The Community Care Program gives services to older adults with disabilities to help them live independently in their homes, instead of in a nursing home or other facility. It is run by the Illinois Department on Aging (IDOA). If you qualify, you can get help from a homemaker who can help you manage the things you do in your daily life. You may also be able to get other services from the program, including:

• Adult day services (in a community setting in your local area).
• Emergency home response service.
• Automated medication dispenser service.

To be able to get Community Care Program services, you must:

• Live in Illinois.
• Be enrolled in or eligible for Medicaid or meet one of the Community Care Program’s other eligibility categories.
• Be at least 60 years old.
• Be at risk of being put in a nursing home according to the Determination of Need (DON) assessment.

There are three ways you can start your application:

• Fill out the online application on the IDOA website.
• Contact the Care Coordination Unit that serves your area. You can locate your Care Coordination Unit using the map tool on IDOA’s website.
• Call the Illinois Senior Helpline at 1-800-252-8966 (or dial 711 for Illinois Relay).

After you apply for the Community Care Program, an evaluation will be done to see whether you need help, and if so, what help you need. Care Coordination Units are the community organizations that set up Community Care Program services and do evaluations after you apply for the Community Care Program.

Your Care Coordination Unit will give you a DON score based on how well you can do daily living activities. The following are things that IDOA looks at for your DON score. The Care Coordination Unit person may also ask questions about each one:

Eating

• Can you 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

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

Grooming

• Can you 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

• Can you put on and take off your clothes on your own, including buttons and zippers?
• Can you 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

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

Cooking

• Can you make healthy meals for yourself?
• Do you need help opening containers and using kitchen appliances?
• Can you 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 prescription 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 recognize, avoid, and respond to danger 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 your doctor’s office?
• When away from your home, can you 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 and finances 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 housework like sweeping, vacuuming, dusting, cleaning up spills, washing the dishes and cleaning your bathroom on your own?

It is important for you to give accurate information about what help you need, to make sure the evaluation is accurate. The answers you give should not be about your best days. Tell them about the days when your disability impacts you the most. For example, if you have bad arthritis but sometimes have a good day when you can dress yourself, but on most days you need help getting dressed, say that you need help with dressing.

The Care Coordination Unit will also talk to you about your friends, family, or other supports to help you with these tasks. If you have these supports but they are not always available to you, stress that they are temporary, only able to help in emergencies, or not always available.

After talking to you, the Care Coordination Unit will assign you a DON score between 0 and 100. The bigger your level of need, the higher your DON score should be, and the more home care hours you may be able to get. To be able to get Community Care Program help, you must have a DON score of at least 29.

The Care Coordination Unit will also ask your doctor to fill out forms and give medical records that prove your disability before approving you for the Community Care Program.

Once approved, you will either continue to work with a Care Coordination Unit representative to coordinate your services, or you will get a case coordinator through a health insurance company. This is called a Managed Care Organization (MCO). The Care Coordination Unit will talk to you every year to make sure you are still eligible for services and to ask about any changes in your needs.

Before your services start, you will work with someone from the Care Coordination Unit or your MCO case coordinator to write a service plan. This will say the types of services you will get, and in what amounts. The Service Plan must state:

• The type of service(s) you will get. 
• How often each task will be done. 
• The number of hours each task will be done per month.
• The amount each service costs.

8. What is an authorized representative?
You have the right to choose a trusted person as an authorized representative. An authorized representative is a person who can talk with the Care Coordination Unit and service providers for you. They can help in your service planning process. They can also help you with appeals. If you would like to have an authorized representative, ask your case coordinator to send you the “form for authorized representatives.”

There are several terms you should know because you will hear them from people talking about the Community Care Program.

• DON score – Stands for Determination of Need. The higher the score, the more needs you have.
• Homemaker – This is a trained, supervised person who helps you with personal care things like cooking, laundry, cleaning, and shopping.
• IDOA – Stands for Illinois Department on Aging (IDOA)
• MCO – Stands for Managed Care Organization (MCO)

You can file an appeal if you do not agree with a decision that the Care Coordination Unit or MCO makes. An appeal is a way to try to change their decision. You also have the right to appeal if the Care Coordination Unit or MCO asks you to sign a Memorandum of Understanding. Whenever the Care Coordination Unit or MCO or denies your services or gives you less than you think you should have, it should tell you in writing how to file an appeal, including on how to ask for a state fair hearing. If you get services through an MCO, your appeal will be looked at by the MCO before it will be looked at by the State.

Be sure to send your appeal before the deadline stated in the notice you get from the Care Coordination Unit or MCO. After you send your appeal, you will get more information from the State on the appeal and hearing process.

If you want help with your appeal, including to ask for legal help in your appeal hearing, call the Illinois Home Care Ombudsman program at 1-800-252-8966 or e-mail Aging.HCOProgram@illinois.gov. If the Ombudsman cannot assist you, contact Equip for Equality.