Overview of Illinois’ Supportive Living Program
Illinois’ Supportive Living Program (SLP) provides a Medicaid-funded alternative to nursing home care for IL residents who are elderly or physically disabled and are at risk of nursing home placement. To delay or prevent the need for nursing home care, program participants live in state approved residential settings, called supportive living facilities or supportive living communities. These facilities are similar to assisted living residences and provide personal care assistance, laundry, housecleaning, and 24-hour staff response. Some facilities provide specialized care (often called memory care) for persons with Alzheimer’s Disease or a related dementia. Room and board is not covered by SLP; program participants are responsible for paying this.
Many long-term care Medicaid programs allow program participants the option of self-directing their own care, specifically hiring the caregiver of their choosing. Unfortunately, this option is not available via SLP.
SLP is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. Instead, the Waiver has a limited number of participant enrollment slots, and when these slots are full, a waitlist for program participation forms.
The Supportive Living Program is a 1915(c) HCBS (home and community based services) Medicaid Waiver. In addition to allowing Medicaid-funded program participants, the Supportive Living Program permits persons to privately pay.
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a Nursing Home Level of Care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.
Benefits of the Supportive Living Program
Follows is a list of the benefits available via the Supportive Living Medicaid Waiver.
– Case Management
– Dementia Care (in specific settings)
– 24-Hour Staff Availability / Security
– Housekeeping
– Laundry
– Meals / Snacks
– Medication Management
– Nursing Care – on an intermittent basis
– Social / Recreational / Health Activities
– Personal Care Assistance
– Personal Emergency Response Systems
Room and boards costs are the responsibility of program participants.
Eligibility Requirements for Illinois’ Supportive Living Program
The SLP Waiver is for Illinois residents who are elderly (65+ years old), or between the ages of 22 and 64 and physically disabled, and at risk of nursing home placement. Persons cannot require 24-hour skilled nursing care, must test negative for tuberculosis, and cannot be enrolled in another HCBS Medicaid Waiver, such as the Persons who are Elderly Waiver. Additional eligibility criteria follow.
Financial Criteria: Income, Assets & Home Ownership
Income
The income requirement for the SLP is unique in that rather than an income limit, an applicant must have income NO LESS than a specific amount. For a single applicant, this income level is equivalent to 100% of the Federal Benefit Rate (FBR), which increases annually in January. In 2024, this means an individual must have a minimum income of $943 / month. Married applicants, with both spouses as applicants, must have a minimum income of $1,415 / month.
When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. 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).
The MMNA is said to be the minimum amount of monthly income a non-applicant spouse requires to avoid spousal impoverishment. In IL, in 2024, the MMNA is $3,853.50 / month. If a non-applicant spouse’s monthly income falls under this amount, income can to transferred to them from their applicant spouse to bring their income up to $3,853.50. Non-applicant spouses who have their own income equal to or greater than $3,853.50 / month are not entitled to a Spousal Income Allowance.
Program participants must contribute all of their monthly income, with the exception of $90 / month as a Personal Needs Allowance, to the supportive living provider to cover room and board. This is why there is a minimum income limit. Remember, Medicaid won’t pay for room and board.
For Medicaid to pay for care services, an applicant’s monthly income cannot exceed what a supportive living provider would receive for a Medicaid-eligible resident. This includes the room and board portion paid by the program participant and the daily Medicaid rate for care services. The formula to calculate the maximum income limit is not straightforward. Based on the region of Illinois in which one lives, the daily rate for calculation varies, with the rate for dementia care higher than for traditional care. When calculating the limit, the daily Medicaid rate in one’s area is multiplied by 30.2 days and then the cost of room and board and a $90 Personal Needs Allowance (PNA) is added.
– Example 1: Regular Supportive Living Program Unit in Chicago – Medicaid-funded daily rate of $140.51 (eff. Jan. 2024)
$140.51 daily rate x 30.2 = $4,243.40 + $853 room and board charge (FBR of $943 – $90 PNA) + $90 PNA = $5,186.40 maximum monthly income limit
– Example 2: Dementia Supportive Living Program Unit in Chicago – Medicaid-funded daily rate is $206.32 (eff. Jan. 2024)
$206.32 daily rate x 30.2 = $6,230.86 + $824 room and board charge (FBR of $943 – $90 PNA) + $90 PNA = $7,144.86 maximum monthly income limit
Program beneficiaries who share a room do not have to contribute more than half of the current FBR for a married couple minus a Personal Needs Allowance of $90 towards room and board. This brings the room and board cost to $617.50 / month. (FBR of $1,415 ÷ 2 = $707.50 – $90 PNA = $617.50).
There is no maximum income limit for private pay beneficiaries.
Assets
In 2024, 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 the applicant and non-applicant spouse 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 $129,084. This larger allocation of assets to the non-applicant spouse is called a Community Spouse Resource Allowance and is intended to prevent spousal impoverishment.
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. This is because 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) for beneficiaries of the Supportive Living Program in the following circumstances.
– The applicant has “Intent” to Return home, and in 2024, their home equity interest is no greater than $713,000. 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.
– The applicant has an adult child that lives in the home and served as their live-in caregiver for two years immediately preceding the move to a facility. This is called the Caregiver Child Exemption.
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 here.
Medical Criteria: Functional Need
An applicant must require a Nursing Facility Level of Care (NFLOC). For the SLP Waiver, a Determination of Need (DON) is completed by the Department of Human Services (DHS) Division of Rehabilitation Services or a care coordination unit contracted by the Department on Aging (DoA). 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) 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.
Illinois has a Medically Needy Medicaid Program for applicants who have high medical expenses relative to their income. Also known as a “spend down” program, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s income limit. For the Supportive Living Program, a beneficiary also pays the supportive living provider the private pay rate during the “spend down”. The amount that must be paid each month can be thought of as a deductible. Once one’s “deductible” has been met for the month, the Supportive Living Program will pay for care services and supports.
When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts 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 for family as inheritance. These 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 Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
How to Apply for Illinois’ Supportive Living Program
Before You Apply
Prior to submitting an application for the Illinois Supportive Living Program, 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 free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.
As part of the application process, applicants will 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. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.
Since the SLP Waiver is not an entitlement program, there may be a waitlist for program participation. The program is approved for a maximum of approximately 14,099 beneficiaries each year. In the case of a waitlist, it is thought that an applicant’s access to a participant slot is based on the date of Medicaid application.
Application Process
To apply for the SLP Waiver, one must apply for IL Medicaid. This can be done via one’s local Department of Human Services’ Family Community Resource Center (FCRC). One can find their local office here. Alternatively, persons can call the Bureau of Customer Inquiry and Assistance at 1-800-843-6154 to locate one’s local office. A needs assessment will be completed as part of the application process to determine if the Nursing Home Level of Care need is met.
Persons can learn more about the Supportive Living Program here. The Department of Healthcare and Family Services, Bureau of Long Term Care can also be contacted at 844-528-8444 or 217-782-0545 for information and / or assistance. SLP providers by county can be found here. The Illinois Department of Healthcare and Family Services (HFS) administers the SLP Medicaid Waiver.
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. Furthermore, as waitlists may exist, approved applicants may spend many months waiting to receive benefits.