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Illinois · Illinois HFS / IDHS-DRS

Illinois EVV: 75% compliance and the three-strike ladder

Electronic Visit Verification decides whether Illinois Medicaid pays a home-care claim. Here is what the state requires, with dates and sources you can check.

What Illinois requires

From Apr 1, 2026

A 75% or greater quarterly EVV compliance percentage is required (Q2 2026 onward).

Source: Illinois HFS EVV updates

Strike one

First non-compliant quarter: agency administrators must complete required Learning Management System training modules within 30 days.

Source: Illinois HFS EVV compliance policy

Strike two

Second non-compliant quarter: a Compliance Action Plan must be submitted to HFS within 10 business days.

Source: Illinois HFS EVV compliance policy

Strike three

Third non-compliant quarter: referral to the HFS Office of Inspector General for investigation.

Source: Illinois HFS EVV compliance policy

Edit-rate / usage rule

Illinois requires a 75%+ quarterly EVV compliance percentage from April 2026, enforced by a three-strike ladder that ends at the Office of Inspector General.

Why the ladder matters more than the number

75% sounds forgiving next to Pennsylvania's 85%, but Illinois attached escalating consequences to repetition. The strikes are quarterly and cumulative: an agency that treats a bad quarter as noise is two quarters from an OIG file. The correct read is that Illinois grades on trend — a failing quarter is survivable only if the next one visibly isn't.

The Home Services Program (IDHS-DRS) side runs its own aggregator arrangement through Sandata, so agencies serving both HFS and HSP populations are effectively running two EVV pipelines with one compliance reputation.

Managing to the quarterly number

Because the measure is quarterly, mid-quarter monitoring is the whole defense: an agency that checks its compliance percentage in week 6 can still fix the quarter; one that learns it from the state's notice cannot. Our edit-rate calculator gives a directional read in thirty seconds — the point is to be the one who measures first.

What are Illinois EVV denials costing you?

The free X-Ray reads your Medicaid 835 in your browser and shows the EVV denials. The file never leaves your computer.

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Denial codes that hit Illinois agencies