# 89 Ill. Adm. Code 140.402: Section 140.402 Copayments for Non-institutional Medical Services

> Illinois · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_IL_IAC_T89_P140_S140_402

## Section

- **Citation:** 89 Ill. Adm. Code 140.402
- **Heading:** Section 140.402 Copayments for Non-institutional Medical Services
- **Jurisdiction:** Illinois
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Illinois Administrative Code / Title 89 SOCIAL SERVICES / CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES / Part 140 MEDICAL PAYMENT / Section 140.402 Copayments for Non-institutional Medical Services

## Text

Section 140
Section 140.402  Copayments
for Non-institutional Medical Services
The following implements cost
sharing in compliance with 42 USC 1396o (section 1916 of the Social Security
Act):
a)         Each recipient, with the exception of those classes of
recipients identified in subsection (d), shall be required to pay a copayment
of $2.00 for generic legend drugs and over-the-counter drugs billed to the
Department, and for other services, with the exception of those services
identified in subsection (e), the nominal copayment amount as defined at 42 CFR
447.54.  For dates of service beginning July 1, 2012 through March 31, 2013 the
nominal copayment amount is $3.65.  Beginning with dates of service on April 1,
2013 through August 31, 2019, the nominal copayment amount is $3.90.  Beginning
with dates of service on or after September 1, 2019, recipients will no longer
be required to pay a copayment for medical assistance services.  Specific
copayment amounts are described and updated on the Department's Web site for
the following non-institutional medical services:
1)         Office visits to enrolled practitioners for services
reimbursed under the Illinois Public Aid Code.
2)         Each brand name legend drug billed to the Department.
3)         Each encounter billed to the Department by an Encounter Rate
Clinic (ERC), Federally Qualified Health Center (FQHC) or Rural Health Clinic
(RHC), but excluding behavioral services provided by these facilities.  For
dates of service beginning July 1, 2013 through August 31, 2019, copayments for
behavioral health services provided by these facilities are no longer excluded
and shall be required to be paid by recipients with the exception of those
classes of recipients identified in subsection (d).
b)         In each instance in which a copayment is payable, the
Department will reduce the amount payable to the affected provider by the
respective amount of the required copayment
ts for
behavioral health services provided by these facilities are no longer excluded
and shall be required to be paid by recipients with the exception of those
classes of recipients identified in subsection (d).
b)         In each instance in which a copayment is payable, the
Department will reduce the amount payable to the affected provider by the
respective amount of the required copayment.
c)         No provider of services listed in subsection (a) may deny
service to an individual who is eligible for service on account of the
individual's inability to pay the cost of a copayment.
d)         The following individuals receiving medical assistance are
exempt from the copayment requirement set forth in subsection (a):
1)         Pregnant women, including a postpartum period of 60 days.
2)         Children under 19 years of age.
3)         All non-institutionalized individuals whose care is subsidized
by the Department of Children and Family Services or the Department of
Corrections.
4)         Hospice patients.
5)         Individuals residing in hospitals, nursing facilities, and
intermediate care facilities for the developmentally disabled who, as a
condition of receiving services, are required to pay all of their income,
except an authorized protected amount for personal use, for the cost of their
care.  For the purpose of this subsection (d)(5), the protected amount shall be
no greater than the protected amount authorized for personal use under 89 Ill.
Adm. Code 146.225(c).
6)         Residents of a State-certified, State-licensed, or
State-contracted residential care program where residents, as a condition of
receiving care in that program, are required to pay all of their income, except
an authorized protected amount for personal use, for the cost of their
residential care program. For the purpose of this subsection (d)(6), the
protected amount shall be no greater than the protected amount authorized for
personal use under 89 Ill. Adm. Code 146.225(c)
re program where residents, as a condition of
receiving care in that program, are required to pay all of their income, except
an authorized protected amount for personal use, for the cost of their
residential care program. For the purpose of this subsection (d)(6), the
protected amount shall be no greater than the protected amount authorized for
personal use under 89 Ill. Adm. Code 146.225(c).
7)         Individuals enrolled in the "Health Benefits for Person
with Breast or Cervical Cancer" program under 89 Ill. Adm. Code 120.500.
8)         American Indians or Alaskan Natives.
e)         The
following medical services are exempt from any copayments:
1)         Renal dialysis treatment.
2)         Radiation therapy.
3)         Cancer chemotherapy.
4)         Insulin.
5)         Services for which Medicare is the primary payer.
6)         Emergency services as defined at 42 USC 1396u-2(b)(2) (section
1932(b)(2) of the Social Security Act) and 42 CFR 438.114(a).
7)         Any pharmacy compounded drugs.
8)         Any prescription (legend drug) dispensed or administered by a
hospital, clinic or physician.
9)         Family planning services and supplies described in 42 USC
1396d(a)(4)(C) (section 1905(a)(4)(C) of the Social Security Act), including
contraceptives and other pharmaceuticals for which the State claims or could
claim federal financial participation at the enhanced rate under 42 USC
1396b(a)(5) (section 1903(a)(5) of the Social Security Act) for family planning
services and supplies.
10)         Other therapeutic drug classes as specified by the Department.
11)         Preventive services as described in section 4106(b) of the
Affordable Care Act.

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_IL_IAC_T89_P140_S140_402. Check the current official text before relying on it. Not legal advice.