Summary
Medicaid’s rules, benefits and name can all vary by state. In Illinois, Medicaid is also called the Medical Assistance Program. This article focuses on Illinois Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers and Aid to Aged Blind and Disabled Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.
Illinois Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Illinois seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:
Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.
Illinois Nursing Home Medicaid beneficiaries are required to give almost all of their income to the state to help cover care expenses. They are allowed to keep a “personal needs allowance” (PNA) of $60/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid recipients.
Illinois Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.
A Nursing Home Alternative – Illinois Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through the Money Follows the Person program (MFP). This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. In Illinois, MFP is also called Pathways to Community Living.
Home and Community Based Services (HCBS) Waivers will pay for long-term care goods and services that help financially limited Illinois seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long term care services for Illinois residents who live in their home, the home of a loved one, an assisted living facility, a memory care unit or adult foster care, also known as a board and care home. While Illinois HCBS Waivers will cover some long-term care services in those settings, it will not cover room and board costs such as mortgage payments, rent, utilities or food expenses.
There are two HCBS Waivers relevant to Illinois seniors:
1. Supportive Living Program
Illinois’ Supportive Living Program (SLP), which is also known as the Waiver for Supportive Living Facilities, provides benefits for the disabled or elderly (age 65 and over) who require a Nursing Facility Level of Care, but instead live in a state-approved residential setting such as a board and care home (also known as adult foster care), assisted living facility or memory care unit for people with Alzheimer’s Disease or a related dementia. SLP benefits include nursing care, Personal Emergency Response Systems, housekeeping assistance, medication management and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).
Not all of the SLP benefits will be available to all program members. Instead, the state conducts an individual assessment to determine which benefits each member needs. This assessment includes a Mini-Mental Status Examination to evaluate cognitive functioning and detect possible dementia, as well as a Determination of Need to confirm the need for a Nursing Facility Level of Care.
Unlike Nursing Home Medicaid, the Supportive Living Program is not an entitlement. Instead, it has a limited number of enrollment spots (14,099 as of 2023) and once those spots are full additional applicants are placed on a waitlist.
2. Waiver for the Elderly
Illinois’ Waiver for the Elderly, also known as the Persons who are Elderly Waiver, provides long-term care services and supports to Illinois seniors who require a Nursing Facility Level of Care, but instead live in their home or the home of a loved one. Benefits include adult day care, Personal Emergency Response Systems, housekeeping and shopping assistance and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).
Not all Waiver for the Elderly benefits will be available to all program members. Instead, an Illinois Community Care Unit will conduct an individual assessment to determine which benefits each member needs. This assessment includes a Mini-Mental Status Examination to evaluate cognitive functioning and detect possible dementia, as well as a Determination of Need to confirm the need for a Nursing Facility Level of Care.
The Waiver for the Elderly has a large but limited number of enrollment spots (approximately 130,000 per year). Once those spots are full, additional eligible applicants will be placed on a waitlist.
Illinois’s Aid to Aged, Blind, and Disabled (AABD) Medicaid provides healthcare coverage and long-term care goods and services to financially limited Illinois residents who are aged (65 and older), blind or disabled. AABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. AABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait.
AABD Long Term Care Benefits
Eligible Illinois seniors who show a medical need for long-term care goods and services can receive those goods and services through AABD Medicaid. These benefits can include in-home personal care, adult day care, meal delivery, home modifications and Personal Emergency Response Systems (PERS). AABD Medicaid recipients qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its benefits immediately available for anyone who qualifies. Instead, Illinois seniors will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.
Dual Eligible AABD Medicaid recipients
AABD Medicaid recipients who also have Medicare, which is known as being “dual eligible,” and need a Nursing Facility Level of Care are required to enroll in one of these programs:
1. Medicaid Managed Long Term Services and Supports
Illinois’ Medicaid Managed Long Term Services and Supports (MLTSS) is part of the state’s HealthChoice Illinois Program, and sometimes MLTSS is simply referred to as HealthChoice Illinois. Benefits available through MLTSS include adult day care, home modifications, care coordination, emergency home response services and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). MLTSS manages Medicaid services for program members, but their Medicare benefits will still be managed by Medicare.
To determine if MLTSS applicants do need a Nursing Facility Level of Care, an Illinois Community Care Unit will conduct a Determination of Need. This includes an assessment of functional needs to determine which services and supports will be provided by MLTSS, as well as a Mini-Mental Status Examination to evaluate cognitive functioning and detect possible dementia.
2. Medicaid-Medicare Alignment Initiative
Illinois’ Medicaid-Medicare Alignment Initiative (MMAI) combines Medicaid and Medicare benefits for dual eligible beneficiaries into one streamlined plan that includes medical, personal, behavioral and long-term care services. The plan will be delivered by a managed care organization, which has a network of care providers. Benefits of the MMAI include physician visits, adult day care, durable medical equipment, home modifications, homemaker services and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).
To determine if MMAI applicants do need a Nursing Facility Level of Care, an Illinois Community Care Unit will conduct a Determination of Need. This includes an assessment of functional needs to determine which services and supports will be provided by MMAI, as well as a Mini-Mental Status Examination to evaluate cognitive functioning and detect possible dementia.
To be eligible for Illinois Medicaid, a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Aid to Aged Blind, and Disabled (AABD) Medicaid.
Just For You: The easiest way to find the most current Illinois Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.
Financial Requirements
Illinois residents have to meet an asset limit and an income limit in order to be financially eligible for Nursing Home Medicaid. The asset limit for a single applicant from April 2024 to March 2025 is $17,500, which means they must have $17,500 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The income limit for Illinois Nursing Home Medicaid for a single applicant from April 2024 to March 2025 is $1,255/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Illinois Nursing Home Medicaid recipients are required to give most of their income to the state to help cover the cost of care. They are only allowed to keep $60/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy spouses who are not covered by Medicaid.
For married applicants with both spouses applying from April 2024 to March 2025, the asset limit for Illinois Nursing Home Medicaid is a combined $17,500, and the income limit is $1,703/month combined. For a married applicant with just one spouse applying, the asset limit is $17,500 for the applicant spouse and $129,084 for the non-applicant spouse (as of Jan. 1, 2024), thanks to the Community Spouse Resource Allowance. The income limit is $1,255/month for the applicant, and the income of the non-applicant spouse is not counted.
Plan Ahead: There are alternative pathways to eligibility for Illinois Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Illinois has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for Illinois Nursing Home Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with nursing homes. This is determined through a state assessment and reports from the applicant’s doctors and other relevant healthcare professionals. The assessment will take an into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as any cognitive or behavioral issues.
Financial Requirements
Illinois residents have to meet an asset limit and an income limit in order to be financially eligible for both the Waiver for the Elderly and the Supportive Living Program (SLP). The asset limit for a single applicant for the Waiver for the Elderly from April 2024 to March 2025 is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The income limit for the Waiver for the Elderly for a single applicant from April 2024 to March 2025 is $1,255/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants with both spouses applying from April 2024 to March 2025, the asset limit for the Waiver for the Elderly is a combined $3,000, and the income limit is a combined $1,703/month. For a married applicant with just one spouse applying, the asset limit is $2,000 for the applicant spouse and $129,084 for the non-applicant spouse (as of Jan. 1, 2024) thanks to the Community Spouse Resource Allowance. The income limit is $1,255/month for the applicant, and the income of the non-applicant spouse is not counted.
For the Supportive Living Program (SLP) Waiver, the 2024 asset limit is $17,500. This applies to single applicants and married applicants with both spouses applying. For married applicants with just one spouse applying, the 2024 asset limit is $17,500 for the applicant spouse and and $129,084 for the non-applicant spouse.
The income limit for the Supportive Living Program is unique in that it has both a minimum and a maximum limit. It has a minimum limit to ensure that SLP members can afford to pay for their room and board in the assisted living residence where they receive SLP benefits. The minimum income a single applicant is required to have in 2024 is $943/month, and the minimum for a married couple with both spouses applying is $1,415/month. For a married couple with one spouse applying in 2024, the applicant spouse must have a minimum income of $943/month. The maximum allowed income can be no greater than the amount a supportive living provider would receive for caring for a Medicaid-eligible resident, including room and board and the daily Medicaid rate for care services. The formula to determine this exact amount is complicated and varies by location. To see what the maximum income limit for the SLP program is in your area, consulting with a Certified Medicaid Planner in Illinois is advised.
Plan Ahead: There are alternative pathways to eligibility for Illinois HCBS Waiver applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Illinois has a Look-Back Period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers in Illinois is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. This is determined through a state assessment and reports from the applicant’s doctors and other relevant healthcare professionals. The assessment will take an into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as any cognitive or behavioral issues.
Financial Requirements
Illinois residents have to meet an asset limit and an income limit in order to be financially eligible for Aid to Aged, Blind, and Disabled (AABD) Medicaid. The asset limit for a single applicant from April 2024 to March 2025 is $17,500, which means they must have $17,500 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The income limit for Illinois AABD Medicaid for a single applicant from April 2024 to March 2025 is $1,255/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants from April 2024 to March 2025, the asset limit for Illinois AABD Medicaid is a combined $17,500, and the income limit is a combined $1,703/month. These limits are used for both married couples with both spouses applying for AABD Medicaid and married couples with only one spouse applying.
Plan Ahead: There are alternative pathways to eligibility for Illinois AABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Illinois has a Look-Back Period of five years for Nursing Home Medicaid and Home and Community Based Services Waivers applicants to make sure they don’t give away their assets to get under the limit, there is no Look-Back Period for AABD Medicaid applicants. However, AABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.
Functional Requirements
The only functional requirement to receive basic healthcare coverage through Illinois’ AABD Medicaid is being aged (65 and over), blind or disabled. For AABD Medicaid applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.
One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:
These rules apply to all three types of Medicaid, with one important exception – AABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.
Illinois Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Illinois and how you can protect your home from it, click here.
The first step in applying for an Illinois Medicaid Long Term Care program is deciding which of the three programs discussed above you or your loved one want to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aid to Aged Blind and Disabled (AABD) Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Illinois Medicaid when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Illinois Medicaid applicant. These documents will be needed for the official Illinois Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Illinois residents can apply for Medicaid online at the ABE (Application for Benefits Eligibility) website. They can also apply in person at their local Department of Human Services office. For additional help with the application process, seniors can call the Illinois Department of Human Services hotline at 1-800-843-6154.
For step-by-step guides to applying for each of the three types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) AABD Medicaid.
Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.
After being approved for Nursing Home Medicaid through Illinois Medicaid, seniors have to choose which Medicaid-accepting nursing home best meets their needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes take Medicaid, and those that do might not have any available space. Finding the right nursing home can be difficult and time-consuming, especially if you’re looking in a specific location.
There are approximately 700 nursing homes that accept Medicaid in Illinois. Sixty-five (65) of those facilities are within 10 miles of Chicago, but if you expand that search radius to 25 miles within Chicago, you find more than 200 nursing homes. The other 500 nursing homes are spread throughout the state with larger clusters around the cities. There are roughly 30 nursing homes in and around Peoria, and an about another 30 in the Rockford area. The choices thin as you move further south, with a dozen or so nursing homes in the Springfield area and another dozen around Champaign.
Residents in some Illinois communities regularly cross state lines for personal and business reasons, including healthcare, but Medicaid coverage does not cross state lines. That means someone with Illinois Medicaid would not be covered in a nursing home in St. Louis, Missouri, or Dubuque, Iowa, even if there are more choice in those cities than in the Illinois communities just over the border.
TOOLS: To find a nursing home, Illinois residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country. They can also use this Illinois Department of Health locator.
Once you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can be a great source of information. You can also contact your local Area Agency on Aging to find out more information about nursing homes in the state.
After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? What is the food like? Does it provide transportation? Who are the staff doctors? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.
Data collected by CMS reveals that Illinois nursing homes averaged 33.6 health deficiencies that led to citations from 2019-2022, which is more than the national average of 25.7. Illinois nursing homes also averaged 22.0 fire deficiencies during that same time span, which was more than the nationwide average of 13.5. The CMS data also shows that 32.8% of Illinois nursing home residents reported depressive symptoms, which is almost four times that national average of 8.1%. Considering these statistics, it’s extra important for Illinois residents to do their research before choosing a nursing home. If there aren’t any good options, perhaps a Home and Community Based Services (HCBS) Waiver program, like the Supportive Living Program or Waiver for the Elderly, might work for your long term care.
If you need Medicaid long term care but do not meet the financial eligibility criteria, consider working with a Medicaid Planning professional. These fee-based experts help families structure their finances to become eligible, while streamlining the application process and preserving assets for spouses and family members.
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