Basic Legal Requirements

  • Must be 18 years old or older with proof of patient’s identity and age
  • Must be a resident of Illinois with proof of residency

Proof of Qualifying Conditions

  • Must have one of the qualifying conditions
  • Must have a written certification with a bona fide physician-patient relationship

Complete the Paperwork

  • Notarized Homeless Status Certification for homeless qualifying patients
  • Payment of application fee by check or money order
  • Copy of DD214 for Veterans
  • Letter or other documentation as proof of patient’s SSDI or SSI disability program participation showing the amount of monthly disability benefits to be received
  • Applications may be completed online or sent via U.S. mail

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