Illinois Medicaid Definition
Medicaid in Illinois is commonly called the Medical Assistance Program. The program is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. That being said, this page is focused on Medicaid eligibility, specifically for Illinois residents, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home or in assisted living.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Illinois seniors may be eligible. These programs have slightly different eligibility requirements and benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Illinois offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – is an entitlement (anyone who is eligible will receive assistance) & is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services – Limited number of participants. Provided at home, adult day care or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement (all persons who meet the eligibility requirements are able to receive benefits) and is provided at home or adult day care.
Eligibility for these programs is complicated by the facts that the criteria vary with marital status and that Illinois offers multiple pathways towards eligibility. The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is ineligible or cannot become eligible for Medicaid in Illinois. More.
|2020 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||$1,063 / month||$2,000||Nursing Home||$1,437 / month||$3,000||Nursing Home||$1,063 / month for applicant||$2,000 for applicant & $109,560 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$1,063 / month||$2,000||Help w/2 Activities of Daily Living||$1,437 / month||$3,000||Help w/2 Activities of Daily Living||$1,063 / month for applicant||$2,000 for applicant & $109,560 for non-applicant||Help w/2 Activities of Daily Living|
|Regular Medicaid / Aged Blind and Disabled||$1,063 / month||$2,000||None||$1,437 / month||$3,000||None||$1,437 / month||$3,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, 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.
When only one spouse of a married couple is applying for institutional Medicaid or home and community based services via a Medicaid waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. In the situation where one spouse of a married couple is applying for regular Medicaid, income of the applicant spouse and the non-applicant spouse is considered together. This means the income of the non-applicant spouse is counted towards the income eligibility of his / her spouse. For more information on how Medicaid calculates income for eligibility purposes, click here.
For non-applicant spouses of nursing home Medicaid or HCBS Medicaid waiver applicants, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which they are entitled. In 2020, the MMMNA in IL is $2,739 / month, which means applicant spouses are able to transfer their income, or a portion of their income, to their non-applicant spouses to bring their monthly income up to this level. This rule allows Medicaid applicants to transfer income to their non-applicant spouses to ensure they have sufficient funds with which to live. For clarification purposes, there is no spousal income allowance for married couples with just one spouse applying for regular Medicaid.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in it and the home equity value is under $595,000 (in 2020).
For married couples, as of 2020, the community spouse (the non-applicant spouse of a nursing home Medicaid applicant or a Medicaid waiver applicant) can retain up to a maximum of $109,560 of the couple’s joint assets, as the chart indicates above. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA). As with the MMMNA, the asset spousal allowance does not extend to married couples with one spouse seeking regular Medicaid benefits.
One should be aware that Illinois has a Medicaid Look-Back Period, which is a period of 60 months that dates back from one’s Medicaid application date. During this time frame, Medicaid checks to ensure no assets were sold or given away under fair market value. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will ensue.
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 – In a nutshell, one may still be eligible for Medicaid services even if they are over the income limit if they have high medical bills. In Illinois, this program is often called a “spend down” program. The way this program works is one’s “excess income,” (the income over the Medicaid eligibility limit) is used to cover medical bills, such as medical care/treatment/supplies, Medicare premiums, and prescription drugs. Illinois has a one-month “spend-down” period, so once an individual has paid his or her excess income down to the Medicaid eligibility limit for the month, he or she will qualify for Medicaid for the remainder of the month.
Unfortunately, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirement for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in “spending down” extra assets. However, one can “spend down” assets by spending excess assets on non-countable ones, such as home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt.
2) 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 persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Illinois Medicaid Programs
While in all states, Medicaid will pay for nursing home care, Illinois also offers Medicaid waivers, 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 – This waiver provides limited support to help seniors remain living at home. Benefits may include adult day care, homemaker assistance, and medical alert services.
3) Illinois Community Care (CC) – The CC Program has slightly different financial eligibility criteria then the other programs. Available to both Medicaid and non-Medicaid residents of IL, this program provides many of the same in-home benefits as the other programs.
4) HealthChoice Illinois – A managed care program for Medicaid and Medicare recipients. Via HealthChoice IL, a variety of services are available. These may include lab work, medical supplies, home health care, assistance with daily living activities, and more.
5) 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. At the time of this writing, this program is not available statewide.
How to Apply for Illinois Medicaid
There are a variety of ways in which seniors can apply for Medicaid in Illinois. In addition to applying online at ABE (Application for Benefits Eligibility), persons can apply in person at their local Department of Human Services (DHS) office. To find your local office, 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 prove to be helpful with the application process.
Get more information on how to apply for long-term care Medicaid.