Waiver Description
The Illinois Medicare-Medicaid Alignment Initiative (MMAI) is a managed care program for individuals who are eligible for both Medicaid and Medicare (referred to as “dual eligibles”).
MMAI combines both medical care and non-medical home and community-based services into a single program. Therefore, traditional health care services such as hospital care, prescriptions, behavioral health and mental health are combined with non-medical supports such as adult day care, personal emergency response systems, personal care assistance, homemaker and chore services.
Currently, there are five managed care plans from which to choose:
- Aetna Better Health Premier Plan
- Blue Cross Community MMAI
- Humana Health Plan
- Meridian Complete
- Molina Healthcare
To find out the availability of plans by county, click here.
MMAI is operated by the Illinois Department of Healthcare and Family Services.
Eligibility Guidelines
General Requirements
To be eligible for the Medicare-Medicaid Alignment Initiative, one must meet the following criteria:
- An Illinois resident who is at least 21 years old.
- Elderly or disabled.
- Enrolled in both Medicaid and Medicare Parts A, B and D.
Financial Requirements
For seniors, age 65 and older, there are both income and asset limits to be eligible for Medicaid.
Income Limits
As of 2024, the income limit for an aged, blind, or disabled individual is set at 100% of the Federal Poverty Level (FPL). This is equivalent to $1,255 / month for an individual applicant or $1,703 for a couple when both spouses are applying.
When only one spouse is applying, the non-applicant’s income is not counted toward eligibility. Additionally, the applicant spouse may be able to transfer up to $3,853.50 a month (in 2024) to the non-applicant spouse, which is referred to as a spousal income allowance. If the non-applicant spouse already has monthly income equal to or above this figure, a transfer of income is not permitted.
Asset Limits
The asset limit is set at $17,500 for both an individual and a couple. However, several assets are not counted toward this limit. This includes one’s home in which he or she lives, given the equity value is not higher than $713,000, an automobile, funeral and burial plans, among other assets. In addition, for a couple with only one spouse applying, the non-applicant spouse is allowed up to $129,084 in assets.
Over the Financial Limits?
If one is over the asset limit, it is important that assets not be given away or sold for less than they are worth in order to qualify for Medicaid. This is in violation of Medicaid’s 5-year Look Back Period and can result in ineligibility.
If one is over the asset (or income) limit, contacting a professional Medicaid planner is the best course of action. They can help reallocate income and assets in order to meet Medicaid’s limits without violating any laws or regulations.
Benefits and Services
All benefits available through Medicare and Medicaid are accessible through the Illinois Medicare-Medicaid Alignment Initiative. This may include care coordination, doctor visits, hospital stays, prescription drug/over the counter medications, mental health services, hearing / eye services, behavioral health services, laboratory services, dental care, hospice care, emergency/medical transportation, durable medical equipment, medical supplies, nursing home care, 24-hour nurse line, and Home and Community Based Services (HCBS) waiver benefits, such as home health care, adult day care, Personal Emergency Response Systems (PERS), and assistance with Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs), like bathing, personal hygiene, mobility, preparing meals, shopping for essentials, and light housecleaning.
How to Apply / Learn More
Additional information about the Medicare-Medicaid Alignment Initiative can be found on the Illinois Department of Healthcare and Family Services website. One can also call the Illinois Department on Aging at 800-252-8966 for more information.
To enroll, one can call the Medicare-Medicaid Alignment Initiative at 877-912-8880.
