Determination of Need

To qualify for waiver services, you will need to talk to a case manager or a counselor from a state assigned agency. He or she will ask you a series of questions as part of an assessment. These questions are called a Determination of Need or DON. This assessment will typically be done in your home. A representative from the agency will contact you to schedule an assessment. Type of questions you may be asked include:

  • Are you able to feed yourself?
  • Can you prepare your own meals?
  • Do you need assistance with bathing?
  • Do you need assistance getting dressed?
  • Are you able to manage your own finances?
  • Do you have any special equipment you need to use, such as an oxygen tank or IV?

IlliniCare Health does not conduct the Determination of Need. This is done by the Department on Aging or the Department of Rehabilitation Services. However, we may have an IlliniCare Health Care Coordinator present during your DON assessment. Additionally, we will work together with the agency for your annual reassessment or if a reassessment is needed due to a significant change in your condition/needs.

Once the DON is complete and if you are eligible for services, a care plan will be created by IlliniCare Health. The care plan includes services that will help you to remain safely in your home or a community setting. You will work with your IlliniCare Health Care Coordinator to create your own care plan based on the services in your waiver. It will be a mix of the services available to meet your needs to assist you with living independently.