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Critical Access Pharmacies’ (CAP) Self-Attest Criteria
Effective date
Jul 1, 2018
Identified
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.
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What to do
Action · 2 steps
01Pharmacy 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.
02Medical billing teams are not affected by this pharmacy-specific program.
Original notice
Critical Access Pharmacies’ (CAP) Self-Attest Criteria
hfs.illinois.gov · Always check the source before changing claims.
Related changes
See all Illinois Medicaid - HFS changes →2027 Critical Access Pharmacy (CAP) ProgramMediumEffective Jan 1, 2027 · Provider NoticeCritical Access Pharmacies Self-Attest Period Open for Third Fiscal Quarter of 2019LowEffective May 2, 2019 · Provider NoticeCritical Access Pharmacy (CAP) Timely Attestation for Quarterly Payments for Managed Care ServicesHighEffective Feb 2, 2021 · Provider NoticeCritical Access Pharmacy (CAP) UpdateMediumEffective Jan 1, 2026 · Provider NoticeBrowse every Illinois Medicaid - HFS change in the policy list