2027 Critical Access Pharmacy (CAP) Program

The Illinois Department of Healthcare and Family Services (HFS) issued a provider notice on September 25, 2026 announcing the 2027 Critical Access Pharmacy (CAP) Program, established pursuant to Public Act 104-0027. The program requires HFS to make enhanced dispensing fee payments to pharmacies that qualify as Critical Access Pharmacies under defined eligibility criteria. To qualify, independent pharmacies must meet all of the following baseline criteria: the owner or owners hold an ownership or control interest in fewer than 10 pharmacies; the pharmacy is located in Illinois, operates as a brick-and-mortar location open to the public, requires HFS customers to present in person to fill prescriptions, and is neither owned or operated by a hospital nor located within a hospital; and at least 51% of the pharmacy's prescriptions are not mail-order and are not delivered to residential facilities. In addition to the baseline criteria, a pharmacy must meet at least one geographic or underservice criterion: it is physically located in a county with a population under 50,000, or it is located within a Medically Underserved Area (MUA) as designated by HRSA. The MUA designation will be reviewed and applied as of November 2, 2026 for Calendar Year 2027 eligibility; changes to MUA designation made after November 2026 will not be considered for the 2027 determination. Pharmacies seeking 2027 eligibility must complete an online attestation form between October 1, 2026 and October 31, 2026. Submissions outside that window will not be accepted. Newly opened pharmacies that join the Illinois Medicaid program after October 31 and believe they meet all eligibility requirements may request case-by-case review by emailing HFS.CriticalAccessPharmacy@illinois.gov. The eligibility list will be posted on the HFS website no later than December 1, 2026, and pharmacies may appeal by submitting documentation to HFS.CriticalAccessPharmacy@illinois.gov by December 10, 2026, with final updates to the eligibility list completed before January 1, 2027.