Determining Eligibility

In order to qualify for a waiver, members must meet certain eligibility requirements. These include:

  • Be a U.S. citizen or legal alien and a resident of the state of Illinois.
  • Meet Medicaid financial eligibility criteria.
  • Service needs must be able to be provided cost-effectively.

In addition to the above, each waiver also has additional requirements. Below is a chart that outlines the eligibility requirements for each waiver.

Waiver Eligibility Requirements
Aging Waiver Must be 60 years of age or older and meet nursing facility level of care.
Individuals With Disabilities Waiver Must have a physical disability and be between 19-59 years of age and meet nursing facility level of care. This includes adults that are dependent on a ventilator. Those 60 years and older who began waiver services before age 60, may choose to stay within this waiver.
HIV/AIDS Waiver Persons diagnosed with Human Immune Deficiency Virus (HIV), or Acquired Immune Deficiency Syndrome (AIDS), of any age, and meet nursing facility level of care.
Individuals with Brain Injury Waiver Must have a brain injury and meet nursing facility level of care.
Supportive Living Facilities Waiver Must be a person with a disability 22 years and over or be 65 years and over and otherwise would be institutionalized in a nursing facility.

Determination of Need
To qualify for waiver services, members will need to work with a state agency to complete the Determination of Need or DON. This includes a series of questions to assess if the member is able to perform the activities of daily living, the member’s mental acuity, as well as the member’s level of impairment and level of need.

IlliniCare Health does not conduct the Determination of Need. This is done by the Department on Aging or the Department of Rehabilitative Services. However, we may have an IlliniCare Health care coordinator present during a member’s DON assessment.

Once the DON is complete and if the member is eligible for services, a care plan will be created by IlliniCare Health. The care plan includes services that will allow the member to remain safely in the home or a community setting.