To be able to join the Home Services Program, you must:

• Live in Illinois.
• Have or be eligible to get Medicaid, or meet one of the Home Services Program’s other eligibility categories.
• Be under the age of 60 when you apply for the Home Services Program (there is no age limit if you have HIV/AIDS or a brain injury).
• Get a Determination of Need (DON) score of at least 29 when you are tested by DRS.

There are three ways you can start your application:

• Fill out the online referral form on the DRS website.
• Use the online DHS Office Locator and search for “Rehabilitation Services” to find your closest DRS office, then call or visit in person.
• Call 1-800-843-6154 (Voice) or 1-866-324-5553 (TTY).

After you apply for the Home Services Program, a DRS counselor will meet with you to see if you need in-home services. This is called an “evaluation.” DRS used to meet each person in their home, but since the start of the COVID-19 pandemic DRS has been doing this by phone.

DRS will give you a DON score based on your ability to do tasks needed for daily living. The following are the things that DRS looks at for your DON score. They may also ask some questions about each one:

Eating

• Are you able to eat and drink safely on your own?
• Do you have trouble with chewing, swallowing, or drinking without spilling?
• Are you at risk of choking when you eat or drink?

Bathing

• Are you able to take a shower or a bath on your own?
• Do you have trouble getting in and out of the shower or bathtub?
• Are you able to change the water temperature for your shower or bath?

Grooming

• Are you able to take care of your personal grooming needs on your own?
• Do you need help with shaving, cutting your nails, hair care and/or brushing your teeth?

Dressing

• Are you able to put on and take off your clothes on your own, including buttons and zippers?
• Are you able to select and put on clothes that are right for different types of weather?
• Do you have trouble putting on your assistive devices or prosthesis?

Getting out of bed

• Are you able to get in and out of bed or other sleeping spot on your own, safely and without risk of falling?
• Do you need help transferring between your bed or other sleeping spot and a wheelchair?
• Are you able to adjust your bed, move handrails, or reach for assistive devices from your bed?

Cooking

• Are you able to make healthy meals for yourself?
• Do you need help opening containers and using kitchen appliances?
• Are you able to safely cook in your kitchen, without burning yourself or making a fire risk?

Healthcare

• Can you follow directions from your doctors for your care while at home?
• Can you keep track of your medications, know when to take them and in what amounts?

Being Alone

• Can you be safely left alone in your home for periods of time?
• Can you notice, avoid, and respond to danger and/or emergencies when you are alone?
• If there is an emergency, can you leave your home on your own or call for help if needed?

Traveling outside your home

• Can you leave home on your own to run errands or to visit important places, like the grocery store, bank, post office, or doctor’s office?
• When away from your home, are you able to drive or get a ride, cross streets, go in and out of buildings, and find where you need to go?
• When it comes to shopping, can you go to a store, find what you need, bring them home and put them away?

Laundry

• Can you do your own laundry, in your home, your apartment building, or at a laundromat?
• Can you load and unload a washer and dryer?
• Can you sort, fold and put away your laundry?

Managing Money

• Can you manage your money on your own?
• Can you keep track of bills and pay them on time?
• Can you handle paper money and count correct change?

Telephones

• Can you use the phone on your own to make and answer calls?
• Do you need any special devices or equipment to use the phone?

Housework

• Can you do routine housework like sweeping, vacuuming, dusting, cleaning up spills, washing the dishes and cleaning your bathroom on your own?

The answers you give should not be about your best days, but the days when your disability is impacting you the most. For example, if you have bad arthritis and sometimes have good days when you can dress yourself, but on most days you need help, you should say that you need help with dressing.

After talking to you, the counselor will give you a DON score between 0 and 100. The bigger your level of need, the higher your DON score will be, and the more home care hours you may be able to get. To get the Home Services Program, you must have a DON score of at least 29.

Before you get the Home Services Program, DRS will also ask your doctor to fill out forms and give medical records that prove your disability.

Once DRS says you can get the Home Services Program, but before your services start, you will get a service plan. This will say the types of services you will get, and in what amounts. Your doctor must approve the plan. If you are on fee-for-service Medicaid, you will work with your DRS counselor to make the service plan. If you have a Medicaid managed care health plan, you will work with a care manager from your managed care organization (MCO), like Blue Cross Blue Shield, Humana, or Aetna, to make your plan.

If you have managed care, it is important to understand the different roles that DRS and your MCO will have in giving you home services. DRS evaluates you (and reevaluates you each year) to give you a DON score and make sure that you are still eligible for the Home Services Program. Once DRS says you can get services, your MCO case manager plans and gets you your home services.

The Service Plan must state:

• The type of service(s) you will get. 
• If services will be given by a personal assistant (PA) that you hire yourself, or by caregivers sent by a homemaker agency.
• How often each task will be done for you. 
• The number of hours each task is to be done per month.
• The amount each service costs.

• DHS – Stands for Department of Human Services
• DON score – Stands for Determination of Need. The higher the score, the more needs you have.
• DRS – Stands for Division of Rehabilitation Services
• Homemaker agency – An agency that provides personal care services by trained and professionally supervised personnel for individuals who are unable to direct the services of a PA.
• IDOA – Stands for Illinois Department on Aging (IDOA)
• MCO – Stands for Managed Care Organization (MCO)
• PA – Stands for Personal Assistant who provides assistance with household tasks, personal care and, with permission of a doctor, certain health care procedures. PAs are selected, employed, and supervised by individual customers.

You can file an appeal to try to change the decision if DRS says you cannot get services or if you disagree with a service plan given to you by DRS. Whenever DRS denies your services or gives you less than you think you should have, it must tell you how to file an appeal in writing with the DHS Bureau of Hearings. You can also appeal with the Application for Benefits Eligibility online portal or contact your local DRS office to tell them that you want to appeal. Be sure to send your appeal before the deadline. The deadline will be written in the notice you get from DRS. After you send your appeal, you will get more information from DHS on the appeal and hearing process.

If you are enrolled with a MCO and you disagree with your service plan, you can file an appeal to try to change your plan. Follow the appeal instructions given by the MCO with your service plan, the section on appeals within your MCO’s member handbook, or talk about the steps with your MCO care manager.

If you want help with your appeal, including to ask for legal help in your appeal hearing, you can contact the Illinois Home Care Ombudsman program by sending an e-mail to Aging.HCOProgram@illinois.gov or by calling 1-800-252-8966.

If the ombudsman cannot help you, contact your area Center for Independent Living (CIL) by calling 1-800-587-1227 or looking online at https://incil.org/locate to find your area CIL.

If they cannot help you, contact Equip for Equality.