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Elizabeth M. Whitehorn, Director

Provider Notice issued 08/21/14

Affordable Care Act (ACA) Adults and Long Term Care Supports and Services (LTSS)

​To: All Medical Assistance Providers​
​Date: ​August 21, 2014
​Re: ​Affordable Care Act (ACA) Adults and Long Term Care Supports and Services (LTSS)

This Notice informs all Medical Assistance Providers that the new population eligible under the ACA Adult program (adults 19 through 64 years of age) in Illinois are eligible to receive, if qualified, LTSS, including nursing home care; services in an Intermediate Care Facility for Individuals with Developmental Disabilities (ICF/IDD); or services provided through the Home and Community-Based Services (HCBS) waivers under subsection 1915(c) of the Social Security Act.

ACA Adults who need LTSS must meet functional screening requirements to verify the need for care.

ACA Adults are not required to pay for the cost of their care when residing in a Long Term Care (LTC) facility. However, Supportive Living Program (SLP) residents must pay the facility for their room and board costs.

ACA Adults receiving LTSS are not allowed to divert income to their spouse or children who live in the community.

ACA Adults do not have to provide information about current resources for medical eligibility, although must complete HFS 3654, Additional Information for Long Term Care Applicants (pdf) to be eligible for LTSS. Failure to submit the completed form will result in a denial for LTSS and no payment from the Department of Healthcare and Family Services, but does not affect eligibility under the ACA Adult program.

Providers should verify eligibility for all recipients, and electronically enter LTC admissions or other changes, through the Medical Electronic Data Interchange (MEDI) System.

If you have questions, contact the Bureau of Long Term Care (217)782-0545.

 

Theresa A. Eagleson, Administrator

Division of Medical Programs