Memory Care in Illinois

Table of Contents

Memory Care in Illinois

Table of Contents

• The Cost of Memory Care in Illinois
• Illinois Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in Illinois?
• More Ways To Pay for Memory Care in Illinois
• Memory Care Laws and Regulations in Illinois
• Free and Low-Cost Resources for Seniors in Illinois
• Illinois COVID-19 Rules for Memory Care Facilities

Because of the specialized staff training and resources required to provide high-quality memory care, memory care typically costs more than other types of residential care. On average, memory care will cost 20-30% more than assisted living.

To calculate the cost of memory care in Illinois, we've added 25% to the cost of assisted living reported in the 2021 Genworth Cost of Care Survey. When it comes to the state average, Illinois, at $5,610, is just $15 below the U.S. average. Nearby in Wisconsin, seniors pay a little more at $5,750 per month, while in Indiana, Iowa and Missouri, costs for memory care are lower at $5,354, $5,459 and $3,750, respectively.

The cost of memory care varies depending on where in the state seniors receive care, as well as the services and amenities provided. While Chicago's seniors pay an average of $6,031 monthly, those in Decatur pay far less, as the average cost here is just $5,478 per month. In Rockford, the average cost of memory care is $6,563 per month, which is the highest cost in the state.

Illinois Medicaid provides health insurance for low-income seniors and disabled individuals residing throughout the state. While regular Medicaid only covers the cost of institutional care, such as that provided in nursing homes, managed care programs and waivers that amend the program's coverage limitations are available to help seniors access safe and affordable memory care services.

• Who Is Eligible: To qualify for Medicaid as a senior, applicants must be aged 65 or older with an annual household income not exceeding $18,755 annually, or $25,268 for couples.
• How To Apply: To apply for Medicaid in Illinois, seniors can complete their application online or contact the Application for Benefits Eligibility hotline at (800) 843-6154.

Healthchoice Illinois

Healthchoice Illinois is the state's managed Medicare plan. It provides long-term support, along with other necessary health care services, for seniors aged 65 and older. All care is coordinated by a dedicated case manager who can help seniors find doctors, specialists and other important resources. 

• Who Is Eligible: Healthchoice Illinois is open to seniors who are eligible for Medicaid, including those who are dually eligible for Medicaid and Medicare.
• How To Apply: Applications for Healthchoice Illinois can be completed and submitted online.

Illinois Medicaid-Medicare Alignment Initiative

The Medicare-Medicaid Alignment Initiative is a managed care program that's open to seniors with full Medicaid and Medicare benefits. It streamlines the services provided by both plans, helping seniors combine coverage to access care more easily. Thanks to this program, seniors can access services such as memory care and personal care while residing in a long-term care facility. 

• Who Is Eligible: This plan is only open to seniors who participate in both Medicaid and Medicare and live within the service area, which includes Central Illinois and the Greater Chicago Area.
• How To Apply: Seniors who wish to enroll in this program can contact the Medicare-Medicaid Alignment Initiative by calling (877) 912-8880.

Illinois Supportive Living Program

The Illinois Supportive Living Program helps low-income seniors who require a nursing home level of care but prefer to remain in assisted living. It offers funding for the services provided in assisted living or memory care facilities, including personal care, housekeeping services, medication management and social and recreational activities. However, seniors participating in this program must pay their own room-and-board expenses.

• Who Is Eligible: This program is open to seniors who are Medicaid-eligible and require a nursing home level of care. Furthermore, those wishing to participate in this program must be able to reside safely within an assisted living or memory care facility. This program has income limitations, and as such, some seniors may be placed on a waiting list upon approval.
• How To Apply: Applications are processed by the Department of Healthcare and Family Services, Bureau of Long-term Care. Seniors can start their applications by calling this department at (844) 528-8444.

Medicaid Eligibility for Seniors in Illinois

Seniors in Illinois are subject to maximum income and asset limits to qualify for Medicaid coverage. While a single applicant can't earn more than $18,755 per year, those coming from a two-person household, whether applying independently or together, are subject to an annual household income limit of $25,268. Assets are counted as well in consideration for Medicaid eligibility. A single applicant can't own more than $2,000 in countable assets, while applicants in two-person households applying together are limited to $3,000 in countable assets.

2022 Medicaid Income Limits for Seniors in Illinois

In addition to the above income limits, seniors must also meet the following requirements to qualify for Medicaid: 

• Be aged 65 or older or qualify as legally blind or disabled
• Be a U.S. national, citizen, permanent resident or legal alien
• Permanently reside in Illinois

How To Get Help Applying For Medicaid in Illinois

Assistance programs are available to Illinois seniors who need help navigating the Medicaid application process.

Unfortunately, Medicare does not generally cover the cost of Memory Care. Most Memory Care Facilities are considered to be "social settings," so Medicare does not cover the cost incurred in these facilities. The only exception to that is if you are receiving memory care services in a Nursing Home. While this situation is much less common, Medicare would sometimes cover the cost, depending on a number of circumstances.

That being said, Medicare does still cover qualified doctor visits, medications, etc., as it would if you were still at home, but it will not cover the cost of care received at the Memory Care Facility.

In addition to the state programs mentioned above, those looking for resources to finance memory care may consider:

• Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. It's best to sign up for a policy early, as coverage will likely be denied if one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at longtermcare.acl.gov.
• Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loans will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
• Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs such as memory care. More information about these programs can be found on the VA website.

Memory Care Regulation

In Illinois, memory care is provided in assisted living facilities, which are classified as assisted living establishments, shared housing establishments and supportive living facilities, depending on the accommodations they provide and how they’re funded. The Illinois Department of Public Health licenses and monitors assisted living and shared housing establishments, and the state’s Department of Healthcare and Family Services governs supportive living facilities, which are Medicaid-approved residential settings for low-income adults.

Assisted living facilities that provide care for adults with Alzheimer’s disease and other forms of dementia through special care units or freestanding centers are required to disclose this information to their governing agency as well as the resident or their representative.

Information that must be provided in writing includes:

• Their dementia treatment philosophy
• What distinguishes the facility as appropriate for residents with dementia
• Its preadmission, admission and discharge procedures
• How care needs are assessed and care plans implemented
• Its minimum and maximum staffing ratios
• Its physical environment
• The types of activities it provides
• The degree and nature of family involvement and the cost of memory care

Facility Scope of Care

Memory care facilities located within assisted living or shared housing establishments are required to provide services, including housekeeping, laundry, security, emergency response systems and assistance with four or fewer activities of daily living. Residents may contract with home health agencies for care beyond what is provided by the facility. Additionally, facilities are required to provide at least 1.4 hours of services daily for each memory care resident.

In supportive living facilities, residents receive a wide scope of personal and health-related services. These include personal care, medication management and assistance with self-administration, social, recreational and exercise programs, emergency call systems, monitoring by a 24-hour security staff, emergency call systems, health referrals, transportation services, daily checks and maintenance services. Nursing services must also be provided, including assessments, short-term medication administration assistance for self-administered medications and health counseling.

Admissions Requirements

To be admitted to a facility that offers memory care, adults must be at least 22 years old, and their care needs must fall within the scope of care provided by the facility.

Seniors who aren’t eligible for admissions include those who:

• Pose a threat to others or themselves
• Are unable to communicate their needs
• Need total assistance with two or more or partial assistance with five or more activities of daily living
• Require more than minimal assistance with moving to a safe area in the event of an emergency
• Are diabetics that require routine insulin injections by a licensed healthcare professional or require routine sliding scale insulin injections

Care Plan Requirements

Prior to admission to an assisted living or shared housing establishment, a prospective resident must receive a comprehensive assessment by a physician to evaluate their physical, cognitive and psychosocial condition. At least one specified tool, including the Functional Activities Questionnaire, the Functional Assessment Staging and the Clock Drawing Test, must be used to assess the prospective resident’s stage in the Alzheimer’s disease process.

In supportive living facilities, residents receive an initial assessment within 24 hours of admission and a comprehensive assessment within two weeks of admission by a licensed practical or registered nurse.

Medication Management Requirements

Memory care facilities may provide medication reminders to residents and supervise the taking of self-administered medication, as well as medication administration by a licensed healthcare professional employed by the facility as an optional service.

Medication has to be stored in its original container in a locked cabinet, container or room that is inaccessible to residents. A separate medication record must be maintained for each resident that includes their name; the name, dosage, directions and route of administration of the medication; the date and time of when the medication is supposed to be given; what time it’s actually given and the signature or initials of the employee who administered the medication.

Facility Requirements

Facility requirements for memory care facilities vary depending on whether they’re located within an assisted living establishment, a shared housing establishment or a supportive living facility.

In assisted living and shared housing establishments, each unit must have a bathroom with an operational toilet, sink, mirror, bathing facilities, a means of ventilation and assistive devices as necessary. Additionally, each unit in an assisted living establishment must be able to accommodate small kitchen appliances.

In supportive living facilities, units licensed on or after October 18, 2004, must have a full bathroom, lockable doors, emergency call systems, a kitchenette with a sink, microwave or stove and a refrigerator and a separate bedroom for each occupant.

Staffing Requirements

In assisted living and shared housing establishments, the manager and a sufficient number of staff members must have the qualifications, education, skills and experience to meet memory care residents’ around-the-clock scheduled and unscheduled needs.

In supportive living facilities, there must be at least one licensed nurse on-site at all times to provide medication management services, and there must be at least one CNA on each shift per 10 residents.

Medicaid Policy

Services in supportive living facilities are covered by Medicaid’s Supportive Living Program waiver program. Medicaid does not pay for services provided in assisted living or shared housing establishments.

Reporting Abuse

Assisted living and shared housing establishments are required to report suspected abuse, neglect or financial exploitation to the Department of Public Health within 24 hours after receiving the allegation, and they must investigate and develop a written report within two weeks of the initial report. Supportive living facilities must report suspected abuse to the Department of Healthcare and Family Services. Abuse can also be reported to the regional ombudsman, through the Senior HelpLine or to the Illinois State Police Medicaid Fraud Unit.

Several free and low-cost resources are available to provide help and support for Illinois seniors who live with dementia and Alzheimer's.

Note: The following information was compiled and most recently updated on 2/7/2022. Since COVID-19 is a rapidly evolving crisis, be sure to contact your Memory Care Facility or local Area Agency on Aging for the most up-to-date information.