Illinois HCBS Medicaid Waiver for Supportive Living Facilities - Financial Support for Assisted Living

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Waiver Description

The Illinois Supportive Living Program provides financial assistance to state residents to help pay for the cost of care services in assisted living. The term “Supportive Living” in the program’s title applies broadly and includes assisted living, board and care homes, and recently, residential memory care (for persons with Alzheimer’s Disease or related dementias). Program participants must be qualified for nursing home care and choose to receive that care in an assisted living environment. The residence provides all the individual's personal care needs, but does not pay for room and board costs. Individuals are permitted to retain $90 / month as a personal needs allowance.

The Supportive Living Program is an Illinois Medicaid program. To avoid confusion, it is worth mentioning that the program is formally referred to as the 1915c Home and Community-Based Services (HCBS) Supportive Living Program waiver.

 Participation in this waiver prevents participation in other Illinois Medicaid Waivers such as the Waiver for the Elderly.

Eligibility Guidelines

One must meet the age, financial, and functional requirements in order to receive the benefits. For elderly applicants, it should be noted that the following guidelines are not comprehensive, but a good guide. To qualify for this waiver, the applicant must be at least 65 years of age and an Illinois resident. If younger than 65, but at least 22 years of age, they must be declared physically disabled by the Social Security Administration. In addition, they must be assessed and found in need of nursing home level care. Finally, they must be financially qualified for Medicaid, which, in Illinois, is also referred to as the Medical Assistance Program.

2018 Supportive Living Program Income Limits
This program is a little unique in that an applicant must have income that is equal to, or greater, than the current SSI rate. As of 2018, this figure is $750 / month for a single applicant and $1,125 / month for a married couple. These figures are the minimum amount of income a resident(s) must receive per month in order to pay their room and board charges (which Medicaid won’t cover) and still receive the $90 personal allowance mentioned above. In addition, in order for an applicant to receive Medicaid services in a supported living facility, their income has to be less than the provider would receive from a Medicaid resident. The formula for maximum income for Medicaid recipients is a bit complicated and varies based on the region in Illinois in which someone lives. For instance, the daily supportive living program Medicaid rate is multiplied by 30.4 days, the room and board cost is added, plus the $90 personal allowance is added, which equals the maximum income an applicant can have.

An example: An applicant lives in Cook County, where the supportive living Medicaid rate is $83.55 / day. Therefore, $83.55 x 30.4 = $2,539 + $660 (this figure is the SSI rate of $750 - $90) + $90 personal allowance = an income limit of $3,289 / month.

Another example: An applicant lives in Jackson County, where the supportive living Medicaid rate is $65.89 / day. Therefore, $65.89 x 30.4 = $2,003 + $660 (this figure is the SSI rate of $750 - $90) + $90 personal allowance = an income limit of $2,753 / month.

To see the Supportive Living Program Medicaid Rates, click here. Please make note, dementia care is more costly.

The Supportive Living Program also supports private pay clients, which comprises approximately 40% of the program participants.  There is no maximum income limit for private pay clients.

2018 Supportive Living Program Asset Limits
The Medicaid asset limit for a single applicant is $2,000. For a married couple, the limit is $3,000, except if one spouse is applying for Medicaid and the other is not. In 2018, in this split-spouse situation, the non-applicant can retain up to $109,560 in assets. (This is referred to as the Community Spouse Resource Allowance). Certain assets and property are exempt from the Medicaid accounting of net worth, including the home, a car, and personal property such as furniture and jewelry. Note, the home is only considered an exempt asset if the homeowner (or their spouse) lives in the home and the home equity value does not exceed $572,000.

Options for Individuals Exceeding the Limits
For individuals whose income or assets exceed the limits, there are two options that can help them qualify for Medicaid. Illinois offers Medically Needy Medicaid, which is for persons with very high medical expenses. This program looks at both an applicants medical expenses and their income. With this pathway to eligibility, one’s health care premiums and medical expenses can be deducted from their income, effectively lowering their countable income. If it is determined they cannot afford their care requirements, then they will qualify for some Medicaid assistance.

Another option is to work with a Medicaid planning professional to re-structure one's assets and income so that one meets the eligibility requirements. Assets over the limit can be converted from "countable assets" to "exempt assets." This option has the additional benefit of helping families maintain some of their financial resources for future generations. Find assistance applying for Medicaid.

 

Benefits and Services

The Supportive Living Waiver provides for a variety of services appropriate for individuals residing in assisted living environments. Applicants are assessed individually and the services for which they are eligible are determined. These can include:

  • Personal care - assistance with the Activities of Daily Living (ADLs), such as bathing and grooming
  • Medication administration - supervision and assistance taking prescription drugs
  • Chore services - laundry, housekeeping, and other Instrumental Activities of Daily Living (IADLs)
  • Social, recreational and physical activities - provided in or by the supportive living community
  • Personal emergency response (PERS / Medical Alert devices and services)
  • Around the clock security 
  • Skilled nursing - on a temporary basis only
  • Transportation

The Support Living Program does not cover the participant’s room and board expenses. Participants are expected to pay for those expenses using Social Security or Supplemental Security Income. Within limits, family members are also permitted to supplement their loved one’s expenses.

 

How to Apply / Learn More

The Supportive Living Program is available to seniors statewide. However, not every county has approved supportive living facilities. Participants may be required to move to a county other than their own to receive care. A list, by county, of approved facilities is available here.

To apply for this waiver, interested individuals should contact the Department of Healthcare and Family Services (HFS), Bureau of Long Term Care. One can learn more about the Supportive Living Program here. One can also call 217-782-0545 or 844-528-8444 for additional information.

Did You Know? Free assistance is available to help Illinois seniors find affordable assisted living residences and also specialized memory care homes. Get help here.