Long-Term Care Planning in Illinois: Costs, Medicaid & Your Options (2026 Guide)

Illinois long-term care costs are near or below national averages — assisted living averages $6,219 per month (near the national average of $6,200), nursing home care averages $8,304 per month (approximately 13% below the national average of $9,581), and home care averages $6,864 per month (near the national average of $6,673). Adult day care is available at $1,977 per month. Illinois Medicaid is administered by the Illinois Department of Healthcare and Family Services, with eligibility determined by the Illinois Department of Human Services. Illinois stands out for its $17,500 asset limit — significantly higher than the $2,000 limit in most states — and its Medically Needy spenddown pathway with a unique "pay-in spenddown" option. Notably, Illinois is one of the few states that counts VA Aid & Attendance as income for Medicaid purposes. This guide covers care costs, Medicaid eligibility, and planning options across Chicago, Springfield, Naperville, Rockford, and statewide.

Illinois's Aging Population: The Numbers Behind the Need

Illinois is home to more than 2 million residents aged 60 or older, making it one of the largest senior populations in the Midwest. The Chicago metropolitan area — including Chicago, Naperville, Aurora, Joliet, and Elgin — accounts for the majority of the state's long-term care demand and facility concentration. Significant aging communities also exist in Springfield, Rockford, Peoria, Champaign, and Decatur.

Illinois's geographic diversity — from the dense urban core of Chicago to the rural farmland of central and southern Illinois — creates distinct challenges for long-term care delivery. Downstate communities often have fewer facility options, making home and community-based services and supported living facilities essential for seniors outside the Chicago metro area.

Unpaid Caregivers in Illinois: Scale and Impact

An estimated 1.4 million unpaid family caregivers in Illinois provide care to aging relatives and adults with disabilities. According to AARP research, family caregivers nationwide spend an average of $7,242 per year in out-of-pocket costs related to caregiving.

Illinois's HCBS Waiver for the Elderly (also called the Persons who are Elderly Waiver) offers limited support to help seniors remain living at home, including adult day care, homemaker assistance, automated medication dispensers, and medical alert services. The Supportive Living Program (SLP) provides support for elderly or disabled persons in "supportive living facilities" — similar to assisted living — with services including personal care assistance, housekeeping, laundry, intermittent nursing care, and memory care for persons with Alzheimer's disease and other dementias.

What Long-Term Care Costs in Illinois

Illinois's care costs by type:

• Assisted Living: $6,219 per month — near the national average of $6,200
• Nursing Home (semi-private room): $8,304 per month — approximately 13% below the national average of $9,581
• Home Care (home health aide): $6,864 per month — near the national average of $6,673
• Adult Day Care: $1,977 per month — near the national average of $2,058

At these rates, a three-year nursing home stay in Illinois costs approximately $299,000 — while home care totals roughly $247,000 over the same period. Assisted living, at $6,219/month, totals approximately $224,000 over three years. For a detailed breakdown of care costs by type and how Illinois compares to other states, visit our Illinois Care Costs page.

How to Qualify for Medicaid in Illinois: Eligibility Rules for 2026

In Illinois, Medicaid (commonly called the Medical Assistance Program) is administered by the Illinois Department of Healthcare and Family Services, with eligibility determined by the Illinois Department of Human Services. The state offers Nursing Home Medicaid (Institutional), HCBS Waivers, and Regular Medicaid (Aid to the Aged, Blind, and Disabled — AABD). Consulting with an Illinois elder law attorney or Certified Medicaid Planner early can help families avoid costly mistakes. Eligibility rules vary by program type:

• Nursing Home Medicaid (Institutional): Income limit of $1,304 per month (single) or $1,762 per month (married couple, both applying). All of a beneficiary's monthly income, with the exception of a $60/month Personal Needs Allowance, Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, must go towards nursing home costs — this is called a Patient Liability. Asset limit of $17,500. When only one spouse applies, the non-applicant spouse may retain up to $143,172 in assets (CSRA). This is an entitlement — anyone who qualifies receives benefits.
• HCBS Waivers / Home and Community Based Services: Income limit of $1,304 per month (single); asset limit of $17,500. This is not an entitlement — there are a limited number of participants and waiting lists may exist. Services are intended to delay nursing home admissions and may be provided at home, adult day care, or in supportive living facilities. Based on one's living setting, a beneficiary may not be able to keep monthly income up to this level — persons in supported living residences can only retain $120/month as a Personal Needs Allowance.
• Regular Medicaid / Aid to Aged Blind and Disabled (AABD): Income limit of $1,304 per month (single) or $1,762 per month (couple); asset limit of $17,500. This is an entitlement. Some long-term care benefits, such as personal care assistance or adult day care, may be available. Both spouses' income is counted, and there is no CSMNA or CSRA.

Nearly any income from any source is counted towards the limit, including employment wages, alimony, pension payments, SSDI, SSI, IRA withdrawals, and stock dividends. Unlike the majority of states, Illinois DOES count the VA Aid & Attendance Allowance as income. Holocaust restitution payments are not counted. When only one spouse applies for Institutional Medicaid or an HCBS Waiver, only the applicant's income is counted.

Illinois applies a 60-month (5-year) look-back period for Nursing Home Medicaid and HCBS Waiver applications. Asset transfers during this period can trigger a penalty period of Medicaid ineligibility. The federal $19,000 Gift Tax exclusion (2026) does NOT apply to Medicaid's look-back rules. The look-back period does NOT apply to Regular Medicaid. For the full Illinois Medicaid eligibility breakdown, see our Illinois Medicaid Guide.

Spousal Protections: CSMNA and CSRA in Illinois

When one spouse applies for Nursing Home Medicaid or an HCBS Waiver in Illinois, only the applicant spouse's income is counted. Illinois calls the Spousal Income Allowance the Community Spouse Maintenance Needs Allowance (CSMNA). In 2026, the CSMNA is set at $4,066.50 per month — the federal maximum. If the non-applicant spouse's income is under this amount, income can be transferred from the applicant spouse.

The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain up to $143,172 of the couple's assets (2026). The minimum CSRA is $32,532. For Regular Medicaid, both spouses' income is counted and there is no CSMNA or CSRA.

Illinois Medicaid Programs: SLP, HCBS Waivers, and More

Illinois offers several Medicaid-funded long-term care programs:

• Waiver for Supportive Living Facilities (SLP): Provides support for elderly or disabled persons in "supportive living facilities" (similar to assisted living). Services may include personal care assistance, housekeeping, laundry, intermittent nursing care, and memory care for persons with Alzheimer's disease and other dementias.
• HCBS Waiver for the Elderly: Also called the Persons who are Elderly Waiver. Limited support is provided to help seniors remain living at home. Benefits may include adult day care, homemaker assistance, automated medication dispensers, and medical alert services.
• Medicaid Managed Long Term Services and Supports (MLTSS): Part of the HealthChoice Illinois Program. A managed care program for dual-eligible persons (Medicaid and Medicare). Benefits may include transportation to medical appointments, home modifications, assistance with daily living activities, adult day care, assisted living/memory care services, and more.
• Illinois Medicare-Medicaid Alignment Initiative (MMAI): For dual-eligible individuals, this managed care program streamlines Medicaid and Medicare benefits. HCBS benefits may include physician and dental visits, adult day care, personal care assistance, meal preparation, and housecleaning.
• Money Follows the Person (MFP): Illinois is in the process of implementing this federal program. MFP helps institutionalized Medicaid-eligible persons transition back home or into the community.
• Program of All-Inclusive Care for the Elderly (PACE): Through PACE, the benefits of Medicare and Medicaid, including long-term care, are available via a single program.

Qualifying When Over the Limits: Medically Needy Spenddown

If your income or assets exceed Illinois Medicaid limits, several strategies may help you qualify:

• Medically Needy Spenddown: Illinois has a spenddown program for seniors over the income limit. One can become income-eligible by spending income on medical expenses — medical care, nursing home services, in-home personal care, Medicare premiums, and prescription drugs. The Medically Needy Income Level (MNIL) is $1,304/month for individuals and $1,762/month for couples (eff. April 2025 – March 2026). Illinois also offers a unique "pay-in spenddown" option, allowing one to pay their monthly spenddown directly to the IL Department of Human Services. The medically needy asset limit is $17,500. Illinois does NOT use Qualified Income Trusts (Miller Trusts).
• Asset Spend-Down: Spend excess assets on non-countable items — home modifications (wheelchair ramps, stair lifts), prepaying funeral/burial expenses, and paying off debt. Keep documentation as proof Medicaid's look-back rule was not violated.
• Medicaid Planning: Work with a Certified Medicaid Planner or Illinois elder law attorney to employ legal strategies for eligibility and protect your home from Medicaid's Estate Recovery Program.

Asset Rules: What Counts and What Doesn't

Countable assets in Illinois include cash, stocks, bonds, investments, cryptocurrency, bank accounts (money market, savings, checking), and real estate in which one does not reside. In Illinois, IRAs are also counted as assets — unlike some states that exempt IRAs in payout status. Non-countable (exempt) assets include personal belongings, household furnishings, an automobile, and generally one's primary home (subject to the home equity limit). Irrevocable prepaid funeral burial contracts up to $8,434 are exempt. If funded by a life insurance policy, there is no limit. All assets of a married couple are considered jointly owned regardless of the Medicaid program.

Veterans and Long-Term Care in Illinois

Illinois has a large veteran population, with major military installations including Scott Air Force Base near Belleville and Naval Station Great Lakes north of Chicago. Key VA healthcare facilities include Edward Hines, Jr. VA Hospital in Hines and Jesse Brown VA Medical Center in Chicago. The VA Aid & Attendance benefit provides additional monthly income to veterans and surviving spouses who require assistance with activities of daily living.

Important: Unlike the majority of states, Illinois DOES count VA Aid & Attendance as income for Medicaid eligibility purposes. This means veterans receiving A&A may have higher countable income, potentially affecting Medicaid eligibility. Veterans in Illinois should consult with both a VA-accredited claims agent and an Illinois elder law attorney to coordinate benefits effectively.

For a comprehensive overview of veteran long-term care benefits, see our Veterans Long-Term Care Guide.

Planning Ahead: How to Pay for Nursing Home Care in Illinois

Understanding how to pay for nursing home care in Illinois — or any long-term care setting — requires evaluating multiple funding sources. With nursing home costs at $8,304/month, a 5-year look-back period, and an unusually high $17,500 asset limit, Illinois offers both advantages and challenges for Medicaid planning. Key steps include:

• Understanding your current financial position relative to Illinois Medicaid eligibility thresholds — the $17,500 asset limit is significantly higher than most states
• Evaluating the Medically Needy spenddown pathway or the "pay-in spenddown" option if income exceeds $1,304/month (single)
• Knowing that IRAs are counted as assets in Illinois — unlike states that exempt IRAs in payout status
• Exploring the Supportive Living Program (SLP) and HCBS Waiver for the Elderly to remain at home or in a community setting
• Considering MLTSS (HealthChoice) or MMAI if eligible for both Medicare and Medicaid
• Being aware that Illinois counts VA Aid & Attendance as income — coordinate VA and Medicaid benefits carefully
• Researching Illinois long-term care insurance options while still healthy enough to qualify
• Consulting with an Illinois elder law attorney or Certified Medicaid Planner to protect assets and avoid look-back penalties

Estate Recovery: Protecting Your Home in Illinois

Illinois operates a Medicaid Estate Recovery Program, which allows the state to seek reimbursement from a deceased Medicaid beneficiary's estate for long-term care costs paid by Medicaid. The primary home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.

If none of these conditions are met, Illinois uses a home equity interest limit of $730,000 (2026). Home equity is the value of the home minus any outstanding debt; equity interest is the amount of equity owned by the applicant. If neither the applicant nor qualifying family lives in the home, the applicant must have Intent to Return. There is no home equity interest limit for Regular Medicaid. The home is NOT exempt from Medicaid's Estate Recovery Program — after a beneficiary's death, the IL Medicaid agency attempts reimbursement of care costs through the deceased's estate.

Regional Cost Variations Across Illinois

While Illinois's statewide averages are $6,219/month for assisted living, $8,304/month for nursing home care, $6,864/month for home care, and $1,977/month for adult day care (CareScout 2025), costs vary by region. The Chicago metropolitan area — including Chicago, Naperville, Aurora, Joliet, and Elgin — has the highest concentration of care facilities and the highest costs, driven by demand and cost of living. Families searching for assisted living in Chicago IL, nursing homes in Naperville, or memory care in Aurora will find the Chicago metro is the state's most competitive and costly market.

Central Illinois — Springfield, Champaign, Peoria, and Decatur — generally has lower costs than the Chicago metro. Southern Illinois — including the Belleville/O'Fallon area near Scott AFB — may offer the most affordable care options in the state but has fewer facility choices. The key takeaway: Illinois's below-average nursing home costs and high $17,500 asset limit provide planning advantages, but the Chicago metro's higher costs and the state's treatment of VA A&A as income require careful navigation.

For a detailed cost breakdown and interactive calculator, visit our Illinois Care Costs page.

Application Timeline and Process

Illinois Medicaid applications can be submitted online through ABE (Application for Benefits Eligibility) at abe.illinois.gov, by calling the IDHS Customer Help Line at 1-800-843-6154, by submitting a completed paper application (IL444-2378 B), or in person at a local Illinois Department of Human Services (IDHS) office. Processing typically takes 45 to 90 days.

Common reasons for application delays or denials include incomplete financial documentation, unreported asset transfers within the look-back period, and assets exceeding the $17,500 threshold. Before submitting an application, it is vital that seniors be certain all eligibility requirements are met. If one does not meet the income and/or asset limit(s), Medicaid Planning is strongly suggested.

Federal Policy Update: One Big Beautiful Bill Act (OBBBA)

The One Big Beautiful Bill Act (OBBBA), currently under congressional consideration, proposes significant reductions to federal Medicaid funding — potentially exceeding $1 trillion over ten years. If enacted, these cuts could directly impact Illinois's Medicaid programs. Nursing Home Medicaid, as an entitlement, is largely protected from future funding cuts. However, Home and Community Based Services (HCBS) — including the SLP, HCBS Waiver for the Elderly, MLTSS, and MMAI — are likely to be targeted, potentially leading to reduced service hours, tighter eligibility requirements, or longer waiting lists.

Potential consequences for Illinois families include reduced SLP and Waiver service availability, longer waits for HCBS enrollment, and increased pressure on the state's estimated 1.4 million unpaid family caregivers. Families planning for long-term care in Illinois should consider these policy risks when evaluating their timeline for Medicaid applications and alternative funding strategies.

Last updated: September 2026 | Sources: CareScout 2025, Illinois Department of Healthcare and Family Services, Illinois Department of Human Services, AARP, U.S. Census Bureau