Long-Term Care Medicaid in Illinois: 2026 Guide

In Illinois, Medicaid is run by the Illinois Department of Healthcare and Family Services (HFS), and eligibility is decided by the Illinois Department of Human Services (IDHS) through its local Family Community Resource Centers. Long-Term Care Medicaid can pay for nursing home care, care in a supportive living facility, and care at home. Illinois has its own rules for assets and for the spouse at home, so its figures differ from many states. This guide explains the 2026 rules in plain language.

At a glance: Illinois 2026 figures

Item	2026 figure
Income standard (applicant)	$1,330 a month (AABD standard). Income above it can be met through a spenddown
Asset limit (single applicant)	$17,500
Asset limit (couple, both applying)	$17,500 (the same limit applies to the whole household)
Home equity limit	$752,000
Spouse at home: resource allowance (CSRA)	$143,172
Spouse at home: monthly income allowance (CSMNA)	$4,066.50
Personal needs allowance (nursing home)	$60 a month
Look-back period	60 months (5 years)
Penalty divisor	No statewide figure: the facility’s own monthly private-pay rate

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with the Illinois Department of Human Services before relying on them.

What Long-Term Care Medicaid covers in Illinois

Nursing home care. Medicaid pays for care in a certified nursing facility. You pay most of your income toward the cost each month, and Medicaid pays the rest.

Supportive Living Program. Illinois has a Supportive Living Program, an assisted living-style option in certified supportive living facilities (SLFs). Medicaid can pay for services there for people who would otherwise need a nursing home. The resident pays toward room and board from their income.

Care at home and in the community. For people 60 and older, the Illinois Department on Aging’s Community Care Program provides in-home services, adult day services and emergency home response for people who meet a needs assessment. Other waivers serve younger adults with disabilities. Many Medicaid members get these services through a HealthChoice Illinois managed care plan.

PACE. Illinois has begun offering PACE (Program of All-Inclusive Care for the Elderly) in some areas.

Assisted living. Outside the Supportive Living Program, Medicaid generally does not pay for assisted living in Illinois.

Who qualifies

A person generally must:

be 65 or older, or blind or disabled;
live in Illinois and be a U.S. citizen or qualified non-citizen;
need a nursing facility level of care. A screening is done before nursing home or supportive living admission, and the Department on Aging’s care coordination units assess people for the Community Care Program;
meet the income and asset rules below, as decided by IDHS.

Income rules

Illinois is not an income-cap state. Instead it uses a two-step process:

Step 1, eligibility: your countable income is compared with the AABD standard for one person, $1,330 a month in 2026. If your income is higher, you have a spenddown: the amount above the standard must be met by medical expenses. For a nursing home or supportive living resident, the expected monthly charges at the facility’s private rate usually meet the spenddown.
Step 2, paying toward care: once eligible, most of your income goes to the facility. You keep a personal needs allowance of $60 a month, and money can be set aside for a spouse at home and for health insurance premiums.

Asset rules

In 2026, a single applicant can keep $17,500 in countable assets. This is much higher than the $2,000 limit in many states. For a couple who both need care, the limit is $17,500, because Illinois applies one limit to the whole household.

Countable assets include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value and real estate other than the home.

Usually exempt:

Your home (equity up to $752,000) if you live there or plan to return, or a spouse or dependent relative lives there
One vehicle
Household goods and personal belongings
Prepaid, irrevocable funeral and burial arrangements, within Illinois rules

Spousal protections

Illinois sets its own spousal figures under state law (Public Act 102-1037), and they rise each year.

Assets: The spouse at home can keep a Community Spouse Resource Allowance of $143,172 in 2026, plus the home, one car and belongings. This is set once, at the first determination, and is not updated later.
Income: The spouse at home keeps their own income. If it is below the Community Spouse Maintenance Needs Allowance of $4,066.50 a month, part of the applicant’s income can go to them to bring them up to that amount.

Look-back and penalties

When you apply, Illinois looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
Selling a house or car to a relative for much less than it is worth.
Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor (the private monthly rate of the nursing home or supportive living facility where you live (Illinois has no single statewide figure)).

Example: Suppose the facility charges $9,000 a month (a made-up rate for this example). A $50,000 gift divided by $9,000 is about 5.6 months without Medicaid payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in Illinois

Illinois’s estate recovery program is run by HFS.

What is recovered: Medicaid paid for long-term care and related services from age 55, or at any age for someone permanently in a nursing facility.
When it is put off: recovery is not made while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
Hardship waivers: HFS can waive or put off recovery in some situations. Ask HFS for the current rules and the property it can recover from.
Family members and executors can contact HFS Estate Recovery directly with questions.

How to apply

Online: ABE (Application for Benefits Eligibility), Illinois’s benefits website
In person or by mail: at your local IDHS Family Community Resource Center
For in-home services through the Community Care Program: contact your local care coordination unit through the Illinois Department on Aging. It does the needs assessment and helps with the Medicaid application.
For supportive living: contact a certified supportive living facility, which can explain the screening and application steps.

After you apply. IDHS will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing. The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive, and report changes in income, assets or address when they happen.

Gather what you can before you apply. The caseworker may ask for:

Photo ID, Social Security card and Medicare card
Proof of age and of U.S. citizenship or immigration status
Proof that you live in the state (for example, a utility bill or lease)
Proof of all income: Social Security award letter, pension statements, annuity statements
Bank, credit union and investment statements (often for the full 60-month look-back period)
Deeds, property tax bills and the value of any real estate
Life insurance policies (showing cash value) and prepaid funeral or burial contracts
Vehicle titles
Health insurance cards and long-term care insurance policies
Power of attorney or guardianship papers, if someone is applying for you
For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in Illinois

IDHS and your Family Community Resource Center: Medicaid applications and eligibility.
Illinois Department on Aging and Area Agencies on Aging: local information on long-term care options and the Community Care Program.
Senior Health Insurance Program (SHIP): Illinois’s free Medicare counseling program, through the Department on Aging.
Illinois Long-Term Care Ombudsman Program: free advocates for residents of nursing homes, supportive living facilities and assisted living.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including Illinois:

Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Illinois’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect Illinois’s limit.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

Frequently asked questions

Is the Illinois asset limit really $17,500? Yes, for a single applicant in 2026. The home, one car, belongings and prepaid burial arrangements are usually not counted.

My income is over $1,330 a month. Can I still qualify? Often, yes. Illinois uses a spenddown, and for someone in a nursing home the cost of care at the private rate usually meets it. You then pay most of your income toward care.

How much can my spouse keep? In 2026, $143,172 in assets, plus the home, a car and belongings, and enough of the applicant’s income to bring them up to $4,066.50 a month.

What is supportive living? It is Illinois’s Medicaid-covered alternative to a nursing home in an apartment-style setting. Medicaid pays for services, and the resident pays toward room and board.

How is a gift penalty worked out in Illinois? Illinois uses the private monthly rate of the facility where you live, not one statewide figure. Divide the gift by that rate to get the number of months.

Will the state take my home after I die? HFS can seek repayment for long-term care costs, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with the Illinois Department of Human Services before relying on them.

Sources

IDHS, Manual Release 26.05, CSMNA and CSRA 2026
Illinois Department on Aging, 2026 Illinois Medicaid Income Standards and Resource Limits
IDHS, PM 15-04-04, Use of Income (NH, SLF, and DoA HCBS Waiver)
IDHS, PM 15-02-03-b, Nursing Home/Supportive Living Facility Spenddown
IDHS, WAG 07-02-20-d, transfer penalty
HFS, personal needs allowance notice
ABE
CMS, 2026 SSI and spousal impoverishment standards
Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.