The Home Services Program provides services which allow Illinois residents with disabilities to receive the care they need in their homes rather than in an institutional setting.

Your legal rights

The Home Services Program (HSP) provides an alternative to institutional care for people with severe disabilities. You may be eligible for this program if you need a high level of care. It is possible to give you the services you need in your home at a lower cost than in a nursing home or other institution.

HSP is operated by the Illinois Department of Human Services - Division of Rehabilitation Services (DRS).

Who can get HSP assistance?

To get HSP assistance, you must:

• Be a citizen of the U.S., or be a lawful permanent resident,
• Be a resident of the state of Illinois,
• Have applied for Medicaid, already be a recipient of Medicaid, or already have been found eligible for a Medicaid "spend-down." You are not required to meet the eligibility criteria for Medicaid. Eligibility or verification of application is not required to receive interim services.
  If you applied for HSP assistance before October 1, 1991, you are not required to apply for Medicaid,
• Be under the age of 60 at the time of application for HSP services. There is an exception if you have AIDS or a brain injury, in which case there is no age limit,
• Have a severe disability which is expected to last for at least 12 months,
• Be in need of long-term care,
• Have a physician's certification that the long-term care you need can be safely provided in your home, and
• Be able to show that it is cheaper to provide your care in the home than in a nursing home or other institution.

Asset limits

To be eligible for HSP, you must meet the asset limitation. If you are 18 years or older, you cannot have more than $17,500 in assets. If you are under 18, you and your family cannot have more than $35,000 in assets.

If you are married and your spouse does not receive HSP services, the total value of assets you own personally cannot exceed $17,500. This amount is adjusted annually. If you own assets worth more than $17,500, you may be able to transfer some of them to your spouse and then remain eligible. However, there are limits on the amount of assets you can transfer to your spouse in order to stay eligible. If you are having trouble with asset eligibility, you may choose to speak with a lawyer.

Many types of property are not counted when determining whether you meet the asset limit. These are called exempt assets.

Some examples include:

• Your home, including its furnishings and contents and the land it is on,
• Your cars and other vehicles, except those used primarily for recreation,
• Your personal property, such as clothing,
• The equipment you use to earn a living,
• Life insurance, 
• In the case of a child, the value of the parent's pension or IRA funds, and 
• An ABLE account.

Your contribution to the cost of services

There are no charges to you for HSP services. This is true regardless of your income level.

What is a Determination of Need? (the DON)

To be eligible for HSP services, you must be in need of a high level of care. This type of care would usually be provided in a nursing home or other institution. DRS evaluates your mental and physical condition, as well as the level of help that you need, using an assessment test called the Determination of Need (DON).

There are three parts to the DON. They are the mini-mental state examination, scoring of impairment, and scoring of need. The mini-mental state examination measures cognitive functioning. DRS will ask questions to measure your cognitive abilities.

DRS uses the DON to evaluate your ability to perform activities of daily living, including:

• Eating,
• Bathing,
• Grooming,
• Dressing,
• Transferring (in and out of bed),
• Incontinence care,
• Preparing meals,
• Being alone,
• Telephoning,
• Managing money,
• Routine health care tasks,
• Special health,
• Travel outside the home,
• Laundry, and
• Housework. 

DRS will score each activity from 0 to 3 for impairment and for need. Impairment measures how much you can do the activity safely in your home. Need measures the availability of resources that can meet your needs without HSP services.

A higher score means that you have a higher need for services. To be eligible for HSP, you must obtain a DON score of at least 29.

Besides determining whether you are eligible for HSP, the DON also determines how much assistance you will receive. The higher your DON score, the higher the maximum amount that may be spent for HSP services.

The amount that can be spent on HSP services is called the Service Cost Maximum (SCM). This amount reflects the amount that the State would expect to pay for your care if you were in an institution. For example, if your DON score is between 41 and 49, the maximum monthly amount that could be spent on HSP services would be $2,878. If you have AIDS, or you are on a ventilator, the SCM amount is higher.

How to apply for HSP assistance

If you are between 18 and 59 and you seek admission to a nursing home through Medicaid, DRS will determine if you are eligible for HSP services. This is called pre-screening. The state pre-screens to cut down on nursing home costs paid by Medicaid, and to make sure that you are aware of HSP assistance.

If you are not seeking admission to a nursing home and you want HSP services, you must submit an application. You may start the application process by completing the DRS online referral form, or by contacting your local DRS office.

After DRS receives your application, a DRS Counselor will evaluate you to decide if you are eligible. The counselor will determine your DON score and decide if you meet the other eligibility criteria.

You are entitled to receive a written decision on your eligibility for HSP services within 60 days of the date of your completed application. If DRS finds you ineligible for HSP services, you may file an appeal, as explained below. You also can reapply for HSP at any time, if you believe there has been a change in your situation.

Once DRS approves you to participate in HSP, they will reevaluate you once a year, in order to verify that you are still eligible. If there is a change in your situation that may cause you to require more or fewer services, DRS will determine this at your annual reevaluation.

The Service Plan

Once DRS determines that you are eligible for HSP services, but before your services can begin, you will receive a service plan. This is used to identify the specific types of services you will receive, and in what amounts. Your doctor must approve the plan. Depending on your circumstances, you may work with your DRS counselor in order to develop the service plan. However, if you are enrolled in a Medicaid managed care health plan, then you will instead work with a care manager from your managed care organization (MCO) to develop your plan.

As a general matter, if you are enrolled in managed care, it is important to understand the different roles that DRS and your MCO will fulfill in providing your home services. DRS is responsible for evaluating you (and reevaluating you each year) in order to determine your DON score and thus verify whether you are eligible to participate in HSP. On the other hand, once DRS verifies your eligibility, your MCO case manager is responsible for planning and making all necessary arrangements for you to actually receive home services.

The Service Plan must indicate:

• The type of service(s) to be provided, 
• Whether services will be provided by a personal assistant (PA) whom you employ yourself, or by caregivers provided by a homemaker agency,
• How often each task will be performed, 
• The number of hours each task is to be provided per month, and
• The amount that will be paid for the service(s).

Appropriate service providers

If DRS approves you to employ your own PA, then you can hire almost anyone you wish. If you need help finding a PA, your counselor may be able to help you, or you may wish to contact your local Center for Independent Living for assistance.

However, DRS cannot pay family members who already have a legal responsibility to provide care. This includes:

• A spouse,
• A parent of a minor child receiving services, or
• A minor child of a person receiving services.

Otherwise, family members are also eligible to work as paid caregivers within HSP.

Services available under the HSP Program

Types of services that may be provided to you under the HSP Program:

• Personal Assistant (PA) Services. A PA may assist you with:
  • Household tasks, shopping, or personal care
  • Simple health care tasks which do not require medical skill
  • Monitoring to ensure your health and safety
  • Attending public university or community college classes. If they are attending class only to provide you support, the school cannot charge them tuition. However, schools are not required to pay for them to be there.
• Adult Day Care (ADC) Services. You may receive direct care and monitoring in a group setting for some portion of the day.
• Homemaker Services. You may receive assistance from caregivers assigned to you by a homemaker agency, if you cannot manage your own PAs or cannot locate them to hire. 
• Maintenance Home Health Services. You may receive health care services prescribed by your doctor which require professional skill. This includes:
  • Healthcare provided by a registered nurse (RN) and/or a licensed practical nurse (LPN), or by a Certified Nurse Aide (CNA) who is supervised by an RN or LPN
  • In-home therapy, including physical, occupational and speech therapy
• Home Delivered Meals. Agencies can bring prepared food to your home, including hot lunch and a smaller dinner meal that may be refrigerated and eaten later. These services are available if you need help in meal preparation, but you can feed yourself.
• Electronic Home Response Services (EHRS). You may receive a 24-hour per day emergency communication link to assistance outside your home if no one in your home can help you in an emergency.
• Assistive Equipment. You may receive devices which increase your ability to perform the activities of daily living independently. With HSP money, you may purchase, rent, or repair assistive equipment, depending on how long it is anticipated that you will need the item.
• Environmental Modification. DRS may pay for modifications to your home so that you may be more independent in performing activities of daily living.
  • Examples: Doorways can be widened to accommodate a wheelchair, or special kitchen or bathroom fixtures may be installed.
• Respite Services. You may receive Personal Assistant, Homemaker, and Maintenance Home Health services on a short-term basis. This may occur while the person who provides these services is unavailable. DRS provides these services to allow the normal caregiver time for vacations, rest, errands, family crises, and emergency situations. DRS delivers these services regardless of financial need, for a maximum of 240 hours per calendar year. 

Note: You may qualify for Respite Care services even if your DON score is too low for other HSP services.

Additional services for individuals with a brain injury

If you have a brain injury, you may be entitled to one or more of the following services. This is in addition to those listed above:

• Day Habilitation Services. DRS can give you this assistance so that you may learn, retain and improve skills. These skills could be for self-help, socialization and adaptive skills. DRS provides these services in a setting outside of your home.
• Pre-Vocational Services. DRS provides services that are aimed at preparing you for paid or unpaid employment but are not job-task oriented. These include teaching concepts such as compliance, attendance, task completion, problem solving and safety.
• Supported Employment Services. DRS can provide you these services if you have a brain injury and competitive employment is unlikely. Because of your disabilities, you need intensive, ongoing support to perform in a work setting. These services consist of job supervision, training, and paid employment.
• Behavioral Services. DRS can provide you with therapies. These could help decrease severe maladaptive behaviors, better manage your behavior and help you become more independent.

Case management services for persons with HIV/AIDS or brain injuries

The Department of Human Services (DHS) has agreements with agencies to provide case management services to persons diagnosed as having HIV/AIDS, or as having brain injuries, and who are or may be eligible for the Home Services Program.

These agencies must assign case managers to all persons with HIV/AIDS or brain injuries who are referred to them. If you are such a person, the case managers have the responsibility to give you services which include:

• Assessing your eligibility for HSP and gathering information,
• Developing a care plan,
• Re-assessing your needed level of care periodically,
• Networking and coordinating services to help you obtain other agencies' services,
• Assisting you if problems arise with your caregiver services, and
• Counseling and advocacy.

Denial or [no-lexicon]termination[/no-lexicon] of HSP services

DRS can deny or terminate your HSP services at any time that you:

• Move from Illinois or cannot be located,
• Are determined to have service costs that are greater than what it would cost to serve you in an institution,
• Refuse services or fail to cooperate in other ways,
• Are institutionalized and not expected to be released for more than 60 days,
• Fail to act appropriately, such as being abusive or threatening to a provider or a DHS employee, or
• Experience an improvement in your condition, so that you are no longer at risk for institutionalization.

How to protect or [no-lexicon]enforce[/no-lexicon] your rights

The right to notice and appeal

You are entitled to file an appeal if DRS denies your application to participate in the Home Services Program. If you are already an HSP participant, you may file an appeal if DRS reduces or terminates your services, refuses you services that you request, or fails to take timely action on your request for services.

DRS must send you a written notice at least 15 working days before any change, reduction, or termination of your services. The notice must include the following:

• Statement of the action being taken,
• Statement of the basis for the action,
• The effective date of the action,
• Statement of your right to a hearing and how to initiate the hearing, and
• The name, address and telephone number of the person to whom the request for a hearing must be made.

Services continue while your appeal is pending

If you appeal a change, reduction, or termination of services that you are already receiving, DRS must continue to provide the same services until a final decision has been made on your appeal. This is not true if the services being provided were obtained through misrepresentation or criminal conduct on your part.

The appeal process in general

Anytime you disagree with an action taken by DRS regarding your application for or participation in HSP, you can file an appeal in order to request a hearing. 

Requesting a hearing

The written notice of the action by DRS includes instructions on how you can file your appeal. In general, you can submit your appeal in writing to your local DRS office, in writing or by phone with the Illinois Department of Human Services Bureau of Hearings, or via the Application for Benefits Eligibility ("ABE" online portal).

You must submit the request for a hearing so that it is received by DRS:

• Within 30 calendar days after the date you received notice of the action being appealed or within 35 calendar days after the date on which DRS issued the notice, or
• If there is no written notice, within 30 calendar days after the date that you knew or should have known of the issue being appealed.

In general, the hearing must be held no later than 60 calendar days after DRS receives your request.

At least 10 days before the scheduled date of the hearing, the Hearings Coordinator must send you a letter by certified mail which tells you:

• The date, time and location of the hearing,
• The name and address of the hearing officer,
• The issue which will be the subject of the hearing, and your rights at the hearing, and
• How to request an informal resolution conference.

The informal resolution conference

You can ask for this conference at any time in between your filing of the appeal and the hearing decision. You have the right to be represented at this conference.

The supervisor of the DRS employee responsible for the action being appealed must schedule and chair the conference. DRS must hold the conference at a time and date which is convenient for you. 

During the conference, the chairperson should do the following:

• Clarify the issues,
• Present a fair and complete discussion of the relevant information,
• Summarize DRS' position and your position, 
• Provide an opportunity to discuss settlement, and 
• Tell you the next steps of the appeal process, if an agreement is not made.

If there are any agreements reached during the conference, those agreements must be put in writing within a document that will be signed by you and the chairperson. The document should list both those issues on which agreement has been reached and those issues where there is still disagreement. All agreed issues should be withdrawn from the appeal. If there remain any issues that cannot be resolved in the conference, then you must be advised of procedures for the hearing.

The hearing

An impartial hearing officer appointed by DHS will conduct the hearing. You are entitled to be represented by any person of your choice, including an attorney. You also may represent yourself. At the hearing, you have the rights to:

• Present your testimony and other witnesses in support of your claim,
• Present documents that support your case,
• Examine the records relied on by DRS, and
• Cross-examine witnesses.

Depending on your particular circumstances, you may be entitled to assistance from the Illinois Home Care Ombudsman program in the preparation, presentation, and representation of your appeal. You can contact the Home Care Ombudsman at (800)252-8966.

If you desire, you may waive the right to an in-person hearing, and instead submit your evidence in writing to the hearing officer. The Hearing Officer will review the case file and any new evidence or information you submit, and will make a decision based on that information.

You are entitled to any reasonable accommodation necessary to be able to file an appeal and to participate effectively in the hearing.

You may request the services of an interpreter or reader at the hearing. The interpreter or reader can be of either sign language or of a non-English language if you rely on either as your usual mode of communication. You should make your request for an interpreter or a reader at least ten days before the date of the hearing.

If you are blind or visually impaired, you may request either a reader to read materials provided by DRS in preparation for the hearing, or that the materials be provided in an accessible format. You must make this request within 5 working days after you have been informed of the date of the hearing.

At least 3 working days before the hearing, you and the DRS employee responsible for the action being appealed must provide each other and the Hearing Officer with a list of witnesses, copies of documents to be used which are not in the possession of the other party, and a summary of the evidence which you each plan to present at the hearing.

The hearing is conducted following more formal legal rules about what evidence can be used. It is strongly recommended that in the appeal you be represented by an attorney or other trained Advocate.

The Hearing Officer will make an audio tape recording of the hearing proceedings. To assist you in any further appeal, you may obtain one copy at no cost. If an audio tape is not an acceptable format for you due to your disability or mode of communication, at your request, DRS must prepare a transcript in an acceptable format, and provide one copy of the transcript to you at no cost.

The decision

Subsequent to the conclusion of the hearing, the Hearing Officer will issue a written decision. The decision will explain the findings of facts and the relevant laws which are the basis of the decision.

The decision of the Hearing Officer is final and is binding on you as well as on DRS. DRS must start to implement the decision on the date specified in the decision, but no later than 10 calendar days after it is received.

Appeal to Illinois circuit court

You can appeal to the circuit court of your county any DRS decision that is final after the hearing decision. There are two ways you can appeal.

This first way to appeal is through a complaint for administrative review. You should file your complaint within 35 days from the date that the DRS decision is final.

The second way to appeal is through a writ of certiorari, which should be filed within 6 months of the decision.

It is strongly recommended that you be represented by an attorney in these proceedings because of the complex procedures and legal rules that must be followed.

Where to go for more information

Related Home Services Programs

• For children and young adults with developmental disabilities: The Illinois Division of Specialized Care for Children (DSCC) administers these programs, which help families care for children with severe and persistent disabilities and illnesses at home or in another community setting, rather than in a hospital or nursing home.
• For adults with developmental disabilities: The Illinois Division of Developmental Disabilities administers this program. It is for people age 18 or over with a qualifying intellectual disability who needs home-based support services, but not a 24-hour a day supervision.
• For older adults: If you are age 60 or over, you may receive similar services through the Community Care Program of the Illinois Department on Aging.

Statutes and regulations

The portion of the Disabled Persons Rehabilitation Act, which outlines the purposes of the Home Services Program, can be found at 20 ILCS 2405/3.

The regulations of the Illinois Department of Human Services which govern the operation of the Home Services program are at 89 Ill.Admin Code Parts 676 through 686.

The regulations concerning the appeal process can be found at 89 Ill.Admin. Code Part 510. Further rules governing Level II hearings are found at 89 Ill.Admin.Code Part 104.

The federal regulation which permits the State to operate the Home Services Program with Medicaid funding as a Medicaid Waiver program is found at 42 CFR 440.180.

Who to contact

For more information about the Home Services Program and to locate the nearest DRS office, visit the online DHS office locator or call:

(800) 843-6154 (V)
(800) 447-6404 (V/TTY)