MedicaidAdministrativeMedium impact
Critical Access Pharmacy (CAP) Update
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Illinois is updating its Critical Access Pharmacy (CAP) program effective January 1, 2026, consolidating two existing programs into one streamlined model with new eligibility criteria and increased dispensing fees to $21.05. Pharmacies must complete new attestation forms by October 31, 2025 to participate in the 2026 program.
Action Required
By October 31, 2025: If your practice operates or partners with independent pharmacies in Illinois that serve Medicaid patients, ensure those pharmacies complete the new consolidated attestation form available on the HFS Pharmacy Webpage to maintain CAP program eligibility. Direct CAP-related questions to HFS.CriticalAccessPharmacy@illinois.gov. Note that final 2025 MCO payments will be issued in December 2025.