Illinois Medicaid Nursing Home Eligibility: A Complete Guide

Illinois nursing home costs average approximately $65,000–$85,000 annually for a semi-private room. Illinois Medicaid, administered by the Department of Healthcare and Family Services (HFS), covers nursing home care for eligible residents and offers strong community-based alternatives.

Who Qualifies

1. Medical necessity — Physician certifies need for nursing facility level of care. Illinois uses a Determination of Need (DON) assessment tool.
2. Financial eligibility — Income and asset limits.
3. Illinois residency — U.S. citizenship or qualifying immigration status.

Income Requirements

• Monthly income limit: $2,829/month (300% of SSI, 2025)

A Qualified Income Trust (Miller Trust) is available for applicants whose income exceeds the cap. Community spouse: Monthly Maintenance Needs Allowance up to approximately $3,715/month.

Asset Requirements

• Individual applicant: $2,000 in countable assets
• Community spouse: Up to $148,620 (2025 CSRA)

Exempt assets: Primary home, one vehicle, personal property and household goods, irrevocable prepaid burial arrangements.

Look-back period: Illinois enforces a 60-month look-back period.

Application Process

Apply through the Illinois Department of Human Services (DHS):

1. Find your local DHS office at dhs.state.il.us or call 1-800-843-6154.
2. Apply online at abe.illinois.gov.
3. Submit: income and asset documentation, 60 months of bank records, physician certification.

What Illinois Medicaid Covers

Covered: Semi-private room and board, skilled and custodial nursing care, physical/occupational/speech therapy, physician and specialist visits, prescriptions, medical equipment.

Not covered: Private rooms (unless medically required), personal comfort items, cable TV and telephone.

Home- and Community-Based Programs

• Community Care Program (CCP): Administered by the Illinois Department on Aging. Provides homemaker services, emergency home response, and adult day services to seniors 60+ at risk of nursing home placement.
• Home Services Program (HSP): Personal care and home health for individuals with disabilities.
• Supportive Living Facilities (SLF): Illinois-unique Medicaid-funded assisted living for individuals who qualify for nursing home level of care.
• PACE Illinois: Available in select areas.

Frequently Asked Questions

What is a Determination of Need (DON) assessment?

The DON is a standardized functional assessment that determines whether you qualify for nursing home level of care and for community-based programs like CCP.

Where do I find a Care Coordination Unit?

Contact the Illinois Department on Aging at 1-800-252-8966 or visit aging.illinois.gov.