MedicaidAdministrativeLow impact
Applications for the State Chronic Renal Disease Program
Illinois Medicaid - HFS·IL · Nephrology·Provider Notice
Effective date
Oct 6, 2004
We identified it
Jun 21, 2026
Summary
The Illinois Department of Healthcare and Family Services has made application forms for the State Chronic Renal Disease Program available online for download. However, completed forms must still be mailed with original signatures rather than submitted electronically.
Action Required
Renal dialysis facilities and hospitals in Illinois can now download application forms from http://www.dpaillinois.com/renalprogram/ for patient enrollment in the State Chronic Renal Disease Program. Completed forms must be mailed with original signatures to the department. Contact Bureau of Comprehensive Health Services at 217-782-5565 with questions.