Overview of FIDE SNPs
Illinois’ Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) provides long-term services and supports for elderly and disabled adults who are “dually eligible” for Medicaid and Medicare. While nursing home care is an available benefit, Home and Community Based Services (HCBS) are also available to delay and prevent unnecessary nursing home admissions. Intended to promote independence and allow persons to live at home, the home of a relative, a supportive living facility (similar to an assisted living residence), or potentially an adult foster care home, HCBS may include personal care assistance, homemaker services, personal emergency response systems, home modifications for safety and accessibility, and adult day care.
FIDE SNP, a special type of Medicare Advantage plan, combines the delivery of medical, behavioral health, and long-term care Medicaid benefits and Medicare benefits, including prescription drug coverage, via one managed care plan. The plan is essentially a private healthcare company, with its own a network of care providers through which program participants receive services and supports. Within Illinois, there are four managed care plans from which to choose. While many long-term care Medicaid programs have a participant-directed option, allowing beneficiaries to hire the caregiver of their choosing, FIDE SNP does not.
The Fully Integrated Dual Eligible Special Needs Plan is available statewide and is a voluntary Medicaid program for persons who require long-term care and meet the eligibility criteria. However, eligible IL residents who do not enroll in a FIDE SNP, must enroll in the Managed Long Term Services and Supports (MLTSS) Duals Specialty Program. However, unlike FIDE SNP, through which program participants receive Medicare, prescription drug, and Medicaid benefits via one plan, with MLTSS, only Medicaid benefits are received. Medicare benefits continue to be received via Medicare.
Both FIDE SNP and the MLTSS Duals Specialty Program are entitlement programs, which means meeting eligibility requirements equates to immediate receipt of program benefits. Put differently, neither programs limit the number of participant enrollment slots and there is never a waitlist for program participation.
The Fully Integrated Dual Eligible Special Needs Plan replaced a previous IL Medicaid program, the Medicare-Medicaid Alignment Initiative (MMAI), eff. Jan. 1, 2026. The Illinois Department of Healthcare and Family Services (HFS) and the Centers for Medicare and Medicaid Services (CMS) jointly operate this program. Medicaid benefits are overseen by HFS and Medicare benefits are overseen by CMS.
Benefits of the FIDE SNPs
Follows is a list of potential benefits available via FIDE SNP. An individual care plan determines which long-term care services and supports a program participant receives. Meeting program requirements does not guarantee receipt of all listed benefits.
– 24/7 Nurse Line
– Adult Day Care / Adult Day Service – transportation to / from the facility may be provided
– Behavioral Health Services
– Care Coordination
– Dental Services
– Durable Medical Equipment
– Hearing Services
– Home / Vehicle Modifications
– Home Health Care
– Homemaker Services
– Hospice Care
– Hospitalization
– Laboratory Tests / X-Rays
– Medical Supplies
– Mental Health Services
– Nursing Home Care
– Personal Care Assistance
– Personal Emergency Response Systems – includes installation and monthly service fees
– Physician Visits
– Prescription Medications
– Transportation – non-emergency medical
– Vision Services
Medicaid will also help to pay for Medicare premiums, as well as out-of-pocket expenses (cost sharing) for Medicare Part A & Part B.
Eligibility Requirements for Illinois FIDE SNPs
The Fully Integrated Dual Eligible Special Needs Plan is for Illinois residents (21+ years old) who are disabled or elderly and enrolled in Medicaid and Medicare (Parts A and B). Additional eligibility criteria for Medicaid long-term care follows. Alternatively, one can take a quick, non-binding IL Financial Medicaid Eligibility Test.
Financial Criteria: Income, Assets & Home Ownership
Income
The applicant income limit is equivalent to 100% of the Federal Poverty Level (FPL), which increases annually in January. Specific to Illinois Medicaid, the program income limits increase in April. Effective 4/1/26 – 3/31/27, an individual applicant can have a monthly income up to $1,330. For a married couple, with both spouses as applicants, the monthly income limit for the couple is $1,803. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Only the applicant spouse’s income is considered, which is limited to $1,330 / month. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance (MMNA).
In IL, in 2026, the MMNA is $4,066.50 / month. If a non-applicant spouse’s monthly income falls under this amount, income can be transferred to them from their applicant spouse to bring their income up to this amount. Non-applicant spouses who have their own income equal to or greater than $4,066.50 / month are not entitled to a Spousal Income Allowance.
Assets
In 2026, the asset limit is $17,500 for a single applicant, as well as for married couples with both spouses as applicants. When only one spouse is an applicant, the assets of both spouses are still limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can retain up to $17,500 in assets and the non-applicant spouse can keep up to $143,172. This larger allocation of assets to the non-applicant spouse is called a Community Spouse Resource Allowance.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, Illinois Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has “Intent” to Return, and in 2026, their home equity interest is no more than $752,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse that lives in the home.
– The applicant has a disabled or blind adult child that lives in the home.
– The applicant has a child under 21 years old that lives in the home.
While the home is likely exempt while one is receiving Medicaid benefits, it may not be safe from Medicaid’s Estate Recovery Program. Learn more about the potential of Medicaid taking the home.
Medical Criteria: Functional Need
An applicant must require a Nursing Facility Level of Care (NFLOC) in order to receive nursing home care or Home and Community Based Services via a FIDE-SNP Plan. A needs assessment to determine one’s level of care requirement is completed by a Community Care Unit (CCU) contracted by the state. The tool used is the Determination of Need (DON). To assess functional needs, one’s ability / inability to independently complete the Activities of Daily Living (i.e., transferring from the bed to a chair, mobility, eating, toileting, bathing) and Instrumental Activities of Daily Living (i.e., housework, laundry, preparing meals) is considered. A Mini-Mental Status Examination (MMSE) considers one’s cognitive functioning, such as sense of awareness and memory, which is relevant for persons with Alzheimer’s disease or a related dementia. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
While Illinois has a Spenddown Program that permits Medicaid applicants to spend “excess” income on medical expenses in order to meet Medicaid’s income limit, the Fully Integrated Dual Eligible Special Needs Plan prohibits persons from qualifying via this avenue.
When persons have assets over the limits, Irrevocable Funeral Trusts are an option. These are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Another option are Medicaid-Compliant Annuities that turn countable assets into a stream of income. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Illinois to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, there are additional planning strategies that not only help one meet Medicaid’s financial criteria, but can also protect assets from Medicaid’s Estate Recovery Program, preserving assets for family as inheritance. For example, some states allow Lady Bird Deeds, a type of life estate deed that protects one’s home from Estate Recovery by automatically transferring the home to a beneficiary upon the death of the Medicaid enrollee. Unfortunately, this strategy cannot be used in Illinois. However, a Medicaid Planner can assist with an alternative option. These planning strategies often violate Medicaid’s 60-month Look-Back Rule, and therefore, should be implemented well in advance of the need for long-term care. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Certified Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s).
How to Apply for FIDE SNPs
Before You Apply
Prior to submitting an application for IL Medicaid (and enroll in a FIDE SNP once approved), applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Financial Medicaid Eligibility Test to determine if one might meet the criteria.
As part of the application process, applicants need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. A common reason applications are held up is required documentation is missing or not submitted in a timely manner.
Application Process
To enroll in a FIDE SNP plan, one must first apply for IL Medicaid. One can apply online via the ABE (Application for Benefits Eligibility) portal or in-person via their local Department of Human Services’ Family Community Resource Center (FCRC). For assistance in locating one’s local office, one can call the Department of Human Services Helpline at 1-800-843-6154. As part of the application process, the Department on Aging will arrange an in-person needs assessment to determine if the Nursing Home Level of Care need is met.
Dually eligible persons already enrolled in Medicaid who meet the eligibility criteria for FIDE SNP can go to Medicare.gov and click on “Find Plans”. Make sure to look for Medicare Advantage Plans (Part C), which can be found by zip code. When asked “Do you get help with your Medicare health or drug costs”, mark the section for Medicaid. Alternatively, persons can call 1-800-633-4227 (1-800-MEDICARE).
There are four available FIDE SNP Managed Care Plans: Aetna Medicare FIDE (1-866-600-2139), Humana Dual Fully Integrated (1-800-787-3311), Molina Medicare Complete Care Plus (1-877-901-8181), and Wellcare Meridian Dual Align (1-844-536-2180). To learn more about each plan, one can contact the managed care plan directly. Additionally, persons can enroll by calling the managed care plan.
Approval Process & Timing
The Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.