Payers
Established in 1979 by Public Act 81-202, the Illinois Department on Aging’s Community Care Program helps senior citizens, by providing care in home services who might have otherwise referred to nursing home care.
Are you wondering how to find the personal services that will help you or your loved one stay at home? The Illinois Department of Aging wants you to know that the required assistance is provided through one OF their programs called Community Care Program (CCP). This program is designed to help you remain independent in your own home and keep you out of a nursing home as long as a nursing home is not necessary for you. For more information on Community Care Program services, please contact Illinois Department of Aging’s Senior HelpLine by calling 1-800-252-8966 or 1-888-206-1327 (TTY) Monday to Friday from 8:30 a.m. to 5 a.m. or email aging.ilsenior @ illinois.gov. The Care Coordination Unit (CCU) will assign a care coordinator which is at no cost to you, who come at your home, to discuss, to evaluate, and understand your needs and goals, and help you choose the right services for you. Services include in-home care services, adult day care, flexible senior services, emergency home response services and, in some areas of the state, senior companions. After you qualify for Community Care Program services, the Care Coordination Unit will evaluate your circumstances to confirm your needs, set up services that are suitable for you and communicate with you to make sure the services continue to meet your needs.
You are eligible for Community Care Program services if:
- You are a US citizen or a legal alien;
- You are a resident of the State of Illinois;
- You are 60 or older;
- You meet the asset requirements that will be explained to you when the care coordinator arrives at your home for in-home assessment;
- You are determined to be physically in need of care services, which means you are at least moderately impaired;
Services under the Community Care Program (CCP) are:
- In-home Care Service
- Senior Companion
- Flexible Senior Services
- Emergency Home Response Service
The Division of Rehabilitation Services (DRS) is an rehabilitation agency for seniors working with the Illinois Department of Human Services. The aim of DRS is to help people with disabilities to find and maintain competitive employment. DRS counselors provide assessments, vocational advice and counseling, job development / placement and follow-up services to eligible persons. The DRS works with many community partners to offer various coordinated services. Working with the Home Services program, DRS serves Illinois residents with significant disabilities to remain at home and enjoy life independently as much as possible. Through the Secondary Transitional Experience Program (STEP), DRS provides services to people with disabilities during their high school or transitional years. DRS consumers are empowered to live a self-determined life, to be actively involved in their communities and to keep authority over the services they receive.
Under certain circumstances, state assistance programs may cover the following services:
- Homemaker Services
- Assistive Equipment
- Respite Services
- Home Health Services
- Home Delivered Meals
- Electronic Home Response
- Home Delivered Meals
- Environmental Modifications
- Respite Services
- Brain Injury (BI) Pre-Vocational / Services
- Brain Injury (BI) Supported Employment
- Brain Injury (BI) Behavioral / Cognitive Therapies
- Brain Injury (BI) Habilitation
- Brain Injury (BI) Supported Employment
In order to qualify for state assistance, the following conditions must be met:
- Have applied, cooperated and established a decision on Medicaid eligibility, unless it is already Medicaid or spending.
- Have assets under the asset limit, which is different for individuals under 18 years of age and those over 18.
- Must be under 60 at the time of application, unless in the Medicaid Waiver Program for AIDS or Brain Injury.
- Have a severe disability that ongoing for 12 months or more or for the duration of life.
- Have a doctor approved of the initial care plan.
- Have applied, cooperated and established a decision on Medicaid eligibility, unless it is already Medicaid or spending.
- Be a resident of the State of Illinois with US citizenship or demonstrate proof of legal entry into the United States.
- Require services in the home that cost the same or less than the costs of nursing homes.
The Home Service Program staff will:
- Get a clear and easily identifiable copy of the customer's state of Illinois photo ID or valid driver's license.
- Obtain the necessary information for medical documentation and obtain a doctor's certificate that services are necessary and appropriate
- Develop a service plan and assistance in the search for service providers
- Visit the person at home to discuss eligibility and availability of services.
- Complete the application and carry out financial and non-financial eligibility assessments.
- Provide alternative resources and information on appeals if eligibility is not met.
- Call toll-free: (800) 843-6154 (Voice, English or Español) (800) 447-6404 (TTY). For general questions about DRS, email DHS.ORS@illinois.gov.
With effect on 1 March 2021, ActiveCare Home Care is a participating provider in Community Aging
- Referral Program (CARP) through the Illinois Department for Aging (IDOA).
- CARP is a referral program that uses certified Community Care Program (CCP) providers to secure private pay-in-home care services at the state provider rate.
- In order to qualify for CARP, you must have assets between $17,500 and $35,000.
- To be a CARP participant, you must contact Illinois Department for Aging (IDOA) for a comprehensive assessment and discuss your available community resources.
- You must fill out the CARP form to ActiveCare Home Care to confirm eligibility to receive home care at a discounted state rate of $18.29 per hour.
- CARP participants must pre-pay for two weeks of receiving in-home care services in accordance with a pre-agreement contract.
ActiveCare Home Care also offers private pay services to people who do not qualify for state-funded programs or have acquired long-term care insurance. In order to access our private, non-medical home care, a tailored needs assessment and home safety inspection must be carried out to determine the appropriate care plan for your loved ones. ActiveCare Home Care’s private pay, non-medical home care terms and care options are as follows:
Come and Go hour Minimum:
4 hour per day
Hourly rates starting from
24$/hour
Shower visit/tuck in
per visit 75$
Or contact as at 844-545-CARE(2273) or visit www.activehcare.com
Veterans or their surviving spouse may qualify for the Veterans Administration’s Assistance and Attendance Pension Benefit (A & A). A & A is the highest level awarded to veterans or surviving spouses who need help in daily activities like dressing, bathing, cooking, eating, transfer, incontinence care and grooming. By working closely with community resources, ActiveCare Home Care can help veterans or survivors to submit an application for aid and attendance pension benefits.
Amount of Home Care Services Available:
117 hours
of home care per month for 2 Married Veterans
88 hours
of home care per month for a Couple
48 hours
of home care per month for a Surviving Spouse
74 hours
of home care per month for Veteran
War Periods for Eligibility:
Starting December 7, 1941
Through December 31, 1946
Must have served 90 days active duty
Starting June 27, 1950
Through January 31, 1955
Must have served 90 days active duty
Starting August 5, 1964
Through May 7, 1975
Feb 28, 1961 is the starting date for veterans who served “in country” (Vietnam)
before Aug 5, 1964
Starting August 2, 1990 through an end date to be set by law or Presidential Proclamation
Through December 31, 1946
Must have served 2 years active duty
Requirements
- Qualifying medical costs must exceed the income by 5%.
- Served 90 days in active duty, 1 day in wartime with honorable discharge.
- Must be 60 per cent house bound as certified by a licensed doctor.
Long-term cares the medical, social, rehabilitation or housekeeping services that can be extended over a varying time period to improve or maintain the health of the person. Eligible people can benefit from these services not only in nursing homes, but also in their own homes or even community set-ups like assisted living homes and independent living.
ActiveCare Home Care provide non-medical services in your home or in a residential environment that range from simple light housekeeping to complex, qualified care to maintain or improve the functioning of our clients.
Long-term care insurance can cover our services of personal care, respite care and 24-hour live-in care for clients who meet the eligibility criteria.
In personal care, we offer our clients careful assistance in carrying out the basic activities of Dailiy life, such as bathing, dressing, hygiene, etc. In respite care and 24 hour live-in care, we provide temporary services to look after our clients.
Long-term care insurance takes into account these criteria to qualify for its benefits:
- A chronic disease or cognitive impairment client who is unable to perform at least two activities of daily living (ADLs) without assistance for at least 90 days
- The client may be considered chronically ill and requires considerable supervision in the interest of his health and safety due to cognitive impairment.
Few terms to understand the above-said criteria:
The inability of a client to perform the daily life activities (ADLs) is the most common criterion used by insurance companies to decide whether a client is entitled to benefits. The 6 main scientifically researched ADLs are bathing, dressing, eating, using the bathroom, urinary continence and locomotion. Although most long-term care policies use all six ADLs as benefits triggers, it may be harder to qualify for benefits from a policy that uses five ADLs when the first basic ADL i.e bathing is removed. Therefore, it is always advised to ask your insurance company which ADLs are covered under your policy.
Chronic Illness
Chronic illness is defined as a disease with permanency, residual disability, the requirement for rehabilitation or an extended period of home care supervision, and in-house care. The person may suffer from one or more of the above mentioned traits. While chronically ill is a term that describes a person who needs long-term care at home, either because of an inability to perform daily activities (ADLs) without help or because of severe cognitive impairment. Some long-term care insurance policies pay benefits if the client’s doctor medically confirms home care
Elimination Period/Waiting Period
An elimination or waiting period is the time the long-term care plan owner must pay for covered home care before the insurance company begins to pay. You are entitled to this deduction for a longer period if your plan has a lower premium. So you should always consult your insurance company to understand the elimination period.
Cognitive impairment
Cognitive impairment is a term used to describe deficiency in a person’s short or long term memory, motor coordination, reasoning ability, or making decisions as it relates to safety awareness. Most long-term care plans also pay benefits for “cognitive impairments,” if a client cannot pass certain cognitive impairment tests. Coverage of cognitive impairment is essential when developing Alzheimer’s or dementia.
A managed care organization or MCO is a health care company or health plan that focuses on managed care as a model to lower costs while maintaining a high quality of care for older adults. ActiveCare Home Care is a participating provider for the Integrated Care Program (ICP), as well as for the Medicare Medicaid Alignment Initiative (MMAI) in Illinois.
It’s a plan that helps you save cost by employing high-quality health providers.
ActiveCare Home Care work with the following Managed Care Organizations (MCOs):
In this read you’ll understand what managed care is, how it makes your life more accessible. Finally, what are the types of managed care and which one you can opt for.
What is Managed Care and Managed Care Organizations?
Managed care is a wellness program. It aims to reduce your general health costs and provide high quality of services. Managed health organizations become the means of ideal care management. They help you achieve goals of improved health.
The Medicare Medicaid Alignment Initiative (MMAI) is a effort made by State of Illinois reforming the way care is provided to beneficiaries who qualify for Medicare and Medicaid services (known as dual beneficiaries). The aim of the program is to create a unified delivery system that is easier to navigate for all dually eligible beneficiaries. MMAI provides both medical care and non-medical care, combining them into “home and community-based services” as a single program.
How Can Managed Plan Help Your Health Planning?
1. All-Inclusive Savings
Managed health organizations contract with health providers from various domains. These facilities range from doctors, labs, specialists, hospitals, and many more. This allows you to save extra costs. When services taken from any of the above facilitate.
2. Prevention is Better Than Cure
And as they say, these care plans focus on preventive care plans. Their agenda is to take preventive actions. These actions, include:
- Annual check-ups
- Particular vaccines
- Routine blood screenings.
It helps diagnose disorders before it becomes a big deal. Routine analysis and preventive measures help lower death rates. This allows them to save costs. Helps you to have health better than ever.
Some other features of Managed Care
3. Assurance by Insurance Company
If you are getting surgery, treatments, or any procedures done, it is screed through your insurer. The Insurer decides if your need for procedure is genuine and approves fairly.
4. Prescription Preferences
In case your health plan covers prescription costs, they might have preferences over some type of medication over others. For example, is that they often provide more coverage for generic medicines than the branded ones.
What are the Types Managed Care plans?
Following are some of the basic managed care plans:
1.HMO (Health Maintenance Organization)
They demand low monthly payments. For which they offer fairly quality network providers. Nonetheless, they offer less flexibility. Once opt for HMO, you can’t take services from providers outside the network. 100% preventive care is included.
2. PPO (Preferred Provider Organization)
PPO lets you see providers outside of the network as well. However, they provide more coverage for those inside the network. PPO like HMO focuses on routine check-ups and preventive measures.
3. POS (Point of Service)
These are kind of a combination of HMO and PPO. Unlike HMOs, they require higher individual costs. They share the same goal. This provides in-and-out of the network services, like in PPO.
4. EPO (Exclusive Provider Organization)
EPO’s costs are higher than HMO. Nevertheless, they charge less than PPO.EPO does not pay for service providers out of the network.
You also might want to get familiar with the term PCP (Primary Care Providers). You have to choose PCP before consulting with any specialist or doctor. It helps lead you to your ideal health care.
PPO and EPO do not require PCP to take advantage of their services. On the contrary, POS and HMO require PCP to manage your health plan.