Illinois Supportive Living Program / Medicaid HCBS Waiver

Last updated: April 21, 2021

 

Overview of Illinois’ Supportive Living Program

Illinois’ Supportive Living Program (SLP) provides a Medicaid-funded alternative to nursing home care for elderly and physically disabled residents of IL. Program participants who are at risk of nursing home placement, instead live in a state approved residential setting in which personal care assistance, laundry, housecleaning, and 24-hour staff response is available. “Supportive living” settings include board and care homes, assisted living residences, and memory care units, which provide specialized 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, which means 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 program. In addition to allowing Medicaid-funded program participants, the Supportive Living Program permits persons to privately pay.

 What are 1915(c) HCBS Medicaid Waivers?
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+), or between 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.

 The American Council on Aging now offers a quick and easy Illinois Medicaid eligibility test for seniors. Start here.

 

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 on an annual basis in January. In 2021, this means one must have an income level of $794 / month at a minimum. Married applicants, with both spouses as applicants, must have an income level of $1,191 at a minimum.

When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of his/her 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. The maximum amount that can be transferred in 2021 is $2,739 / month. This spousal allowance is intended to ensure the non-applicant spouse has a minimum monthly income of this amount. Non-applicant spouses who have their own income equal to or greater than $2,739 / 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 is added.

Example 1: Regular Supportive Living Program Unit in Chicago – Medicaid-funded daily rate of $108.59 (as of April 2021)

$108.59 daily rate x 30.2 = $3,279.42 + $704 room and board charge (FBR of $794 – $90 personal needs allowance) + $90 personal needs allowance = $4,073.42 maximum monthly income limit

Example 2: Dementia Supportive Living Program Unit in Chicago – Medicaid-funded daily rate is $137.91 (as of April 2021)

$137.91 daily rate x 30.2 = $4,164.88 + $704 room and board charge (FBR of $794 – $90 personal needs allowance) + $90 personal needs allowance = $4,958.88 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 $505.50 / month. (FBR of $1,191 ÷ 2 = $595.50 – $90 personal needs allowance = $505.50).

There is no maximum income limit for private pay beneficiaries.

 

Assets
In 2021, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000.

When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are limited, though the non-applicant spouse is allocated a larger portion of the assets to prevent spousal impoverishment. (Unlike with income, Medicaid considers the assets of a married couple to be jointly owned). In this case, the applicant spouse can retain up to $2,000 in assets and the non-applicant spouse can keep up to $109,560. 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. This is because Medicaid has a look back rule and violating it results in a penalty period of Medicaid ineligibility.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our free spend down calculator.  

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take their home. Fortunately, 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 to the home and his / her home equity interest is no greater than $603,000. Home equity interest is the current value of the home minus any outstanding mortgage.
– 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 his/her live-in caregiver for two years immediately preceding the move to a facility. This is called the caregiver child exemption.

To learn more about the potential of Medicaid taking the home, click 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, eating) 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.

 For more information about long-term care Medicaid in Illinois, click here

 

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 annuities that turns 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 the state of 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 12,600 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.

For additional information about the Supportive Living Program, click here. Persons can also contact the Department of Healthcare and Family Services, Bureau of Long Term Care at 844-528-8444 or 217-782-0545 for information and / or assistance. Persons can find SLP providers by county 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 even further. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, despite the law, applications are sometimes delayed even further. Furthermore, as wait-lists may exist, approved applicants may spend many months waiting to receive benefits.

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