The Medicaid program for Illinois residents covers a variety of healthcare services for low income and low asset Illinoisians. Medicaid eligibility requirements vary from Medicaid program to Medicaid program, but all programs are predicated on a lack of ability to private pay for health insurance and being under the asset limits for countable assets. Illinois Medicaid is managed by the Illinois Department of Healthcare and Family Services, administering the many programs for low-income families, including managing the application process and processing Medicaid applications.
The most applicable programs for Illinois seniors are Medicaid’s home and community based services (HCBS) and nursing home care (in long-term care facilities) and health coverage related to those services. Medicare does not cover these services, such as long-term care, in-home services, and personal care services, so Illinois Medicaid provides these senior services for those who cannot afford them. Under these programs, Medicaid will pay providers and nursing homes directly for those who meet eligibility criteria and achieve enrollment. For those who exceed the applicable income limit, the care recipient is often required to “spend down” a portion of their Social Security and other income as a co-pay before the state provided services begin. For home and community based services, Medicaid will pay the caregiver (or caregiver home care agency). This process involves an HCBS waiver from other services in order to allow the individual to remain in-home. This supportive living program also covers adult day care.
In the case of married couples, when one spouse enters long-term care and requires Medicaid coverage, Illinois Medicaid will set aside a certain amount of assets, which protects the non-applicant spouse (also known as the community spouse) from becoming impoverished. In addition to this community spouse resource allowance, key exempt assets for both married couples and individuals are the primary residence, one vehicle, and personal belongings.
Illinois Medicaid recipients can also receive Medicaid coverage for ancillary care needs, medical expenses, personal care, and some other costs. For individuals who meet Medicaid eligibility requirements but reside in assisted living rather than a nursing home or long-term care facility, Illinois Medicaid provides a waiver program. The program covers personal care, prescription drugs, and other services, but usually does not cover room and board.
Nursing home residents can meet the eligibility requirements for the Qualified Medicare Beneficiary program (QMB). In this case, all Medicare deductibles and co-pays are covered by the state of Illinois. Additionally, Medicare premiums and health insurance premiums can be paid directly from any monthly income due to the nursing home as a monthly co-pay.
In sum, Illinois seniors in need of care, children, pregnant women, and other people with disabilities in need of medical assistance have a variety of Medicaid programs available for a variety of assistance sources for those who meet Illinois Medicaid eligibility requirements. Please contact QMC to learn more about ways to receive assistance for care at home, in assisted living, or in a nursing home today.