LTSS Eligibility

In order to qualify for the Blue Cross Community MMAI (Medicare-Medicaid Plan)SM LTSS program, you must be eligible for a Home and Community Based Service (HCBS) waiver program or the Nursing Facility program.

We do not decide if you are eligible for these programs. Instead, either the Department on Aging or the Department of Rehabilitative Services will. The following are some of the eligibility requirements — you must:

  • Be a resident of the state of Illinois
  • Be a citizen of the United States or a legally-admitted immigrant
  • Have a Determination of Need (DON) score of 29 points or more
  • Have less than $17,500 in assets or $35,000 family assets for a child under the age of 18
  • Fully cooperate with the Medicaid application process and maintain Medicaid eligibility
  • Needs will be met at a cost less than or equal to the cost of nursing services in an institutional setting

If you do not meet or maintain your eligibility requirements, you may be removed from the waiver program.

For more information, see the Long Term Services and Support Handbook on the Forms & Documents page.