Illinois Medicaid Long Term Care Eligibility for 2025

Illinois Long Term Care

Eligibility in 2025:

Illinois Medicaid, known as the Medical Assistance Program, provides long-term care services for eligible seniors and individuals with disabilities. This includes nursing home care, support in assisted living or supportive living facilities, and services to help individuals remain in their own homes or with loved ones.

To qualify, applicants must meet specific residency, medical, income, and asset requirements. Additional programs offer non-medical supports, such as personal care assistance and adult day care, under Home and Community Based Services (HCBS) waivers.

1. Residency and Citizenship – Applicants must be Illinois residents and U.S. citizens or have proper immigration status.

2. Age/Disability – Applicants must be 65 or older, blind, or disabled and meet medical requirements consistent with a Nursing Facility Level of Care (NFLOC).

3. Income Limitations – Income limits for 2025 are $1,255/month for single applicants and $1,703/month for married couples applying together. If income exceeds these limits, applicants may still qualify by using Illinois’ spend-down program. A $60/month personal needs allowance is excluded from income calculations for nursing home residents.

4. Asset Limitations – Applicants must have $17,500 or less in countable assets. Exempt assets include a primary residence (equity up to $730,000), one vehicle, personal belongings, and irrevocable burial contracts up to $7,981.

Exempt Assets for 2025:

i. $17,500 or less in countable assets for individuals. Excess assets must be spent down before eligibility.

ii. One home (equity up to $730,000) is exempt if the applicant, spouse, or dependent lives there. Applicants must also declare Intent to Return if they are institutionalized.

iii. One vehicle of any value used for medical, employment, or community living purposes.

iv. Irrevocable prepaid burial contracts (up to $7,981) and life insurance with a face value of $1,500 or less.

Spousal Rules for 2025:

**Community Spouse Resource Allowance (CSRA):** A community spouse may retain up to $135,648 of the couple’s assets. For total combined assets under $31,584, the community spouse may retain all assets up to this amount.

**Minimum Monthly Maintenance Needs Allowance (MMMNA):** A community spouse may keep up to $3,948/month in income. Additional income from the institutionalized spouse may be transferred if the community spouse’s income is below this threshold.

Illinois is an “income-first” state, meaning the institutionalized spouse’s income must be used first to meet the community spouse’s needs before increasing the CSRA.

Medicaid’s Look-Back Period:

Illinois enforces a 60-month look-back period to review asset transfers made for less than fair market value. Violating this rule results in a penalty period of ineligibility.

Illinois Medicaid Programs for Long-Term Care

**1) Waiver for Supportive Living Facilities:** Provides personal care, laundry, and housekeeping services in assisted living or memory care facilities.

**2) HCBS Waiver for the Elderly:** Offers services like adult day care, homemaker assistance, and medication reminders to help seniors remain at home.

**3) Managed Long Term Services and Supports (MLTSS):** Combines Medicaid and Medicare benefits for dually eligible individuals, including transportation, home modifications, and personal care.

**4) Program of All-Inclusive Care for the Elderly (PACE):** Provides integrated Medicare and Medicaid benefits, including long-term care services, through one program.

How to Apply for Illinois Medicaid

Applications can be submitted online through Illinois’ ABE Portal, by phone at 1-800-843-6154, or in person at an IDHS office. Assistance is also available through local Area Agencies on Aging.