Illinois Benefit Rights and Eligibility under Medicaid
Depending on your assets and level of income each month, you may be eligible to receive assistance for your medical bills, including your care in the nursing home. This assistance program is called Medicaid, and is administered through the Illinois Department of Healthcare and Family Services. The eligibility requirements for a nursing home resident are different, depending on whether you are an individual, or whether you are married with a spouse living in the community. This notice explains the eligibility requirements for a single individual.
If you are an individual, you may be eligible to receive assistance for your medical bills and nursing home care if your total assets do not exceed any of the following limits:
- No more than $17,500 in cash, bank assets, stocks, bonds or securities
- No more than $1,500 either for a revocable pre-paid burial plan or the cash value of your life insurance policy
- No more than $6,774 for an irrevocable prepaid burial contract.
- The portion of a funeral/burial contract that clearly represents the purchase of burial space, including mausoleums, urns, caskets, grave-markers, and opening and closing of the gravesite is exempt without limitation, and is not counted toward the $1,500 revocable or the $6,774 irrevocable burial plan limits.
Trusts set up after August 11, 1993 are considered to be assets. Assets distributed over the last 60 months for less than fair-market value are considered countable assets.
To apply for medical financial assistance under Medicaid:
Contact your local Illinois Department of Human Services office or apply online at https://abe.illinois.gov/abe/access/ . If you do not know where your local Human Services office is, or if you have further questions, you may call the Illinois Department of Healthcare and Family Services toll-free at 800-843-6154 or visit the website www.dhs.state.il.us. At the point that you request financial assistance from the local Healthcare and Family Services office, you will be required to fill out a financial statement listing your assets and income. The agency will also be asking you, or a person helping you, to provide verification of your financial statement and supporting documentation.
The Illinois Department of Healthcare and Family Services will require the Applicant and/or Authorized Representative to provide copies of the following:
- Last five years
- of SAVINGS ACCOUNT statements
- Last five years of CHECKING ACCOUNT statements
- An explanation of deposits and withdrawals from either of the above if over $500, excluding Social Security income
- Social Security card
- Medicare card
- Blue Cross/Blue Shield, AARP or other Health Insurance cards
- Proof (check, Benefit Letter, etc.) of Social Security income
- Proof of Pension income
- Proof of other income
- Health and life insurance policies with a statement of cash value of life insurance and cost of health insurance
- Any pre-paid burial plans, funeral arrangements or cemetery lots with an itemized statement of date of purchase and cash value
- Stocks, bonds, other securities and safe deposit box receipts
- Deeds and tax statements for property owned currently or sold in the last five years
- Verification of any accounts closed in the last five years
- Trusts and annuities
Depending on your assets and level of income each month, you may be eligible to receive assistance for your medical bills, including your care in the nursing home. This assistance program is called Medicaid, and is administered through the Illinois Department of Human Services. The eligibility requirements for a nursing home resident are different, depending on whether you are an individual, or whether you are married with a spouse living in the community. This notice explains the eligibility requirements if you are married with a spouse living in the community.
You may be eligible to receive assistance for your medical bills and nursing home care if your total assets do not exceed $135,648. The Nursing Home resident (institutionalized spouse) may be allowed to divert up to $3,948 of his/her income to a qualifying community spouse. In addition, when you go into a nursing home, your spouse may keep your home, your car and your household furnishings, and they are not counted toward the assets. Trusts set up after August 11, 1993 are considered to be assets. Assets distributed over the last 60 months for less than fair-market value are considered countable assets.
To apply for medical financial assistance under Medicaid:
Contact your local Illinois Department of Human Services office or apply online at https://abe.illinois.gov/abe/access/. If you do not know where your local Human Services office is, or if you have further questions, you may call the Illinois Department of Human Services toll-free at 800-843-6154 or visit the website www.dhs.state.il.us. At the point that you request financial assistance from the local Healthcare and Family Services office, you will be required to fill out a financial statement listing your assets and income. The agency will also be asking you or a person helping you, to provide verification of your financial statement and supporting documentation.
The Illinois Department of Healthcare and Family Services will require the Applicant and/or family to provide copies of the following for BOTH spouses, indicating ownership:
- Last five years of SAVINGS ACCOUNT statements
- Last five years of CHECKING ACCOUNT statements
- An explanation of deposits and withdrawals from either of the above if over $500, excluding Social Security income
- Social Security card
- Medicare card
- Blue Cross/Blue Shield, AARP or other Health Insurance cards
- Proof (check, Benefit Letter, etc.) of Social Security income
- Proof of Pension income
- Proof of other income (e.g., spouse’s income)
- Health and life insurance policies with a statement of cash value of life insurance and cost of health insurance
- Any pre-paid burial plans, funeral arrangements or cemetery lots with an itemized statement of date of purchase and cash value
- Stocks, bonds, other securities and safe deposit box receipts
- Deeds and tax statements for property owned currently or sold in the last five years
- Verification of any accounts closed in the last five years
- Marriage certificate
- Trusts and annuities
COVERED SERVICES as promulgated by the Illinois Department of Healthcare and Family Services, effective 11-17-05. The Medical Assistance Program provides payment for receipt of documented long term care facility services that are determined essential, based on the attending physician’s orders and the medical and/or social needs of the Resident. All participating long term care facilities are to provide the following services at no additional charge, as they are recognized costs under the Department’s cost-related reimbursement system:
- All staff, routine equipment and supplies (including oxygen, if less than one tank has been furnished per Resident during each service month) required to provide the services needed by Residents accepted for care by a facility. (Examples of equipment and supplies to be provided include, but are not limited to: standard wheelchair, walker, floatation pad and mattress, intermittent positive pressure machine, and those included in the program as “Personal Care Items,” listed below in Appendix C-26);
- Room and board, supervision and oversight, and all laundry services;
- Food substitutes and nutritional supplements;
- Medications which are regularly available without prescription at a commercial pharmacy and which may be stocked by the facility under Department of Public Health regulations, including, but not limited to, those listed in Appendix C-26;
- Over the counter drugs or items ordered by a physician (including, but not limited to, drugs and items listed in the Department’s Long Term Care Provider Handbook, Appendix C-26 and excluding drugs and items reimbursed under the Department’s Drug Program); and
- All other services necessary for compliance with the requirements of IDPH, as set forth in Skilled Nursing and Intermediate Care Facilities Code, Rules and Regulations (77 Ill. Adm. Code, Section 300).
APPENDIX C-26: PERSONAL CARE AND GENERAL HEALTHCARE EQUIPMENT AND SUPPLIES
Adhesive Tape
Administration equipment & Supplies for Parenteral Fluids-Intravenous or Subcutaneous (excluding TPN solution and administration equipment)
Alcohol, Alcohol Swabs, Wipes, Sticks
Antiseptics
Aspirator Bulbs
Atomizers
Band-Aids and Bandages
Bedpans and Urinals
Bilevel Positive Airway Pressure (BiPAP)
Blood Pressure Kits
Body Lotion
Brushes
Underpads
Catheters
Combs
Comfort Lotions and Creams
Corn Starch
Cotton, Cotton Balls, Cotton Swabs
Continuous Positive Airway Pressure (CPAP)
Cushions, Non-Custom
Dental Floss and Denture Supplies
Deodorant, Antiperspirant
Diabetic Testing Supplies
Diapers, Disposable and/or Non-disposable
Disinfectants
Disposable Enemas
Drainage Tubing and Receptacles
Dressings
Durable Equipment Non-Custom
(i.e., walkers, wheelchairs, beds, etc.)
Dusting Powder
Elbow and Heel Protectors
Emesis Basins
Emollients
Enteral Therapy Equipment & Supplies
Eye Patches
Gauzes
Germicides
Hair Conditioner
Hearing Aid Batteries
Heat Lamps
Hot Water Bottles
Hydrogen Peroxide
Ice Bags
Irrigation Solutions
IV Poles and Supplies
Jay Cushions
Lubricating Jelly
Mattress Covers
Mouthwash
Nail Care Supplies
Nebulizers
Orthotics, Non-custom (i.e., helmets, elastic braces)
Oximeters and Oxygen Analyzers
Oxygen and Equipment and supplies necessary for its administration
Pads (i.e., sheepskin, moleskin)
Petroleum (i.e., Vaseline)
Razors
Rectal Tubes
Restraints
Roho Cushions
Rubber Gloves and Finger Cots
Sanitary Napkins and Related Items
Scissors
Shampoo, Non-prescription
Sharps Collectors
Shaving Cream
Soaps and Soap Substitutes
Suppositories
Syringes and Needles
Suction Catheters and Suction Machine
Talcum Powder
TENS Unit and Supplies
Thermometers
Tissues, Towels, and Washcloths
Tongue Depressors
Toothbrush and Toothpaste
Trach Supplies and Trach Care Kits
Urological Supplies
Ventilators
Vinegar Douche
Drugs and Medications:
Acetaminophen and Pain Relief/Analgesics
Antacids/Acid Reducer
Aspirin (buffered, enteric coated)
Bicarbonate of Soda Powder
General Multivitamins
Iron Replacements
Laxatives and Lozenges
Lice Treatment
Milk of Magnesia
Non-Sedating Antihistamines
Saline Nasal
Spray
