Waiver Description
The Illinois Supportive Living Program provides financial assistance for “supportive” services to help prevent nursing home placement. Seniors receive these services in a state-approved residential setting, such as assisted living, instead of a nursing home, allowing the individual live independently. Program participants must require a nursing home level of care and choose to receive that care in an assisted living environment.
The program pays for the individual’s personal care needs in the facility, but it does not cover the cost of room and board. Individuals are permitted to keep $90 a month of their income as a personal needs allowance.
What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through “Medicaid Waivers,” which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.
Eligibility Guidelines
In addition to being an Illinois resident, one must meet the age, financial, and functional requirements in order to receive benefits through this program.
General Requirements
To qualify for this waiver, the applicant must be 65+ years of age, or if between the ages of 22 and 65, be declared physically disabled by the Social Security Administration. In addition, persons must be assessed and found in need of a nursing home level of care.
- Note: One cannot be participating in any other HCBS Waiver program.
Financial Requirements
Applicants must also meet financial requirements.
Minimum Income Limits
This program is different from most Medicaid waivers when it comes to income limits. It requires the participant to have income that is equal to or greater than the current SSI rate. As of 2024, this figure is $943 / month for a single applicant and $1,415 / month for a married couple. They must also contribute all of their income toward room and board, meals and services, except for a $90 personal needs allowance.
Maximum Income Limits
In order for an applicant to receive financial assistance from this program, his/her income has to be less than what the supportive living facility would receive from a Medicaid-eligible resident. The formula for maximum income varies based on the region in Illinois in which one lives. For example, the daily Medicaid rate is multiplied by 30.2 days, plus the cost of room and board and the $90 personal allowance, which equals the maximum income an applicant can have.
The Supportive Living Program Medicaid rates for 2024 can be found here. Please make note that dementia care is more costly.
The Supportive Living Program also supports private pay clients, which comprises approximately 40% of the program participants. There is no maximum income limit for private pay clients.
Asset Limits
In 2024, the asset limit for a single applicant is $17,500. For a married couple with both spouses applying, the limit remains the same. If one spouse is applying for Medicaid and the other is not, the non-applicant can retain up to $129,084 in assets. (This is referred to as the Community Spouse Resource Allowance.)
Certain assets and property are exempt from the Medicaid accounting of net worth, including the home, a car, and personal property such as furniture and jewelry. Note, the home is only considered an exempt asset if the applicant lives in the home or has intent to live in the home and his/her home equity interest does not exceed $713,000. The home is also exempt if a non-applicant spouse remains in the home.
Over the Financial Limits?
For individuals whose income or assets exceed the limits, there are two options that can help them qualify for Medicaid. Illinois offers Medically Needy Medicaid, which is for persons with very high medical expenses. This program looks at both an applicant’s medical expenses and their income. With this pathway to eligibility, which is also called a “spenddown” program, one’s health care premiums and medical expenses can be deducted from his/her income, effectively lowering his/her countable income. If it is determined that an applicant cannot afford his/her care requirements, he/she will qualify for some Medicaid assistance.
Another option is to work with a Medicaid planning professional to restructure one’s assets and income so that one meets the eligibility requirements. Assets over the limit can be converted from “countable assets” to “exempt assets.” This option has the added benefit of helping families maintain some of their financial resources for future generations. Find assistance applying for Medicaid.
A Word of Caution It is vital that persons do not give away assets or sell them for less than fair market value within 60 months of one’s Medicaid application date. This is because doing so is a violation of the Medicaid look-back period and can result in Medicaid denial.
Benefits and Services
The Supportive Living Waiver provides a variety of services appropriate for individuals residing in assisted living environments. Applicants are assessed individually and the services for which they are eligible are determined. These can include:
- Personal care – Assistance with the Activities of Daily Living (ADLs), such as bathing and grooming.
- Medication administration – Supervision and assistance taking prescription drugs.
- Chore services – Laundry, housekeeping, and other Instrumental Activities of Daily Living (IADLs).
- Social, recreational and physical activities – Provided in or by the supportive living community.
- Personal emergency response – Medical Alert devices and services.
- Around the clock security.
- Skilled nursing – On a temporary basis only.
- Transportation.
The Supportive Living Program does not cover the participant’s room and board expenses.
How to Apply / Learn More
The Supportive Living Program is available to seniors statewide. However, not every county has approved supportive living facilities. Participants may be required to move to a county other than their own to receive care. To find approved facilities by county, click here.
To apply for this waiver, interested individuals should contact the Department of Healthcare and Family Services (HFS), Bureau of Long Term Care at 217-782-0545 or 844-528-8444. One can learn more about the Supportive Living Program here.
