Illinois
What Is Illinois Medicaid Long-Term Care?
Illinois Medicaid, also known as the Medical Assistance Program, offers healthcare coverage to individuals with low income. While it serves various groups, this guide focuses on long-term care coverage for seniors aged 65 and older. In addition to nursing facility care, Illinois Medicaid funds supportive services that enable elderly individuals to stay at home, live with family, or reside in supportive living environments (comparable to assisted living). Seniors in Illinois may qualify for one of three types of long-term care Medicaid programs.
What Are the Three Main Types of Illinois Long-Term Care Medicaid Programs?
Who Is Eligible for Nursing Home Medicaid?
This program is a guaranteed benefit for those who meet the financial and medical qualifications. It strictly covers care received in licensed nursing home facilities.
What Are Medicaid Waivers / Home and Community Based Services?
These waiver programs are not automatic benefits. They have enrollment caps and may include waiting lists. Services are intended to delay or prevent nursing home placement and are provided in home settings, adult day care centers, or supportive living facilities.
What Is Regular Medicaid for the Aged, Blind, and Disabled (AABD)?
Also an entitlement program, AABD provides a range of long-term care services for individuals who meet eligibility rules. This includes help with personal care and adult day services.
How Is Illinois Medicaid Funded and Administered?
Though funded by both state and federal governments, the Illinois Medicaid program operates under state management within federal guidelines. The Illinois Department of Healthcare and Family Services oversees program administration, while the Illinois Department of Human Services (IDHS) determines eligibility.
What Are the Financial Limits to Qualify for Long-Term Care Medicaid in Illinois?
What Are the Basic Income and Asset Limits for Single Applicants in 2025?
- Monthly income must not exceed $1,304.17
- Countable assets must be under $17,500
- A Nursing Facility Level of Care is required
What Are the 2025 Income and Asset Limits by Marital Status?
Note: Some income must go toward care costs, minus allowances for personal needs, spouse support, and Medicare premiums.
What Types of Income Are Counted and Exempt?
What Is Counted as Income for Medicaid?
Most income sources are counted, such as wages, pensions, Social Security, IRAs, and investment earnings. However, Holocaust reparations are not counted. Illinois does count VA Aid & Attendance as income, unlike many other states.
How Is Income Evaluated for Married Couples?
For Nursing Home Medicaid or Waivers, only the applicant’s income is considered. The non-applicant spouse may qualify to receive income from the applicant to maintain a minimum standard of living. In 2025, this spousal allowance is up to $3,948/month.
For AABD Medicaid, both spouses’ incomes are evaluated together, and the spousal allowance does not apply.
What Assets Count Toward the Limit, and What Is Exempt?
What Are Countable and Non-Countable Assets?
Countable assets include cash, bank accounts, stocks, IRAs, and real estate not used as a primary residence. Exempt assets include personal belongings, one vehicle, household furniture, and the primary home (with limits). Prepaid funeral plans up to $7,981 are also exempt.
How Are Assets Treated for Married Couples?
All assets are viewed as jointly owned. For Nursing Home Medicaid and Waivers, the non-applicant spouse can keep up to $135,648 in 2025 as a Community Spouse Resource Allowance (CSRA). This allowance is not available under AABD Medicaid.
What Is the Medicaid Look-Back Period?
How Does the Look-Back Rule Affect Eligibility?
Illinois enforces a 60-month (5-year) look-back period before application for Nursing Home Medicaid or Waivers. If assets were given away or sold below value during this time, it may result in a penalty period of ineligibility.
Note: Gifts allowed under the federal tax law (up to $19,000 per recipient in 2025) may still violate Medicaid rules.
When Is a Home Considered Exempt from Medicaid?
What Are the Rules for Home Equity?
To keep a home exempt, the applicant or their spouse must live there. If not, the applicant must state an intent to return. In 2025, the applicant’s equity interest must be under $730,000. For AABD, this cap does not apply.
However, the home is subject to Medicaid Estate Recovery after the Medicaid recipient passes away.
What Are the Medical and Functional Requirements for Medicaid?
Applicants must demonstrate a need for long-term care. For Nursing Home Medicaid and Waivers, this means requiring a nursing facility level of care. For AABD, the applicant must need assistance with daily living activities (ADLs), though a nursing level of care is not always required.
Can Someone Qualify If Over the Income or Asset Limits?
What Is the Medically Needy Pathway (Spenddown)?
If an applicant’s income exceeds Medicaid limits, they can still qualify by using excess income to cover medical expenses. Once the spenddown amount is met, they become eligible. In 2025:
- Individual MNIL: $1,304.17/month
- Couple MNIL: $1,762.50/month
- Asset limit: $17,500
What Is the Asset Spend Down Strategy?
Excess assets can be converted to non-countable assets by:
- Paying off debt
- Making home modifications
- Prepaying burial expenses
Care must be taken not to gift or transfer assets below market value, as it may trigger penalties under the look-back rule.
What Is Medicaid Planning?
Medicaid planning professionals help individuals legally qualify for Medicaid despite being over income or asset limits. These strategies also help protect assets, such as the family home, from estate recovery.
What Medicaid Long-Term Care Programs Are Available in Illinois?
Supportive Living Program (SLP)
SLP helps seniors and disabled individuals live in supportive living residences, offering services like personal care, memory care, and housekeeping.
HCBS Waiver for the Elderly
This waiver supports seniors who live at home, providing services such as adult day care, medication reminders, homemaker help, and emergency response systems.
Medicaid Managed Long Term Services and Supports (MLTSS)
Available through HealthChoice Illinois, MLTSS supports individuals who qualify for both Medicaid and Medicare. Services include home care, transportation, assisted living, and modifications.
Illinois Medicaid-Medicare Alignment Initiative (MMAI)
MMAI coordinates both Medicaid and Medicare for dually eligible individuals, offering care services ranging from doctor visits to home care.
Money Follows the Person (MFP) Program
Though not fully implemented yet, MFP aims to help institutionalized Medicaid recipients return to community or home settings.
Program of All-Inclusive Care for the Elderly (PACE)
PACE integrates Medicare and Medicaid into one care model, providing full-spectrum health and long-term care services.
How Can Seniors Apply for Illinois Medicaid?
Applications can be submitted:
- Online via the ABE portal
- By phone at 1-800-843-6154 (IDHS)
- By paper form or in person at an IDHS office
Applicants should confirm eligibility before applying. If unsure about qualifications, it’s recommended to seek assistance from a Medicaid planner or Area Agency on Aging.
