Illinois Medicaid Definition
Medicaid is a jointly funded state and federal health care program for low-income individuals of all ages. This page, however, is focused on Medicaid eligibility for elderly Illinois residents, aged 65 and over. Specifically, long term care is covered. In addition to nursing home care and supported living facilities (assisted living services), Illinois Medicaid pays for non-medical support services to help frail seniors remain living at home or in the home of a loved one.
Medicaid in Illinois is commonly called the Medical Assistance Program. It is administered by the Illinois Department of Healthcare and Family Services and eligibility is determined by the Department of Human Services (DHS).
Income & Asset Limits for Eligibility
There are several Medicaid long-term care programs for which Illinois seniors may be eligible. These programs have varying eligibility requirements and benefits. Further complicating eligibility is that the criteria vary with marital status and that Illinois offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services – These are not entitlement programs; There are a limited number of participants and wait lists may exist. Intended to delay the need for nursing home admissions, services and supports are provided at home, adult day care or in assisted living. More on Waivers.
3) Regular Medicaid / Aid to Aged Blind and Disabled (AABD) – This is an entitlement program; All persons who meet the eligibility requirements are able to receive benefits. Various long-term care benefits, such as personal care assistance or adult day care, may be available.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from an Illinois Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Medicaid in IL. More.
|April 2022 – March 2023 Illinois Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$1,133 / month*||$2,000||Nursing Home||$1,526 / month*||$3,000||Nursing Home||$1,133 / month for applicant*||$2,000 for applicant & $109,560 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$1,133 / month†||$2,000||Nursing Home||$1,526 / month†||$3,000||Nursing Home||$1,133 / month for applicant†||$2,000 for applicant & $109,560 for non-applicant||Nursing Home|
|Regular Medicaid / Aid to Aged Blind and Disabled||$1,133 / month||$2,000||Help with ADLs||$1,526 / month||$3,000||Help with ADLs||$1,526 / month||$3,000||Help with ADLs|
†Based on one’s living setting, a beneficiary may not be able to keep monthly income up to this level. Persons in supported living residences can only retain $90 / month as a personal needs allowance. Income may also go towards Medicare premiums and an income allowance for a non-applicant spouse (if applicable).
What Defines “Income”
Any income that a Medicaid applicant receives is counted. This income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. An exception exists for Holocaust restitution payments and Covid-19 stimulus checks, which do not count as income, and therefore, have no impact on Medicaid eligibility.
When only one spouse of a married couple applies for Institutional Medicaid or a Medicaid Waiver, only the income of the applicant is counted. This means the non-applicant spouse’s income is disregarded and does not impact their spouse’s income eligibility. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse to prevent spousal impoverishment. Specific to IL, it is called a Community Spouse Maintenance Needs Allowance (CSMNA). In 2022, the CSMNA is $2,739 / month. If a non-applicant spouse has monthly income under this amount, income can be transferred to them from their applicant spouse, bringing their monthly income up to $2,739 / month. A non-applicant spouse who already has a monthly income of $2,739 or more is not entitled to a CSMNA / spousal income allowance.
Income is counted differently when only one spouse applies for Regular Medicaid / Aid to Aged Blind and Disabled; The income of both the applicant spouse and non-applicant spouse is calculated towards the applicant’s income eligibility. For more information on how Medicaid calculates income for eligibility purposes, click here.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, IRAs, credit union, savings, and checking accounts, and real estate in which one does not reside. There are also many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and generally one’s primary home. For home exemption, the Medicaid must live in their home or have intent to return, and in 2022, their home equity interest must be no more than $636,000. Equity interest is the value of the home in which the Medicaid applicant owns. If a non-applicant spouse lives in the home, it is exempt regardless of where the applicant spouse lives and their equity interest in the home.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, the non-applicant spouse of an Institutional Medicaid or Medicaid Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain up to $109,560 of the couple’s joint assets, as shown in the chart above.
Illinois has a Medicaid Look-Back Period, which is 60 months that immediately precedes one’s Medicaid application date. During this period, Medicaid checks to ensure no assets were gifted or sold under fair market value. If this has been done, the Medicaid agency assumes it was done to meet Medicaid’s asset limit. Violating the look-back rule results in a penalty period of Medicaid ineligibility.
Qualifying When Over the Limits
For Illinois residents, 65 and over, who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – Illinois has a spenddown program for seniors who have income over Medicaid’s income limit. This program allows persons to become income-eligible for Medicaid services by spending the majority of their income on medical bills. This may include medical care/treatment/supplies, nursing home services, in-home personal care, Medicare premiums, and prescription drugs. Effective April 2022 – March 2023, the medically needy income limit (MNIL) in IL is $1,133 / month for an individual and $1,526 / month for a couple. The “spenddown” amount is the difference between one’s monthly income and the MNIL. It can be thought of as a deductible. The state also allows the option of a pay-in spenddown, which allows one to may their monthly spenddown directly to the IL Department of Human Services. Once one has met their “spenddown”, they are Medicaid eligible for the remainder of the month. The medically needy asset limit is $2,000 for an individual and $3,000 for a couple.
2) Asset Spend Down – Seniors who have assets over Medicaid’s asset limit can reduce their countable assets by “spending down” extra assets for Medicaid qualification. This can be done by spending countable assets on non-countable ones, such as making home modifications (i.e., installing wheelchair ramps or stair lifts), prepaying funeral and burial expenses, and paying off debt. Remember that assets cannot be gifted or sold under fair market value, as it violates Medicaid’s look back rule. When “spending down”, it is best to keep documentation of how assets were spent as evidence the look back period was not violated.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, yet they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s estate recovery program. Read more or connect with a Medicaid planner.
Specific Illinois Medicaid Programs
While Medicaid will pay for nursing home care in all states, Illinois Medicaid also offers other long-term care programs, which provide for “home and community-based services” (HCBS).
1) Waiver for Supportive Living Facilities – This waiver provides support for disabled or frail, elderly persons in “supportive living facilities”, which are less formally called assisted living residences. This includes memory care for persons with Alzheimer’s disease and other dementias.
2) HCBS Waiver for the Elderly – Also called the Persons who are Elderly Waiver, this program provides limited support to help seniors remain living at home. Benefits may include adult day care, homemaker assistance, and medical alert services.
3) Medicaid Managed Long Term Services and Supports (MLTSS) – Part of the HealthChoice Illinois Program, MLTSS is a managed care program for “dual eligible” persons. Dual eligible means one is a recipient of both Medicaid and Medicare. Via MLTSS, a variety of services are available. These may include transportation to medical appointments, home modifications, assistance with daily living activities, adult day care, assisted living services / memory care services, and more. Program participants continue to receive their Medicare benefits through Medicare.
4) Illinois Medicaid-Medicare Alignment Initiative (MMAI) – Also for individuals who are dually eligible for Medicaid and Medicare, this is a managed care program that streamlines both program benefits. Home and community based services, both medical and non-medical, are available. Benefits may include physician & dental visits, adult day care, personal care assistance, meal preparation, and housecleaning.
How to Apply for Illinois Medicaid
Seniors can apply for Illinois Medicaid online at ABE (Application for Benefits Eligibility) or in person at their local Department of Human Services (DHS) office. To find local offices, click here. Seniors can also call the Illinois Department of Human Services (IDHS) customer service hotline at 1-800-843-6154 for additional program information or for application assistance. One’s local Area Agency on Aging office may also be helpful with the application process.
Get more information on how to apply for long-term care Medicaid.