Friday, February 1st, the Integrated Care Phase Two Pilot began. Phase Two includes all non-developmental disability waivers and nursing homes. It is important to note that the Medically Fragile Technology Dependent Children’s Waiver is also carved out of Phase Two. Below are some helpful tips on Phase Two. We are in the process of updating our Integrated Care Toolkit but you can go to this link that we developed for Phase One because it still has useful information including appeal rights. Please keep us informed about any problems you may be experiencing with the Integrated Care Pilot.Arc Integrated Care Pilot Toolkit (May, 2012)

  1. Aetna Better Health: http://www.aetnabetterhealth.com/illinois/long-term-care/  and includes a Member Handbook for Phase 2: http://www.aetnabetterhealth.com/illinois/assets/docs/IL-LTSS-Program-Overview.pdf

 

  1. IlliniCare: http://www.illinicare.com/for-members/waiver-services/eligibility/

Illinicare has a good explanation of the Determinatio of Need (DON,relationship between DHS/DOA and ICP is a little fuzzy): http://www.illinicare.com/for-members/waiver-services/determination-of-need/
 
To qualify for waiver services, you will need to talk to a case manager from a state assigned agency. He or she will ask you a series of questions as part of an assessment. These questions are called a Determination of Need or DON. This assessment will typically be done in your home. A representative from the agency will contact you to schedule you assessment. Type of questions you may be asked include:

  • Are you able to feed yourself?
  • Can you prepare your own meals?
  • Can you bathe yourself?
  • Do you need assistance getting dressed?
  • Are you able to manage your own finances?
  • Do you have any special equipment you need to use?
  • Do you have special medical needs such as an oxygen tank or IV?

IlliniCare does not conduct the Determination of Need (DON). This is done by an outside agency. However, we may have an IlliniCare care coordinator present during your DON assessment. Additionally, we will work together with the agency for your annual reassessment or if a reassessment is needed due to a significant change in your condition/needs.
Once the DON is complete and if you are eligible for services, a care plan will be created by IlliniCare. The care plan includes services that will allow you to remain safely in your home or a community setting, so you are able to live independently. You will work with your IlliniCare Care Coordinator to create your own care plan based on the services in your waiver. It will be a mix of the services available to meet your needs so you can live independently.
 
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Tony Paulauski
Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423
815-464-1832 (OFFICE)
815-464-1832 (CELL)
Tony@www.thearcofil.org