A CRS Review of 10 States: Home and Community-Based Services -- States Seek to Change the Face of Long-Term Care: Illinois

Publication Date: June 2003

Publisher: Library of Congress. Congressional Research Service

Author(s):

Research Area: Health

Type:

Coverage: Illinois

Abstract:

Demographic challenges posed by the growing elderly population and demands for greater public commitment to home and community-based care for persons with disabilities of all ages have drawn the attention of federal and state policymakers for some time. Spending on long-term care by both the public and private sectors is significant. In 2001, spending for long-term care services for persons of all ages represented 12.2% of all personal health care spending in 2001 (almost $152 billion of $1.24 trillion). Federal and state governments accounted for almost two-thirds of all spending. By far, the primary payor for long-term care is the federal-state Medicaid program, which paid for almost half of all long-term care spending in 2001.

Many states have devoted significant efforts to respond to the desire for home and community-based care for persons with disabilities and their families. Nevertheless, financing of nursing home care, chiefly by Medicaid, still dominates most states' spending for long-term care today. To assist Congress understand issues that states face in providing long-term care services, the Congressional Research Service (CRS) undertook a study of 10 states in 2002. This report, one of a series of 10 state reports, presents background and analysis about long-term care in Illinois.

Illinois is the fifth largest state in the country with 12.4 million people in 2000; the population increased by almost 9% or about one million people in the past decade. About 12% of the state's population is age 65 and older -- 1.5 million people in 2000. By 2025 the Illinois elderly population is expected to increase by over 50% and will be 16.6% of the state's total population. Illinois is one of the few states in the country that provides older persons and younger adults, who meet the eligibility criteria, with state entitlements to home and community-based long-term care services. Both entitlements resulted from court cases that were brought to eliminate waiting lists for services. The state funds the Community Care Program for older adults and the Home Services Program for persons with physical disabilities with a combination of state general revenue funds and Medicaid Section 1915(c) waiver funds. The Community Care Program uses contracted agencies for the provision of homemaker, adult day care services, and case management services. In contrast, the Home Services Program's relies primarily on personal assistants, whom consumers supervise, to provide services.

According to state officials, in 2002 the state had about 3,000 people with developmental disabilities in state-operated development centers (SODCs), 6,500 people in private intermediate care facilities for the mentally retarded (ICFs/MR) and 8,800 people in Section 1915(c) Medicaid home and community-based services waivers for the developmentally disabled.

The 10-state study was funded in part by grants from the Jewish Healthcare Foundation and the U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Rural Health Policy.