Medicaid And Nursing Homes
Medicaid is a State and Federal program, administered by the Illinois Department of Healthcare and Family Services . It pays for care in skilled nursing facilities and intermediate care facilities. A doctor must confirm the resident needs this level of care. The resident must be eligible for benefits based on their income and assets. The resident is required to file a detailed application showing all assets and income. They must also provide certain documents to verify their finances. Then eligibility can be determined.
Do all nursing homes accept Medicaid?
No. Many facilities are certified to accept Medicaid patients. Others choose not to take Medicaid. This is because the amount paid per day is lower than the amount paid by private pay residents. The nursing home you choose will keep a resident whose funding source switches from private pay or Medicare to Medicaid, if this may occur in your situation. Many residents find it traumatic to be moved from one nursing home to another once they have settled into a routine and become familiar with the staff.
Discrimination against Medicaid recipients is prohibited. However, a nursing home that accepts Medicaid recipients can limit the number of Medicaid available beds. Even if you have been told that the facility takes Medicaid, there may not be a Medicaid bed available. If you know you will need one in the future, give the nursing home plenty of warning. This way, they can plan to have a bed available.
The Seniorscore For Peoria Il
Peoria has a SeniorScore of 74, which is typical for Illinois and two points higher than the national average. The city’s wealth of attractions for older adults result in the Recreation & Leisure category earning the most points, followed by Health & Safety. Although the General Quality of Life and Finances categories take 3rd and 4th places, respectively, both still reveal aspects of Peoria that appeal to seniors.
Families visiting nursing homes in Peoria have plenty of choice when considering somewhere to take loved ones on a day trip. The city has 18 parks, ranging from Bradley Park, a vibrant place that’s perfect for watching sports and walking dogs, to Detweiller Park, a more laid-back location with a nature reserve and abundance of picnic tables. There are also 157 places of worship, ensuring seniors are always near their congregations. Medicare beneficiaries are assured of quality care as Peoria has a very high number of Medicare registered physicians working in a range of disciplines, such as cardiology and primary care. Seniors and families looking for the ideal nursing home have a choice of 17 in and around the city. Average life expectancy is also favorable, being slightly above the U.S. average at 79.
Illinois Unitedhealthcare Nursing Home Plan
UnitedHealthcare Nursing Home Plans are Institutional Special Needs Plans that provide individualized, closely monitored care to members who reside in contracted nursing homes. These plans help coordinate care through Optum nurse practitioners and physician assistants on behalf of UnitedHealthcare. UnitedHealthcare Nursing Home Plans do not require referrals for specialty care.
- UnitedHealthcare Nursing Home Plan
- UnitedHealthcare Nursing Home Plan
- UnitedHealthcare Nursing Home Plan
Health Maintenance Organization plans have a defined network of contracted physicians and hospitals to provide member care. Generally, members must use these providers to receive benefits for covered services, except in emergencies.
Point of Service plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services – typically at a higher cost.
Preferred Provider Organization plans offer members access to a network of contracted physicians and hospitals, but also allow them the flexibility to seek covered services from outside of the contracted network, usually at a higher cost.
UnitedHealthcare offers Medicare Advantage Special Needs Plans that combine the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional benefits and services designed to meet the unique needs of identified Medicare consumer populations.
Tools and Resources – UnitedHealthcare® Nursing Home Plan
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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.
Medicaid Programs & Waivers
Medicaid is health insurance for low-income and disabled individuals and seniors. Medicaid care was originally provided as institutional care, but now also covers a variety of services and benefits in ones home and community. This is to prevent and / or delay nursing home placements. In Illinois, there are two managed care health plans that are relevant to the elderly.
1) HealthChoice Illinois is for Medicaid eligible state residents of all ages, as well as those who are dual eligibles, meaning they are enrolled in both Medicaid and Medicare. Via this program, long-term care services are available and include assistance with Activities of Daily Living , such as bathing, grooming, and mobility, home health care, and adult day care. This program has lower income limits than do the HCBS Medicaid waiver programs. Learn more about program eligibility and benefits.
2) Illinois Medicaid-Medicare Alignment Initiative is intended for disabled individuals and seniors who receive both Medicaid and Medicare benefits. This health plan streamlines the services from both programs, allowing program participants to receive all services via one plan. Adult day care, personal care assistance, personal emergency response systems and other long-term supports are available via MMAI. Unfortunately, this program is not currently available statewide. To see where MMAI is available, .
- Personal care assistance
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When Does A Person Need A Long
When a person needs help with dressing, shopping, meal preparation and personal chores â and when these needs cannot be met by family or community services â a long-term care facility could be the best choice. When a person needs medical attention that the family cannot afford to provide at home, or when keeping the individual at home may severely upset family life, long-term care could be needed. Other care needs also may make it necessary to make this choice.
First, talk the situation over with other family members, including the person needing the care. Consult your physician. If you are faced with having to move someone from a hospital to a long-term facility, talk to the hospital’s social worker.
Always consider the individual’s needs and preferences. After all, it is his or her lifestyle that will change. Everyone, regardless of age or degree of health, has a right to influence his or her own life.
Consider family needs. Often, after reviewing all possibilities, it is determined that institutional care is the best alternative. No one needs to feel guilty about moving a loved one into a long-term care facility, especially if all alternatives and consequences have been carefully weighed and if the long-term care facility is chosen with care.
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 facility’s 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 person’s physician says such care is needed and his or her decision is approved by the program.
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Should I Visit All The Homes On My List
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.
Who Regulates Nursing Homes
Nursing homes in Illinois are licensed, regulated, inspected and/or certified by a number of public and private agencies at the state and federal levels, including the Illinois Department of Public Health and the U.S. Department of Health and Human Services Health Care Financing Administration . These agencies have separate — yet sometimes overlapping — jurisdictions.
Contingency Capacity Strategies To Mitigate Staffing Shortages
When staffing shortages are anticipated, health care facilities and employers, in collaboration with human resources and occupational health services, should use contingency capacity strategies to plan and to prepare for mitigating this problem. Crisis level staffing mitigation strategies are discussed in a separate section below. Contingency mitigation strategies include:
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.
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Assisted Living In Illinois
We have gathered data for over 20,000 assisted living communities serving seniors across the U.S., and over 500 statewide. Our research indicated that a resident in an assisted living community in Illinois will pay $4,030 per month on average.
According to the United States Census Bureau, the population of the elderly living in Illinois has grown over the past five years. Its possible seniors are choosing to retire in the state because they do not have to pay state tax on social security income, public or private pensions, or income from a retirement savings account such as an IRA.
Illinois Supportive Living Program
The Illinois Medicaid waiver that helps pay for some assisted living costs is referred to as the Supportive Living Program . It pays for personal care services, housekeeping, meals, exercise programs, medication supervision and assistance, and 24-hour staff to ensure residents scheduled and unscheduled needs are met. Residents are responsible for room and board costs.
Who Is Eligible?
Residents interested in applying for the SLP must meet the following age, financial, and functional requirements:
- Age 65 or older or have a physical disability
- Monthly income must be equal to or greater than the Supplemental Security Income rate of $750 for single residents or $1,125 for married residents
- Eligible for nursing home care but choose to receive care in an AL environment
If eligible, all of your monthly income except for $90 will go to the assisted living facility.
How to Apply
To apply for the SLP, residents or their legal representative should contact the ALF, and they will help complete the appropriate assessments and paperwork. Not all facilities accept the waiver, so be sure to ask if they are an SLP participant.
Interested applicants who would like more information about SLP or those with questions about an ALF, can also call the Department of Healthcare and Family Services, Bureau of Long-Term Care at 782-0545 or 528-8444.
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Who May Receive Nursing Facility Services
NF services for are required to be provided by state Medicaid programs for individuals age 21 or older who need them. States may not limit access to the service, or make it subject to waiting lists, as they may for home and community based services. Therefore, in some cases NF services may be more immediately available than other long-term care options. NF residents and their families should investigate other long-term care options in order to transition back to the community as quickly as possible.
Need for nursing facility services is defined by states, all of whom have established NF level of care criteria. State level of care requirements must provide access to individuals who meet the coverage criteria defined in federal law and regulation. Individuals with serious mental illness or intellectual disability must also be evaluated by the state’s Preadmission Screening and Resident Review program to determine if NF admission is needed and appropriate.
Nursing facility services for individuals under age 21 is a separate Medicaid service, optional for states to provide. However, all states provide the service, and in practice there is no distinction between the services.
In some states individuals applying for NF residence may be eligible for Medicaid under higher eligibility limits used for residents of an institution. See your state Medicaid agency for more information.
Residents Suspected To Have Covid
Test symptomatic residents regardless of vaccination status.
Isolate using transmission-based precautions until results of tests are known.
Monitor residents at least daily.
Use dedicated medical equipment.
Staff wear full PPE .
Visitation – Follow visitation guidance listed above for Residents with confirmed COVID-19.
Communal dining Dining for persons confirmed to have COVID-19 is not allowed in communal areas. Dining should occur in the resident room.
Group activities residents suspected of having COVID-19 must not participate in group activities until recovered.
Routine cleaning and disinfection of surfaces and equipment.
After discharge, leave the room empty for a period of 60 minutes. HCP must not enter to remove equipment or terminally clean the room for at least 60 minutes after discharge unless they are wearing full PPE. After 60 minutes, they can enter wearing appropriate PPE for the terminal cleaning.
If limited single rooms are available or if numerous residents are simultaneously identified to have COVID-19 exposures or symptoms concerning for COVID-19, residents should remain in their current location, draw a privacy curtain between beds, and wait for test results.
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Designation Of Penalty Monies
All penalty monies collected on violations of state standards are deposited into a special fund used by IDPH to monitor health care facilities that violate licensure standards and in which the owner or operator is unable or unwilling to make necessary corrections. The Long Term Care Monitor and Receivership Fund allows the Department to monitor facilities not in compliance with licensure standards and to safeguard facility patients or residents whether or not the owner is cooperative.
More Ways To Finance Assisted Living
Some additional ways to finance assisted living costs include:
- Veterans Benefits: Veterans can take advantage of several different pension programs to help cover the cost of assisted living. For more information, see the article on benefits.va.gov.
- Life Insurance Policies: Even if a spouse or loved one hasnt died, certain types of life insurance policies can be used to pay for assisted living. More information is available at longtermcare.acl.gov
- Long-Term Care Insurance: Long-term care insurance is a type of insurance policy that pays for long-term care when it becomes necessary, including the cost of assisted living. For more information on the benefits and drawbacks of this financing method, visit longtermcare.acl.gov.
- Reverse Mortgages: Reverse mortgages allow seniors to access the equity from a home that they own, and these funds can be used to pay for assisted living. The U.S. Department of Housing and Urban Development offers a federally insured reverse mortgage program.
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Nursing Homes Facilities In Illinois
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Area Agencies On Aging
Area Agencies on Aging is a network of hundreds of nonprofit organizations across America that provide federal and state-funded services to older adults in their local areas.
Illinois has several Area Agencies on Aging that offer comprehensive information on various kinds of programs and community supports for seniors.
|Area Agency on Aging|
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