MedicaidCoverageMedium impact
Chapter M-200, Handbook for Providers of Medical Equipment and Supplies New Topic M-213.4 - Medical Foods
Illinois Medicaid - HFS·IL · Pediatrics, Endocrinology, Genetics +1 more·Provider Notice
Effective date
Nov 25, 2020
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers medical foods for children ages 0-20 with specific inborn errors of metabolism (phenylketonuria, maple syrup urine disease, homocystinuria). Prior authorization is required using form HFS1313 along with HFS1409 and prescription documentation.
Action Required
Immediately: Billing team must establish prior authorization workflow for medical foods for Illinois Medicaid patients ages 0-20 with inborn errors of metabolism. Providers must complete form HFS1313 (Medical Food Nutrition Review Questionnaire) and submit with HFS1409 (Prior Authorization Request) and prescription copy before dispensing. For managed care participants, contact specific HealthChoice Illinois plan for approval requirements. Claims will be denied without proper prior authorization.