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Illinois Medicaid - HFSMedicaid · Coverage · Provider Notice · IL · PharmacyMedium impact

COVID At-Home Rapid Antigen Test Kit Quantity Limit

Act
by Aug 31, 2026
Effective date
Sep 1, 2026
Identified
Aug 12, 2026

Summary

Effective September 1, 2026, Medicaid will limit COVID At-Home Rapid Antigen Test Kits to 8 units per beneficiary per rolling 365-day calendar year across both Fee-for-Service (FFS) and Managed Care Organization (MCO) plans. Billing teams must implement quantity controls in their systems to enforce this new annual limit and prevent claim denials for excess quantities.

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What to do

by Aug 31, 2026 · 6 steps
01Billing team must update pharmacy billing system to enforce an 8-unit annual quantity limit per Medicaid beneficiary for COVID At-Home Rapid Antigen Test Kits on a rolling 365-day basis from first dispensing date.
02Configure system to flag or reject claims exceeding 8 units within any rolling 12-month period.
03Coordinate with pharmacy staff to reference the covered COVID At-Home Rapid Antigen Test Kit list on the Medicaid Preferred Drug List (HFS) to ensure only eligible products are subject to this limit.
04Document the new limit in billing procedures and train billing staff on enforcement.
05Failure to implement controls will result in claim denials for quantities exceeding 8 per rolling year.
06For questions, direct providers to Bureau of Professional and Ancillary Services at 877-782-5565 or applicable MCO.

Original notice

COVID At-Home Rapid Antigen Test Kit Quantity Limit
hfs.illinois.gov · Always check the source before changing claims.
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Illinois Medicaid - HFS policiesIL policy changesPharmacy

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