also covers:

  • Retreatment of root canals

Vision Care

You must go to an in-network provider to receive vision services. You can find a CountyCare vision provider by going on our website or by calling CountyCare Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).

Please refer to CountyCare’s vision benefits here. If you have questions about specific services, please call Member Services.

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.

Vision benefits:

  • All members get one exam from our network of optometrists and ophthalmologists every calendar year.
  • Your choice from our standard selection of frames. As an added benefit, 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.
    • For members 21 years and older, 1 pair of eyeglasses are available in a two-year period.
    • For members 20 years and younger, 1 pair of eyeglasses are available every calendar year.
  • As an added benefit, all members 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.
  • If certain prescription requirements are met, single vision and bifocal lenses for your glasses are fully covered.

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:

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.

Telehealth Counseling

Do you feel anxious, lonely, sad, or need someone to talk to?

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.

Pharmacy Benefits

CountyCare provides pharmacy coverage for members through our vendor, CVS Caremark. 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?

Please review the list of medications that are covered under the State of Illinois’ Preferred Drug List (PDL). The PDL is sometimes called the formulary.

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.

Criteria for medication coverage:

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, Jewel-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 1-833-845-4702 to help you access your medications. For direct medication reimbursements requests, please use this form.

CountyCare members who would like to use CVS Caremark’s mail order pharmacy should follow the steps outlined here. To enroll in mail order please use the form 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.

Some prescription drugs require a prior authorization. Your doctor can submit a prior authorization form to request approval for a drug that is non-preferred or preferred by prior authorization only on CountyCare’s Preferred Drug List.

CountyCare works with CVS Caremark to administer pharmacy benefits, including the pharmacy prior authorization process. CountyCare requires prior authorization for select drugs on the Preferred Drug List, as well as certain drugs not listed on the list.

Follow these steps for completing your pharmacy prior authorization requests:

    1. Complete and submit online the Medication Request Form
      – or –
      Complete and print the CVS Caremark form: Medication Request Form
    2. Fax the completed and printed form to CVS Caremark at 1-866-255-7569.
    3. Once approved, CVS Caremark notifies the prescriber by fax and the member by letter.
    4. If the clinical information provided does not support the reason for the requested medication, CVS Caremark will notify the prescriber by fax, offering PDL alternatives. The member will also receive a letter regarding the decision.
    5. For urgent or after-hours requests, a pharmacy can provide up to a 72-hour supply of most medications by calling the CVS Caremark Pharmacy Help Desk at 1-800-364-6331.
    6. All pharmacy prior authorization requests for CountyCare members should be submitted to CVS Caremark.

To submit a specialty pharmacy prior authorization, please complete and submit online the Medication Request Form or fax the printed Medication Request Form to CVS Caremark at 1-866-255-7569.

To submit a Preferred Drug List exception request, please complete and submit online the Medication Request Form or fax the printed Medication Request Form to CVS Caremark at 1-866-255-7569.

CVS Caremark Portal

Log in to the CVS Caremark 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 CVS Caremark portal, you can also do the following:

  • Ask for an exception or prior authorization.
  • Order a refill by mail.
  • Find a pharmacy in your zip code.
  • Check for drug interactions.
  • Check for common drug side effects.
  • Look for generic drug options.
  • You can get your drugs at no cost.

Transportation Services

As of January 1, 2022 if a non-emergent ambulance trip is required, please contact Transdev FFS at 877-725-0569 (Monday through Friday, 8 a.m. to 5 pm. CST). They will then provide a list of transportation providers for you to call and schedule your trip. If you are having issues scheduling, you can contact Transdev again or your care coordinator. 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 Transdev at least 72 hours (3 days) before your appointment. You can schedule a ride by calling 630-403-3210 or by using the self-service web portal. If this is your first time using the web portal to schedule a ride, you will need to select “Register Now” to create an account. Enter your name and Medicaid ID number as it appears on your CountyCare Member ID card.

If you are having a medical emergency, call 911. CountyCare covers ambulance service for emergency care.

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:

  • Anxiety
  • Bipolar disorder
  • Depression
  • Schizophrenia
  • 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).

Brighter Beginnings

CountyCare covers services for maternal and child health services for expectant families, pregnant mothers, and their children through our Brighter Beginnings program. This includes:

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.

CountyCare covers:

  • 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

Having a healthy pregnancy is one of the best ways to promote a healthy birth and baby. Prenatal care is the health care you get while you are pregnant. Getting early and regular prenatal care improves the chances of a healthy pregnancy. If you know or think you might be pregnant, call your doctor or a prenatal care provider to schedule a visit.

Prenatal diagnostic procedures, including genetic testing, are covered if you have a high-risk pregnancy.

Postpartum care is the care received after delivery. The weeks following birth are a critical period for babies and families setting the stage for long-term well-being. To optimize the health of parents and infants, postpartum care should be timely, occurring within six weeks of delivery. Postpartum care includes a comprehensive assessment of physical, social, and psychological well-being and supporting any identified needs of the family and infant. People who experience a miscarriage, stillbirth, or neonatal death should schedule timely follow-up care as well.

CountyCare covered services include:

  • 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.
  • All new mothers should attend at least one postpartum visit between 7 and 84 days after giving birth. You can schedule this appointment before or after you give birth.

CountyCare also covers mental health services for mothers experiencing postpartum depression.

It is important that you see your women’s health provider for an annual Well Woman checkup. During this visit, your provider may perform a PAP smear, a breast exam, STI testing, and can provide family planning services.

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 LTSS 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 or LTSS 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
  • Homemaker
  • Long-Term Services and Supports (LTSS)
  • Nurse Intermittent
  • Nursing Skilled
  • Occupational, Physical and Speech Therapy
  • Prevocational Services
  • Personal Assistant
  • Personal Emergency Response System (PERS)
  • Respite
  • 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