Illinois HCBS Waiver for the Elderly

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 little-known Illinois Waiver for the Elderly exists for individuals who require the level of care typically provided in a nursing home, but who prefer to be at home instead. This program provides adult day care services during daytime hours and provides for a personal emergency response service for the home. In addition, the program will pay for homemaker services that help individuals with the instrumental activities of daily living around their place of residence.

Several alternative names for this program may cause confusion and unnecessary research. This waiver is also referred to as the Persons who are Elderly Program, the Aging Community Care Program, or simply the Elderly Waiver.

This program falls into a category of programs called HCBS Waivers, or Home and Community Based Services Waivers. These are popular in the state as individuals prefer to receive care in their home environment and the government saves money by leveraging family caregivers and avoiding high-priced, institutional care.

 Illinois also offers a Medicaid waiver for assisted living.  Read more.

 

Eligibility Guidelines

Illinois residents at least 65 years old must clear tests for functional ability and financial limits. Individuals who have a disability recognized by the Social Security Administration may apply when they are at least 60 years of age. Social workers administer a functional ability assessment to each applicant. Their level of care must be found to require nursing home level care.

The financial criteria can, at first, appear to be the most complicated part of the eligibility requirements. In brief, single seniors cannot have income greater than 100% of the Federal Poverty Level and must have savings, or cash in the bank, totaling less than $2,000. For greater clarity, we examine the limits in four different common family scenarios.

2017 Illinois Medicaid (Medical Assistance Program) Financial Requirements

1) Individual Applicants - The income limit is $1005 / month and the countable resource limit is $2,000. Note that one's home (up to $560,000 in home equity) and primary vehicle (up to a value of $4500) are considered exempt assets in Illinois.

2) Married Applicants with Both Spouses Applying - The income limit is $1,353 / month and the countable resource limit is $3,000. Again, with both a house and a car exempt from this limit.

3) Married Applicants with One Spouse Applying - The income limit for the Medicaid applicant is $1005 / month, the same as the individual limit. The spouse who is not applying for care can continue to work or receive income in their name alone and this will not be counted for the applicant’s eligibility. The asset limit for the applicant is $2,000, while the non-applicant spouse can have up to $109,560 in cash, savings, or other investments, in what is called the Community Spouse Resource Allowance (CSRA).

4) Persons Over these Limits – The state of Illinois allows individuals whose financial resources are over the allowable limits to qualify for Medicaid, if their medical expenses are too high relative to their current income and assets. These are referred to as “Medically Needy” individuals. Depending on the urgency of the need, a benefits planning professional may help to rearrange one's assets into trusts and annuities helping to protect wealth for the spouse or children of the senior and making sure that the applicant becomes eligible for benefits. Learn more about how professional assistance could save money.

 

Benefits and Services

This waiver is intended to prevent the institutionalization of the elderly by providing services to them in their homes. In addition to personal home care, the available services can include:

  • Homemaker services - assistance with instrumental activities of daily living such as laundry, grocery shopping, housekeeping.
  • Adult day care service - social and personal care assistance on weekdays during normal business hours intended to allow the primary caregivers to work.
  • Emergency home response - personal emergency alerts services sometimes abbreviated as PERS.

 

How to Apply / Learn More

A waiting list may exist for services under this waiver.

This program is available statewide across Illinois. There are, however, a maximum number of available slots for this waiver. If that number is reached, qualified individuals will be put on a waiting list for services. This is not a Medicaid entitlement program. Very detailed information is available about this waiver as a PDF download here. This document is not easily understood. 

Get started through the Illinois Department of Human Services application for Medical Assistance. Alternatively, one can learn more through their local Area Agency on Aging. To identify which AAA serves your area, search our directory of AAAs by state and county.