Illinois’ Medicaid Long Term Care Eligibility Rules

Illinois Medicaid Long Term Care Eligibility Rules


In January, 2012, new regulations became effective in Illinois substantially changing eligibility for Medicaid coverage of long-term care. Although effective in January, the local offices of the Illinois Department of Human Services, the agency making determinations of eligibility for Medicaid, did not implement these new regulations until July, 2012. Additionally, in June of 2012, Governor Quinn signed into law Medicaid reform, the STAMP Act, which also made several significant changes to eligibility for Medicaid long term care coverage. Both the new regulations and the STAMP Act were implemented on July 1, 2012. Highlighted below are the most significant changes to eligibility for long term care Medicaid coverage.

The Medicaid Long Term Care Coverage “Look Back” is Extended to 60 months

To qualify for Medicaid coverage for nursing home, supportive living, or the community care program, an applicant is required to document that they did not make any transfers of assets for purposes of qualifying for Medicaid during the applicable “look back” period. Until January, 2012, the look back period was 36 months. The regulations effective in January, 2012, changed the look back to 60 months. However, it was not implemented until July, 2012.

All applicants for Medicaid long term care coverage who filed on or after July 1, 2012, are required to produce monthly statements for all assets held during the 60 months prior to the date of the Medicaid application.

All Non-Allowable Transfers Made During the 60 Month Look Back are Aggregated for Purposes of Determining a Penalty Period of Ineligibility for Medicaid

Regulations effective in January, 2012, changed the method by which the Department penalizes an applicant for long term care Medicaid who transferred assets during the look back period. Unlike prior regulations, the new regulations require the Department to add together all transfers made during the look back period and use the total amount when calculating the penalty caused by the transfer. These new regulations were not implemented at the local office level until July, 2012.

A Non-allowable Transfer Made During the 60 Month Look Back Results in Future Ineligibility for Long-Term Care Medicaid coverage

The Department imposes a penalty period of ineligibility for Medicaid coverage for any non-allowable transfers which occur during the look back period. Under prior regulations, the penalty period began with the month of the non-allowable transfer. Under new regulations, the penalty period, consisting of a number of months and partial months of ineligibility for Medicaid, does not begin until the month that the applicant is receiving long term care services and is eligible for Medicaid based upon an application which is approved but, except for the imposition of the penalty period. In other words, a person who gave away assets does not begin the penalty period of non- eligibility for Medicaid until they are receiving nursing home care, supportive living or community care services, and have no assets other than Medicaid exempt assets.

For example, Mary Smith, in December of 2011, gave each of her two children $12,000.00 In April of 2012, she gave each of her 4 grandchildren $3000.00 She lives in a nursing home costing $6000.00 per month and applies for Medicaid, and is determined eligible (but for the penalty period) in July, 2012. Under the old rules, Mary would have incurred a four month penalty ($24,000.00 ÷ $6000.00 = 4) for the gifts to her children in

December of 2011, beginning in December, 2011, and expiring March, 2011. She would have incurred a 2 month penalty ($12,000.00 ÷ $6000.00 = 2) for the gifts to her grandchildren in April, 2012, beginning in April and expiring in May, 2012.

This information is not to be considered legal advice.  If you have questions about it, please contact us.

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