Section 682.10  General Applicability

 

In order to receive services through HSP, an individual must meet all non-financial eligibility criteria and financial eligibility criteria as listed in this Part.

 

Section 682.100  General Eligibility Criteria

 

In order to receive services through HSP a customer must:

 

a)         be a citizen of the United States, or be an individual who is living permanently in the United States after having been legally admitted;

 

b)         have applied for, be a recipient of, or be found eligible for Medicaid benefits through HFS and within 60 days after the date of application for HSP, the HSP staff must have verification of the aforementioned.  HSP staff shall seek to obtain this verification through the Integrated Eligibility System (IES) or another HFS system that provides verification of Medicaid Status.  Customers may need to provide this verification, if HSP staff is unable to verify through other means.  Customers may be found eligible for Medicaid and be placed on Spend Down.  However, a customer is not required to meet the eligibility criteria for Medicaid to receive benefits, nor is Medicaid eligibility or verification of application required to receive Interim Services (see 89 Ill. Adm. Code 682).  The customer must agree to apply for Medicaid, and cooperate with HFS, to receive Interim Services. Customers having applied for HSP services prior to October 1, 1991 may choose to apply for Medicaid;

 

c)         be a resident of the State of Illinois;

 

d)         be under the age of 60 at the time of application for HSP services, unless the individual is applying for services under the HSP AIDS Medicaid Waiver or under the HSP Brain Injury Medicaid Waiver, in which case there is no age criteria for application;

 

e)         have a severe disability that is expected to last for at least 12 months or for the duration of life;

 

f)         be an individual with a disability who is in need of long-term care, as determined by the DON score completed as a result of a prescreening (89 Ill. Adm. Code 679) or application for HSP services.  In order to be determined to have met this criteria, the individual must receive a DON score of at least 15 points on part A, which includes, if applicable, the 10 points from the Mini-Mental Examination, with a total DON score of at least 29 points; and

 

g)         not require in-home services that are expected to cost more than the cost the State would pay for institutional care for an individual with a similar DON score.

 

(Source:  Amended at 48 Ill. Reg. 3165, effective February 16, 2024)

 

Section 682.200  Assets Limitation

 

a)         Adult Customers, age 18 years or above, may have no more than $17,500 in Customer-only non-exempt assets in order to receive services through HSP.

 

b)         Minor Customers, those under 18 years, may have no more than $35,000 in total family non-exempt assets.  In order to determine total family assets, the Customer and all other individuals who contribute to the family unit, or rely on the family unit for support, shall be counted.

 

c)         A married Customer, whose spouse does not receive HSP services and is not institutionalized, shall not own interest in non-exempt assets having a total value in excess of $17,500.  Non-exempt assets having a value over this figure and up to the amount allowed by the Community Spouse Asset Allowance, as adopted by the Illinois Department of Healthcare and Family Services (HFS) at 89 Ill. Adm. Code 120.379(d), must be transferred to, or for the sole benefit of, the community spouse.  If the Customer's assets exceed the asset disregard and prevention of spousal impoverishment amount, but the excess is less than $17,500, the Customer is eligible for HSP services.  If the excess is greater than $17,500, the individual is ineligible for services.  Customers who may be qualified for the spousal impoverishment exception may receive Interim Services while HFS determines the eligibility factor.

 

(Source:  Amended at 43 Ill. Reg. 2122, effective January 24, 2019)

 

Section 682.210  Transfer of Assets

 

a)         Any transfer or sale of non-exempt assets which occur within the time periods specified in this Section shall be used in determining the individual's assets for the purpose of Section 682.200.

 

b)         Transfers involving a trust shall be considered as an asset unless the transfer occurred 60 months prior to the individual's application for services.

 

c)         If an individual applying for services has transferred or sold non-exempt assets within the last 36 months prior to application for services, he/she must verify that he/she received fair market value for the assets.  Fair market value is the worth on the open market of the asset, at the time it was transferred or sold.  If less than fair market value was received, the difference between the amount received for the asset and the fair market value of the asset will be used in determining the individual's assets for the purpose of Section 682.200.

 

d)         The transfer or selling of non-exempt assets at the time of application or while an individual's Home Services Program case file is open will result in the fair market value of the asset being used in determining the individual's assets for the purposes of Section 682.200.

 

(Source:  Amended at 22 Ill. Reg. 2226, effective January 12, 1998)

 

Section 682.220  Exempt Assets

 

For the purpose of determining the amount of the individual's assets, as described in Section 682.200, the following assets shall be considered to be exempt and not counted:

 

a)         the individual's primary residence, including its furnishings and contents and all contiguous property on which it is situated;

 

b)         vehicles, except those used primarily for recreation;

 

c)         personal property;

 

d)         resources, including, but not limited to, land, buildings and equipment, supplies, or tools used in business or agricultural income-producing operations;

 

e)         life insurance including:

 

1)         group life insurance held as a condition of employment or provided by an employer;

 

2)         a prepaid burial plan with a value of up to $1,500; or

 

3)         any life insurance policy with cash value, or redeemable face value of $2000, or less;

 

f)         the principal of a trust if the trust document establishing the trust specifically states the principal cannot be impaired.  HSP administration must be involved in any determination involving trust funds;

 

g)         In the case of a minor customer (Section 682.200(b)), the parents' pension funds are exempt assets.  "Pension funds" are defined as funds held in individual retirement accounts (IRA) or in work-related pension plans or plans for self-employed individuals; and

 

h)         an approved Achieving a Better Life Experience (ABLE) account under the State Treasurer Act [15 ILCS 505/16.6], 26 USCA 529A, and 74 Ill. Adm. Code 722.

 

(Source:  Amended at 45 Ill. Reg. 9033, effective June 29, 2021)

 

Section 682.230  Assets Held in Joint Ownership

 

a)         If an asset is held in joint ownership with a non-spouse, the percentage of the asset owned by the individual shall be used to determine the value of the customer's share.

 

b)         All assets of spouses will be considered joint assets and the value divided equally unless a written legal agreement exists which designates the asset(s) to the other partner.  In the case where a legal agreement exists, only the assets shared in common shall be considered.

 

(Source:  Amended at 20 Ill. Reg. 6307, effective April 18, 1996)

 

Section 682.240  Income Allowances (Repealed)

 

(Source:  Repealed at 24 Ill. Reg. 7724, effective May 12, 2000)

 

Section 682.250  Cost Sharing Provisions (Repealed)

 

(Source:  Repealed at 24 Ill. Reg. 7724, effective May 12, 2000)

 

Section 682.260  General Exceptions to Cost Share Provisions (Repealed)

 

(Source:  Repealed at 24 Ill. Reg. 7724, effective May 12, 2000)

 

Section 682.300  Effect of Other Services on HSP

 

a)         A customer cannot receive services through the HSP if he/she is receiving services through any other agency's home care program if that agency will seek reimbursement for those services through a Medicaid Waiver.

 

b)         A customer receiving services through a program described in subsection (a) above must terminate those services prior to the time any services may be provided through the HSP, pursuant to Medicaid regulations.

 

(Source:  Amended at 23 Ill. Reg. 3981, effective March 19, 1999)

 

Section 682.400  Redetermination Requirements

 

All Customers who want to continue receiving services through the HSP must have their eligibility redetermined and must continue to meet all eligibility criteria stated in Subparts B and C of this Part.

 

(Source:  Amended at 43 Ill. Reg. 2122, effective January 24, 2019)

 

Section 682.410  Redetermination Time Frames

 

a)         Any Customer served under the Medicaid Waiver for Persons with Physical Disabilities shall have his/her eligibility redetermined whenever there is a change in his/her condition or situation that may affect his/her continued eligibility, but if no such change, at least every 12 months.

 

b)         Any Customer served under the Medicaid Waiver for Persons with HIV/AIDS shall have his/her eligibility redetermined whenever there is a change in his/her condition or situation that may affect his/her continued eligibility, but if no such change, at least every 12 months.

 

c)         Any Customer served under the Medicaid Waiver for Persons with a Brain Injury shall have his/her eligibility redetermined whenever there is a change in his/her condition or situation that may affect his/her continued eligibility, but if no such change occurs, at least once every 12 months.

 

(Source:  Amended at 43 Ill. Reg. 2122, effective January 24, 2019)

 

Section 682.500  Exceptions to Eligibility Standards

 

A Customer who was receiving planned services through HSP prior to July 17, 1983, and has remained in a continuous active status since that time, and meets the current minimum DON point requirements may:

 

a)         have a planned service cost above the SCM established for that Customer's DON score as established July 17, 1983; and

 

b)         have more than $17,500 in non-exempt, Customer-only assets.

 

(Source:  Amended at 43 Ill. Reg. 2122, effective January 24, 2019)

 

Section 682.510  Exceptions to Cost Sharing Provisions (Repealed)

 

(Source:  Repealed at 24 Ill. Reg. 7724, effective May 12, 2000)

 

Section 682.520  Exceptions to Service Cost Maximums

 

a)         If the established SCM for a case is exceeded due to a DHS-ORS approved  provider rate increase, the customer may continue to receive the same amount of services even though the SCM will be exceeded.

 

b)         If an increase in services is indicated, services must stay within the established SCM for the case, regardless of the impact of provider rates.

 

c)         Cases involving ventilator dependent customers and other customers with exceptional care needs whose need for care cannot be met by the SCM may have a rate established by Department of Public Aid (DPA) per 89 Ill. Adm. Code 684.70(c).

 

(Source:  Amended at 24 Ill. Reg. 7724, effective May 12, 2000)