Nursing Homes in Illinois
In Illinois, approximately 22% of the population is aged 60 or older, and the Department on Aging (DoA) expects this number to increase to around 25% of the population by 2030. Therefore, ensuring dignified, high-quality care for older adults living in residential settings is a major priority. With around 57,726 people already living in residential nursing care facilities, understanding how the state supports older adults to access the care they need can help seniors plan their finances and living arrangements.
There are currently 703 certified nursing facilities in Illinois. These facilities provide crucial medical services and personal care assistance to older adults and other people with complex medical or care needs that cannot safely be managed at home. In this guide, you can learn about nursing home regulations in Illinois, explore Medicaid and Medicare funding options and find programs designed to support older adults requiring residential nursing care and their families.
Popular Cities in Illinois
Cost of Illinois Nursing Homes
The average cost of nursing homes in Illinois is $178 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in Illinois?
Illinois' Medicaid program, also called Aid to Aged, Blind and Disabled Medical, funds long-term care in state-licensed nursing homes for around 55,000 people through its Long-Term Care (LTC) program. Generally, the applicant needs to be eligible for Medicaid to qualify for financial assistance with the costs of living in a nursing home. Qualifying applicants must contribute any monthly income towards the cost of their care, minus a $30 personal allowance.
Furthermore, Illinois only pays for nursing home care when it is medically necessary. In other words, seniors would likely qualify for assistance if they have medical needs best met in a nursing home, but may not be eligible if they only need personal care support, such as help with washing or transferring. The Department on Aging (DoA) will complete a needs assessment when they apply for the LTC. Seniors have a right to receive nursing home care if the evaluation determines that they need it. However, they may also be eligible for an alternative program, such as the Supportive Living Program or the Pathways to Community Living Program.
Eligibility for Medicaid in Illinois
Applicants need to meet financial and non-financial eligibility criteria to enroll in Illinois' Medicaid program. The state calculates Medicaid income limits as a percentage of the federal poverty level (FPL). The current income limit is $14,580 for individuals and $19,716 for couples, although the state only considers the applicant's income if only one spouse applies. Furthermore, Illinois also sets asset limits when considering financial eligibility. It may count assets such as savings and second homes, but it doesn't usually include belongings, certain burial plans or primary homes. The asset limit differs for non-applicant spouses — spouses of people applying for nursing home funding can retain up to $120,780 in countable assets.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $14,580 | $2,000 |
| Two-Person Household | $19,716 | $3,000 |
*Per year
However, a senior could still qualify for Medicaid if their income or assets exceed the state limits via the Medically Needy Pathway. This pathway allows you to 'spend down' the difference between your actual income and the cut-off limit on medically necessary services, such as medication or medical supplies. Alternatively, Illinois' Asset Spend Down program allows seniors to spend down their countable assets to below the limit. There are several ways to achieve this, such as using your savings to reduce debts or purchasing a burial plan.
You must also be a permanent, legal resident in Illinois and fulfill one or more of the following nonmonetary Medicaid eligibility criteria:
- Have a qualifying disability
- Be aged 65 or older
- Be the parent or legal guardian of a person aged 18 or younger
- Have a visual impairment
Applying for Medicaid in Illinois
Illinois provides several application routes for Medicaid coverage. Applications can be filed online via the Application for Benefits Eligibility (ABE) portal or by downloading a paper application form from the Illinois DHS website. Applicants can mail or fax their completed forms to their local Family Community Resource Center. Many centers also allow you to complete and deliver your application in person, which could be a good option if you need help filling in the forms.
Alternatively, seniors can apply for medical assistance and get help with applications by phone:
- 1-800-843-6154 (Voice) OR
- 1-800-324-5553, 711 (TTY Relay)
What Information You Will Need
- Proof of identity
- Proof of address
- Social Security number
- Information about citizenship or immigration status (if applicable)
- Details for an approved representative if the applicant wishes for a friend or family member to handle the application on their behalf
- Monthly gross income
- Housing and utility costs
- Details of any existing health coverage, such as Medicare or private health insurance
Additional Medicaid Support and Resources in Illinois
Navigating the Medicaid application process and understanding what benefits they are entitled to can be confusing for many people. Therefore, several state organizations provide free advice and support to help people in need of nursing home care find out what they're eligible for and apply for funding. The resources below can help to establish eligibility and access additional financial support.
| Contact | Service | |
|---|---|---|
| Illinois Department of Healthcare and Family Services | (866) 468-7543 or (877) 204-1012 (TTY) | Offers guidance on Medicaid eligibility as well as services, and makes it possible for individuals in Illinois to manage their own medical benefits. |
| ABE- Am I Eligible | (800) 843-6154 | Residents of Illinois have the ability to pre-check their qualification for general Medicaid enrollment as well as other state-run health programs through the use of the screener tool. |
| AABD Cash Aid to the Aged, Blind or Disabled | (800) 843-6154 | People who are blind or disabled, as well as senior citizens who meet certain eligibility requirements, are qualified to receive monthly cash benefits, medical assistance and burial insurance coverage. |
Can You Use Medicare to Pay for Nursing Home Care in Illinois?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support and Resources in Illinois
Accessing support from agencies with specialized knowledge of the Medicare application and benefits system can help seniors and their families to make the right decision. The following departments and agencies offer free resources and advice and can help families connect with other support services.
| Contact | Service | |
|---|---|---|
| Illinois Association of Area Agencies on Aging | Email at caustin@agelinc.org or call (217) 787-9234 | Puts seniors and their caregivers in touch with agencies providing support to older adults. Some agencies can offer Medicare enrollment assistance, including counseling on eligibility and available benefits. |
| Illinois Department of Human Services | (800) 843-6154 | The department provides older adults in Illinois with access to various online health care resources and compiles contact information for a variety of health assistance programs. |
| Northwestern Illinois Area Agency on Aging | (815) 226-4901 or (800) 542-8402 | Provides free Medicare application advice and assistance to seniors and their caregivers and facilitates connections with other support agencies. Examples of available services include caregiver support, pharmaceutical assistance and legal services. |
Other Financial Assistance Options for Nursing Home Care in Illinois
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in Illinois
| Licensing Requirements | All nursing homes in Illinois must be licensed through the Department of Public Health and renew their license every two years. Nursing homes providing multiple levels of care must hold a license for each care level. |
| Staffing Requirements | Each person requiring skilled care must receive at least 3.8 hours of care per day, while people requiring intermediate care must receive 2.5 hours. Of these hours, at least 25% must be provided by a licensed nurse and at least 10% by a registered nurse. |
| Staff Training Requirements | All nursing assistants must begin an approved training course within 45 days and complete their training within 120 days of their start date. Support workers must complete training that allows them to meet the needs of the home's residents. |
| Admission Restrictions | Nursing homes can only admit residents if the setting can meet their health and psychological needs and care for them safely. However, homes can enlist services from outside agencies if they cannot meet the needs of certain residents in-house. |
| Care Planning Requirements | Nursing homes must create and adhere to a personalized care plan for each resident, including measurable outcomes and timelines. Homes must produce the first care plan within 21 days of admission and review the plan at least every 90 days. |
| Dietary and Nutritional Services Requirements | All residential care facilities must either hire a registered dietician (RD) or have a certified dietary manager working collaboratively with an RD. Healthy, balanced meals and snacks must be provided. Each resident's unique dietary and nutritional needs should be reviewed quarterly. |
| Specialized Rehabilitative Services | Nursing homes must facilitate any rehabilitative services prescribed by a doctor. They don't necessarily have to provide these therapies in-house, although many do. Therefore, some homes support residents to attend rehabilitative services in other clinical settings. |
| Medication and Pharmaceutical Services | Facilities must assess whether residents can self-administer their medication on admission. If they can't, a licensed nurse or physician must administer prescription-only medications. However, non-licensed staff may administer over-the-counter medications if they complete state-approved training. |
| Activities Requirements | Nursing homes must provide a program of activities to promote mental, physical and social well-being. The activities should reflect each resident's interests and preferences and include community resources. Activity personnel should dedicate at least 45 minutes of planning and delivery time per resident per week. |
| Infection Control Requirements | Each home should have a nominated infection preventionist and develop policies to prevent infections. Staff must receive annual infection control training. Facilities should test staff and residents when an outbreak is suspected or when instructed by a local health department and quarantine confirmed cases. |
| Medicaid Coverage | Illinois' Medicaid program covers nursing home care for older adults on low incomes and with countable assets worth $2,000 or less for a single applicant. It pays for medically necessary nursing care in residential settings and may also cover certain in-home care services. |
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