Illinois Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Illinois provides long-term care resources to seniors through its Department of Healthcare and Family Services(DHFS) , Bureau of Long Term Care. Through the DHFS, Illinois has applied for a Section 1115 Demonstration Waiver, to test alternative means of providing support to seniors through Medicaid waiver programs that are not currently in place. The Section 1115 Waiver aims to achieve six goals: 1) Rebalance the behavioral health ecosystem, reducing over-reliance on institutional care and shifting to community-based care; 2) Promote integrated delivery of behavioral and physical health care for behavioral health members with high needs; 3) Promote integration of behavioral health and primary care for behavioral health members with lower needs; 4) Support development of robust and sustainable behavioral health services that provide both core and preventative care to ensure that members receive the full complement of high-quality treatment they need; 5) Invest in support services to address the larger needs of behavioral health members, such as housing and employment services; 6) Create an enabling environment to move behavioral health providers toward outcomes- and value-based payments.

In addition to the Section 1115 Demonstration Waiver, the state operates two different home-and-community based (HCBS) Medicaid Waiver programs for seniors over age 65 who would require nursing home care but choose to remain in their own home or community. The DHFS oversees these waiver and provides resources about each program on its website.

Further, theIllinois Department on Aging oversees the state’s resources for seniors looking for information on long term care. These can be accessed by contacting the local Area Agency on Aging.

Medicaid Waiver Programs for Assisted Living and In Home Care

Illinois Supportive Living Program Medicaid Waiver (HCBS SLP Waiver)

The Illinois Supported Living Program (SLP) is administered by the Department of Healthcare and Family Services. The SLP waiver is specifically for assisted living facilities and the goal is to provide an environment that participants may feel more comfortable in than a nursing home facility, while still being able to access the services provided by a nursing home.

Services

Services includedin the SLP waiver: Apartment-style housing with the following with the following resources included: Meals and snacks; Medication oversight; Personal care; Social/recreational programming; Health promotion & exercise programming; 24-hour response/security staff; Emergency call system; Laundry; Housekeeping; Maintenance; Well-being check; and Ancillary services

Eligibility

  1. Health: An applicant must require a nursing home level of care, as determined by an assessment during the applicant process.
  2. Financial: As a 209(b) state, Illinois as strict income and asset limits that are required for financial eligibility. For 2017, the SSI level of incomeis $735 for an individual or $1,103 for an individual with a spouse who is eligible as well. The resources and allowances for the spouse of an applicant (the “community spouse”) follow the federal SSI and Spousal Impoverishment Standards. For 2017, the community spouse is allowed to keep $120,900 in assets (CSRA), and receive a maximum monthly maintenance needs allowance of $3,022.50 (MMMNA) for monthly living expenses.

Practical Considerations

Applicants can contact the Bureau of Long Term Care by phone at (217) 524-7245. There is a limited number of slots for this program, and the strict requirements for income eligibility because of Illinois status as a 209(b) state make it difficult to qualify for Medicaid.

Illinois HCBS Waiver for Persons who are Elderly (Elderly Waiver)

Persons who are Elderly Waiver is administered by the Illinois Healthcare and Family Services (HFS),the State Medicaid Agency, and administered by the Illinois Department on Aging (DoA), component of the Aging Community Care Program (CCP).

Services

Services includedin the Elderly Waiver, in addition to regular Medicaid benefits are: 1) In Home Service (Homemaker) - services consisting of general household activities (meal preparation and routine household care) and personal care provided by a trained home care aide, when the individual regularly responsible for these activities is unable to manage the home and care for himself or herself; 2) Adult Day Service - provides direct care and supervision in community-based setting for the purpose of providing personal attention, and promoting social, physical and emotional well being in a structured setting; and 3) Emergency Home Response Service - a 24-hour emergency communication link to assistance outside the participant's home for participants based on health and safety needs and mobility limitations.

Eligibility

  1. Health: An applicant must require a Nursing Home Level of Care.
  2. Financial: As a 209(b) state, Illinois as strict income and asset limits that are required for financial eligibility. For 2017, the SSI level of incomeis $735 for an individual or $1,103 for an individual with a spouse who is eligible as well. The resources and allowances for the spouse of an applicant (the “community spouse”) follow the federal SSI and Spousal Impoverishment Standards. For 2017, the community spouse is allowed to keep $120,900 in assets (CSRA), and receive a maximum monthly maintenance needs allowance of $3,022.50 (MMMNA) for monthly living expenses.

Practical Considerations

Illinois administers two different home-and-community based waiver programs: 1) the Supported Living Waiver (SLP) and 2) the Elderly waiver, which means that there are more than one pathway for long-term Medicaid-funded care services. However, the SLP waiver is specifically for those who choose to either move from a nursing home or their own home into an assisted living facility and might not be the right option for everyone. Additionally, as of 2014 there was a waitlist of nearly 30,000 people. Further, thefinancial requirements as a 209(b) state make it harder to use a trust to qualify for the strict income limits, however, as a “medically-needy” state, there is some room for utilizing a specialist to help assist in becoming eligible as soon as possible if that is the option you want.

Conclusion

Given that the strict financial requirements for Illinois make it harder for an applicant to use medicaid planning to structure finances to meet the income and resource limits, as well as the long waitlist for services, make Illinois a sub-optimal state for receiving long-term care Medicaid waiver services. Additionally, the strict financial requirements as a 209(b) state mean the income limit is significantly lower, $745 for 2017, than most states, and even though the state allows spenddown for “medically-needy” persons, it would require significant medical expenses along with the help of a Medicaid Planning specialist to ensure you can meet the financial requirements.