III. Level of Care/Programmatic Eligibility for DD Waivers

For all three waivers, individuals are assigned an Independent Service Coordination (ISC) agency; the ISC agency is located in the geographic area in which the individual resides and is the designated ISC agency for that individual. All individuals receive assistance in directing their services from an Independent Service Coordination (ISC) Agency under contract with the Illinois Department of Human Services, Division of Developmental Disabilities. The ISC serves as an advocate and case manager. ISC's also assist the individual and family with ensuring necessary eligibility screenings are completed and identifying and selecting potential services and service providers.

A DHS designated Independent Service Coordination (ISC) Agency screens applicants for Medicaid HCBS waiver programs; screening includes determining clinical eligibility and offering informed choice of services. Please see the Pre-Admission Screening (PAS) Manual for guidance on clinical eligibility determinations.

Clinical eligibility criteria are also known as level of care criteria for HCBS Waiver funding. As part of the waiver eligibility determination process, individuals must be evaluated to determine level of service needs.

ISC agency staff completing initial level of care evaluations (as Pre-Admission and Screening) and re-evaluations must be a Qualified Intellectual Disability Professional (QIDP) as defined in Federal ICF/DD Regulations.

The ISC/QIDPs:

Must inform individuals and/or their guardian, if applicable, about their options during the level of service determination process.
The QIDP presents individuals and/or guardian, if applicable, with all service options, including both Waiver and ICF/DD services the individuals are eligible to receive, regardless of availability, in sufficient detail so they are able to make informed choices.
The QIDP is not permitted to make recommendations regarding where services and supports should be provided or by which provider.
The QIDP provides the individuals, and/or guardians, if applicable, with additional information and materials on the service options they choose to pursue and arranges for and facilitates conversations with potential service providers.
For each individual determined eligible for the waiver, the QIDP must complete Choice of Supports and Services (IL462-1238)PDF.
This form specifically documents the individual's and/or guardian's, if applicable, decision to choose waiver services as an alternative to ICF/DD services. This form also states that choice of supports and services may be changed in the future and must be signed by the individual and/or guardian, if applicable.

A. Eligibility Criteria by Waiver Program

Waiver for Adults with Developmental Disabilities
1. Individuals must be aged eighteen or older.
2. Individuals must be a resident of Illinois living in Illinois.
3. Individuals must be enrolled in Medicaid in Illinois.
4. Individuals must be determined to have an intellectual disability or a related condition as defined by 42 CFR 483.102 (b) (3) and 435.1010.
5. Individuals must be determined to need Active Treatment as defined by 42 CFR 483.440(a).
6. Individuals must not be in need of nursing assessment, monitoring intervention, and supervision of their condition or needs on a 24-hour basis.
7. Individuals receiving other services (i.e., nursing facility, skilled nursing facility, Intermediate Care Facility for individuals with Developmental Disabilities (ICF/DDs), state-operated facility, skilled nursing facility for pediatrics, hospice facility, sheltered care or hospital) must be prepared to move to an appropriate setting prior to receiving Developmental Disability (DD) waiver-funded services.
8. Individuals must not be receiving services funded through another Medicaid waiver program at the time DD waiver-funded services are authorized. This includes the Division of Rehabilitation Services Home Services Program, the Department on Aging Community Care Program, the University of Illinois Division of Specialized Care for Children Technology Dependent/Medically Fragile Children's Waiver Program, and the Supportive Living Facility Program (SLF). If receiving other waiver services, the individual must terminate the other waiver services and choose the Adult Waiver prior to, and as a condition of receiving DD waiver services.
Children's Support Waiver Criteria
1. Individuals must be between the ages of 3 and 21.
2. Individuals must reside at home with their families.
3. Individuals must be a resident of Illinois living in Illinois.
4. Individuals must be or become enrolled in Medicaid in Illinois.
5. Individuals must be determined to have an intellectual disability or a related condition as defined by as defined by 42 CFR 483.102 (b) (3) and 435.1010.
6. Individuals must be determined to need Active Treatment as defined by 42 CFR 483.440(a).
7. Individuals must not be a ward of the State.
8. Individuals must not be in need of nursing assessment, monitoring, intervention, and supervision of their condition or needs on a 24-hour basis.
9. Individuals must not be receiving services in a long-term care facility or hospital. If receiving services in a long-term care facility or hospital, be prepared to move to an appropriate setting prior to receiving Developmental Disability waiver-funded services.
10. Individuals must not be receiving services funded through another Medicaid waiver program at the time Developmental Disability waiver-funded services are authorized. This includes the Division of Rehabilitation Services Home Services Program and the University of Illinois, Division of Specialized Care for Children Technology-Dependent/Medically Fragile Children's Waiver Program.
11. If receiving other waiver services, the individual must terminate the other waiver services and choose the Children's Support Waiver prior to and as a condition of receiving Developmental Disabilities Waiver services.
Children's Residential Waiver Criteria
1. Individuals must be between the ages of 3 and 21.
2. Individuals must be a resident of Illinois living in Illinois.
3. Individuals must be or become enrolled in Medicaid in Illinois.
4. Individuals must be determined to have an intellectual disability or a related condition as defined by as defined by 42 CFR 483.102 (b) (3) and 435.1010.
5. Individuals must be determined to need Active Treatment as defined by 42 CFR 483.440 (a).
6. Individuals must not be a ward of the State.
7. Individuals must be assessed as eligible for ICF/DD level of service.
8. If a related condition, have substantial functional deficits in three out of six major life areas.
9. Individuals must be in need of Children's Residential Waiver supports.
10. Individuals must not be in need of nursing assessment, monitoring, intervention and supervision of their condition or needs on a 24-hour basis.
11. Individuals must not be receiving services in a long-term care facility or hospital. If receiving services in a long-term care facility or hospital, be prepared to move to an appropriate setting prior to receiving Developmental Disabilities (DD) waiver-funded services.
12. Must not be receiving services funded through another Medicaid waiver program at the time DD waiver-funded services are authorized. This includes the Division of Rehabilitation Home Services Program and the University of Illinois, Division of Specialized Care for Children Technology-Dependent/Medically Fragile Children's Waiver Program.
13. If receiving other waiver services, the individual must terminate the other waiver services and choose the Children's Residential Waiver prior to and as a condition of receiving DD waiver services.