Program Eligibility Determination and Service Planning
Prospective customers, or those representing them, may request services by contacting any one of the Division of Rehabilitation offices around the state, or they may submit a request via a web-based referral for services on the Department of Human Services (DHS) website.
A counselor or case management representative will assess the individual in his or her home and administer the Determination of Need (DON) tool to determine program eligibility. The tool evaluates an individual's care needs and identifies an individual's available resources for meeting those needs. Based on the results of the DON, a service plan is developed jointly with the customer to address his or her unmet needs and to assist the customer in coordinating safe, quality, consumer-directed (when possible) services that are also cost-effective. In order to be eligible to receive HSP services, an individual must:
- Be under age 60 at time of application unless applying for the HIV/AIDS or Brain Injury Waiver Programs. Have a severe disability lasting at least 12 months or for the duration of life.
- Be at imminent risk of nursing facility placement as indicated by receiving a minimum of 29 points on the Determination of Need (DON) eligibility determination tool, with at least 15 points in the "Need for Care" category.
- Require services whose cost will not exceed that of nursing or other health care facility services.
- For customers aged 18 or older, have less than $17,500 in non-exempt personal assets; for customers under age 18, have less than $35,000 in family assets.
- Apply for Medicaid and cooperate with the application process.
- Be a resident of Illinois and a U.S. Citizen or legal resident.
Additionally, given the multiple Medicaid Waiver programs in Illinois, including those through the Department's Division of Developmental Disabilities; individuals who are eligible for more than one waiver are evaluated and assisted in making an informed choice as to which waiver most appropriately meets their needs.
DON Score
(Ave. DON Score= 46.57) |
Number of Customers |
Percent of Customers |
Total Spending |
Percent of Spending |
Average Monthly Cost |
| Under 29 |
390 |
1.2% |
$2,855,114 |
0.3% |
$610 |
| 29-32 |
4,730 |
14.0% |
$73,331,553 |
8.5% |
$1,292 |
| 33-40 |
7,781 |
23.0% |
$153,181,881 |
17.7% |
$1,641 |
| 41-49 |
6,871 |
20.3% |
$159,654,725 |
18.5% |
$1,936 |
| 50-59 |
5,899 |
17.4% |
$163,497,381 |
18.9% |
$2,310 |
| 60-69 |
4,008 |
11.8% |
$134,387,487 |
15.5% |
$2,794 |
| 70-79 |
2,678 |
7.9% |
$104,499,176 |
12.1% |
$3,252 |
| 80-100 |
1,540 |
4.5% |
$73,589,658 |
8.5% |
$3,982 |
| Total |
33,897 |
100% |
$864,996,974 |
100% |
$2,127 |
