MedicaidCoverageMedium impact
Screening, Treatment, Medical Monitoring, Counseling and Preventative Drugs for Persons at Risk of Exposure to Human Immunodeficiency Virus (HIV)
Illinois Medicaid - HFS·IL · Infectious Disease, Family Medicine, Internal Medicine +1 more·Provider Notice
Effective date
Sep 26, 2016
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers all FDA-approved drugs for HIV pre-exposure prophylaxis (PrEP) including Truvada, which requires no prior approval. The policy also clarifies that HIV screening, treatment, monitoring, and counseling services are covered, with simplified opt-out testing procedures allowed.
Action Required
Immediately: Billing team should verify that Truvada and other FDA-approved PrEP medications can be prescribed to Illinois Medicaid patients without prior authorization. Update billing workflows to ensure HIV screening, treatment, monitoring labs and counseling services are billed appropriately for high-risk patients. Front desk staff should note that HIV testing consent can now be obtained verbally with documentation in medical records.