MedicaidAdministrativeLow impact
Critical Access Pharmacies’ (CAP) Self-Attest Criteria
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Jul 1, 2018
We identified it
Jun 20, 2026
Summary
Illinois Medicaid has established a Critical Access Pharmacy (CAP) program requiring eligible pharmacies to self-attest quarterly to receive supplemental payments for managed care encounter claims. Pharmacies in counties under 50,000 residents or medically underserved areas can receive quarterly payments based on their Medicaid managed care claims volume.
Action Required
Pharmacy providers only: If operating an Illinois brick-and-mortar pharmacy with fewer than 10 locations in qualifying areas, self-attest quarterly through the Department's MEDI site within 30 days after each quarter ends to receive supplemental payments. Medical billing teams are not affected by this pharmacy-specific program.