When an Illinois Medicaid recipient becomes Medicaid-eligible and enters a nursing home or long-term care facility, their care will be fully covered by the State of Illinois. However, most monthly income, including Social Security and pensions, must be turned over to the skilled nursing facility. This payment to the nursing home can be thought of as a co-pay to contribute to the cost of care. When Social Security payments are raised yearly for the cost-of-living adjustment, the co-pay amount increases accordingly.
Nursing home residents in Illinois are permitted to keep $60.00 per month out of their income as a personal needs allowance (PNA). This monthly personal needs allowance can be used for things like snacks, toiletries, haircuts, and any other small items a nursing home resident might want that are not provided by the facility. Illinois Medicaid recipients are also able to pay healthcare premiums for Medicare and supplemental health insurance plans out of their income before paying the nursing home.
When a Medicaid beneficiary is married, the non-applicant spouse (also referred to as the community spouse) is permitted to keep their own income. In some cases, if the community spouse earns under a certain amount, they are able to keep a portion of the nursing home spouse’s income, which lowers the co-pay to the skilled nursing facility. This ensures that the community spouse does not become impoverished while their family member receives public aid. Fortunately, if a portion of the nursing home resident’s income is granted to the community spouse to live on on a monthly basis, the Medicaid recipient will still receive their personal needs allowance ($60.00 per month) for personal use.
It should be noted that these regulations only apply to full long-term care recipients. Other Illinois Medicaid programs cover intermediate care facilities, supportive living facilities, and residential care in an assisted living facility. Additionally, separate rules apply to home and community-based services (HCBS) for assistance with activities of daily living in the home through Medicaid waivers. Those rules are the subject of other informational entries on this website.