Assisted Living Facilities In Illinois That Accept Medicaid

Requirements For Reporting Abuse

Anyone who suspects abuse, neglect, or financial exploitation of an elderly adult who is living in an assisted living facility may report this suspicion to the Illinois Department of Healthcare and Family Services ALF Complaint Hotline: 226-0768.

If you suspect the assisted living facility or its employees are in violation of the rules and regulations, especially in regards to a residents rights, contact the Regional Long-Term Care Ombudsman Program in your area.

Do Assisted Living Facilities Typically Accept Medicaid

Medicaid will only cover some of the costs of assisted living. But don’t worry, for there are other ways to pay for assisted living as well as different state plans to look into. And here, we discuss the important details about assisted living facilities that accept Medicaid.

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Assisted living is a housing option that offers supportive services to residents that need help with daily activities.

Supportive services typically include personal care, supervision, and some access to nursing care. Assisted living generally provides residents with more independence than nursing homes.

Assisted living is quite expensive, regularly costing over $50,000 annually. So, an important part of planning to move to assisted living is knowing how you will pay for it. Fortunately, there are several available financial aid options to lower personal costs.

When searching for financial assistance, families often wonder whether federal and state programs such as Medicaid cover assisted living costs. The answer is both yes and no.

If you or a loved one is wondering whether assisted living facilities accept Medicaid, the following questions and their answers will help inform your decisions.

Here’s What You’ll Learn:

Medicaid Eligibility For Seniors In Illinois

Seniors in Illinois are subject to maximum income and asset limits to qualify for Medicaid coverage. While a single applicant can’t earn more than $18,755 per year, those coming from a two-person household, whether applying independently or together, are subject to an annual household income limit of $25,268. Assets are counted as well in consideration for Medicaid eligibility. A single applicant can’t own more than $2,000 in countable assets, while applicants in two-person households applying together are limited to $3,000 in countable assets.

2022 Medicaid Income Limits for Seniors in Illinois

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How To Know If Youre Eligible For Medicaid In Illinois

Medicaid eligibility is based on several factors, starting with income. The Illinois Department of Healthcare and Family Services determines legibility if a senior is not receiving Supplemental Security Income. Those that are will get screened for Medicaid with their application for SSI through the Social Security Administration.

In 2022, single applicants for Illinois Medicaid must have an annual pre-tax income of no more than $17,775. A married couple can earn $24,040 a year.

2022 Medicaid Income Limits for Seniors in Illinois

Income Limits*

In addition to these requirements, applicants must:

• Be U.S. citizens or legal aliens
• Need insurance assistant
• Have a documented need for health support and assistance with the activities of daily living.

What Kind Of Long

Some homes specialize in personal care while others specialize in health or nursing care. Others care for residents with all kinds of needs, from help with eating to post-hospital medical care. Since a facilitys name tells you little about the services offered, you should make a personal visit and talk to the administrator.

The administrator may use phrases like skilled nursing facility or intermediate care facility. These terms were created as a result of two government programs â Medicaid and Medicare â that pay bills for a majority of the residents of long-term care facilities. Medicaid pays bills for some low-income people, while Medicare helps pay some bills for eligible persons over the age of 65. These programs classify homes according to the kinds of services offered.

An intermediate care facility is for people who need health services and some nursing supervision in addition to help with eating, dressing, walking or other personal needs. Medicaid may pay for intermediate care but Medicare never does.

A skilled nursing facility is staffed to make round-the-clock nursing services available to residents who require them. In Illinois, the Medicaid program pays for care in a skilled nursing facility if a persons physician says such care is needed and his or her decision is approved by the program.

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Does Medicaid Pay For Memory Care

Though not all communities accept Medicaid, waivers in some states pay for 24-hour dementia care in skilled nursing communities. If a senior chooses to receive care in a memory care community rather than a nursing home, waivers typically dont cover these costs.

For seniors who do choose to receive memory care in a skilled nursing home, waivers usually cover all costs associated with room and board. Under Medicaid policies, seniors must forfeit most of their available income including Social Security checks toward their care and can retain only a small monthly personal allowance. Allowance amounts differ by state but typically are less than $75.

How Do I Find Out If Im Eligible For Medicaid

Eligibility criteria will vary by state. The general requirements are that individuals:

• Spend almost all of existing assets toward care
• Are low-income earners or have medical-related care expenses that exceed income
• Live in the state where they are receiving benefits
• Be a permanent resident or U.S. citizen

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Assistance For Illinoisans Needing Home Health Care

Home health care can include skilled nursing or therapy services, home health aide services like medication management or bathing assistance, and personal care aide services like meal preparation or cleaning. Illinois has several programs that offer payment for home health care services.

First, if you receive AABD Medical, the program will pay for some limited home care services. The services must be prescribed by your doctor as part of a plan of care for a particular problem, and the services must be directed at curing or rehabilitating you. AABD Medical will not pay for services that you might need on a long-term basis like housekeeping, but it will pay for services provided by a home health care agency, a physical therapist, speech therapist, or an occupational therapist.

If you are a disabled individual under 60, then you may qualify for Illinois’ Persons With Disabilities program. The program pays for home health services like a personal assistant, therapy or nursing in your home, delivered meals, and housekeeping. To qualify, you must have a needs assessment that shows that you are at risk of being placed in a nursing home without these services. Illinois operates a similar program for adults suffering from brain injuries. You can obtain more information and apply for the programs online here.

Does Medicaid Pay For Assisted Living

Some but not all states have Medicaid waiver programs that help cover the costs of assisted living. With a waiver, families and seniors can expect help with costs related to medical treatments and personal care services, reducing their overall bill. However, Medicaid often wont cover the total price of room and board in an assisted living community.

In some states, Medicaid can be used to pay for the following:

• Help with ADLs, like toileting, mobility, and dressing
• Home health services, which may be provided in an assisted living community
• Physical, occupational, or speech therapy

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How Does Assisted Living Compare To Memory Care In Illinois

One of the options that can help people care for their loved ones is getting residential care through an assisted living home. These facilities offer housing, meals, support services, and other ancillary services to their residents. Occasionally, these facilities may also host social events to either encourage socialization among residents or promote a healthy lifestyle.

The lack of federal regulation on assisted living communities leaves room for inconsistencies in amenities availability, care quality, facility maintenance, staff training, and community management. This also means that not all assisted living homes in Illinois have memory care special units or trained caregivers to address memory care residents’ special needs.

Dementia care homes are established to address the gap in memory care services. These facilities provide housing, meals, and support services, much like an assisted living institution. However, unlike assisted living homes, Illinois memory care facilities can provide behavioral health services, dementia care treatment, individual and group therapies, supervision, as well as directed care, supervisory care and ancillary services.

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Medicaid is an entitlement program for persons with limited financial means. Medicaid pays for nursing home care when an elderly individual requires it and cannot afford it. 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 or Waiver Funded Services.

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Does Medicare Pay For Nursing Homes

The number one misconception about Medicare is that it will pay for your long-term care, says McDowell. Medicare will only pay for a rehabilitative stay after an acute hospitalization.

Seniors who need care in a skilled nursing facility due to an injury or period of acute illness can receive Medicare coverage to stay in a nursing home for up to 100 days after three nights in a hospital. In addition, the patient must either be making improvements in therapy or require skilled care to prevent a decline in their condition.

A stay in a nursing home comes with the following costs:

• Older adults pay nothing for the first 20 days of a nursing home stay, with Medicare covering the entire bill. This covered nursing home stay is available to seniors after a three-night inpatient stay in a hospital.
• Medicare pays for nearly all nursing home costs for days 21-100 of a nursing home stay, but seniors are responsible for a daily coinsurance. This coinsurance payment is approximately $170.50 per day. This is covered by most Medicare supplement plans.
• After 100 days, Medicare will not pay any nursing home costs.

Medicare also pays for the entirety of hospice and palliative care in a skilled nursing community.

The First Step In Finding The Right Long

Make a list of long-term care facilities in your area that seem to fit the needs and preferences of the person who needs care. The more choices you have, the better your chances of making the best selection. Start with the yellow pages of your phone book. Other possible sources of information are the local health department, senior citizen groups, the local Social Security office, Department of Human Services local office, and your physician, clergyman, relatives and friends. No single individual or group can supply complete information about all possible homes.

No. You can eliminate some by making a few telephone calls to determine whether a home actually provides the kind of care that is needed and, if you are depending on that kind of help, whether the facility participates in Medicare or Medicaid. Be aware that not all facilities will have vacancies for new residents.

Most homes display their licenses and certificates. Never accept someone’s word that certificates exist. Ask to see them and take time to examine them. Be sure they are current. The more important documents include:

When visiting a facility, ask to see the latest state survey report of how it met the state standards set by law.

In addition, the facility also is required to post a list of materials available to the public for inspection. These documents include:

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Moving Into A Senior Living Community

After youve chosen the right community and determined availability, its time for your loved one to move in. The following tips can help make this process as smooth as possible:

• Identify what moving day will look like. How many people will be involved in the moving day process? What items will you bring right away, and how will they fit into the new space? Are you planning on hiring a senior move manager? Considering these questions in advance can help you make a clear plan.
• Bring essential admissions documents and paperwork. These documents include your loved ones Medicare card, all secondary insurance cards, medical paperwork, and a list of emergency contacts. Additionally, bring any legal paperwork, including documentation of power of attorney, a living will, and any Do Not Resuscitate orders.
• Participate in discussions about your loved ones care plan and next steps. Even though your relative is moving, you can still be involved. Ask about when care plan meetings will be and what to expect from staff communication.

Background Checks For Assisted Living

Assisted living facilities in Illinois are required to comply with the Health Care Worker Background Check Act. They cannot hire or retain anyone who has been convicted of committing or attempting to commit one or more of the disqualifying offenses set forth in section 25 of the act. The only exception is if the individual has a waiver granted by the Illinois Department of Public Health .

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Medicaid Supportive Living Program

Medicaid is a jointly funded federal and state program. In Illinois, there is help that pays for care in assisted living through the Illinois Supportive Living Program. To be eligible, your loved one must be accepted to reside in an assisted living facility that works with the program and must go through the preadmission screening. The Supportive Living Program will cover the cost of services in assisted living like laundry, meals, security and transportation and provide a $90 monthly personal allowance. The resident would still need to pay room and board. Your loved one can only apply for Supportive Living Program help if they have income equal or more than the Supplemental Security Income monthly benefit of $841. More on Medicaid here.

Choices for Care

This state program sends care coordinators to evaluate Illinois residents over 60 and determine what needs must be met and whether there is a progressive medical issue like dementia that would require placement in assisted living. Coordinators assess what the best living options are for your loved one. Whether that be staying at home or moving into assisted living, memory care, or a nursing facility. Choices for Care also works with families to identify financial assistance a person is eligible to receive. Screening consultations are free. For more information, find Care Coordination Services in your area here, or visit the Choices for Care program page.

Veterans Affairs

VA Pensions

Illinois Medicaid Patients Will Have 40 New Dementia Care Options

SPRINGFIELD The Illinois Department of Healthcare and Family Services has announced 40 new dementia care sites throughout the state that will be available for Medicaid patients.

Units will start becoming available over the next three years. Many will be ready in 2020, with some being phased in sooner or later. In our area, the apartments will be located in Franklin, Jackson, and Jefferson counties.

They are part of the Supportive Living Program , an HFS Medicaid alternative to nursing home care designed for older persons and persons with physical disabilities. The goals of SLP include encouraging independence and community involvement, along with promoting privacy and dignity.

SLP residents have their own apartment, decide which program services they will receive and determine their own schedule. Services include meals, housekeeping, laundry, medication management, assistance with activities of daily living, social and health promotion activities, emergency call systems, well-being checks and routine nursing assessments.

Residents in a dementia care setting receive increased oversight by staff and additional nursing assessments and are provided opportunities for more activities, all in a community setting.

Without the programs dementia care settings, many residents with moderate dementia would have to transfer to a more costly and institutional higher level of care to receive the services and safety interventions they require.

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Does Medicare Cover Nursing Home Care In Illinois

Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so its most valuable for those who are recovering from an injury, illness or surgery.

Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.

What Does Medicare Cover?

Medicare covers a number of specific services, including:

• Ambulance transportation

What Isnt Covered by Medicare?

Medicare does not cover long-term custodial care that addresses seniors day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.

For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.