CMS approved the “Illinois Healthcare Transformation” waiver on July 2, 2024, which is effective through June 30, 2029, and authorizes medical respite care for a length of stay of up to six months within a rolling 12-month period.
Aimed at individuals enrolled in Medicaid managed care, eligibility criteria include those experiencing or are at risk of homelessness and are at risk of ED/hospitalization or institutional care, in the ED or hospitalized, or in institutional care.
To assist the field of medical respite care in the transition to Medicaid reimbursement, a statewide-capacity building initiative was launched. Participating programs are in development, piloting and/or expanding their medical respite services, and receive funding, technical assistance, and participation in a peer learning cohort. Those programs currently participating have provided input, feedback, and insight as the State works towards finalizing and operationalizing the approved 1115 waiver.
Next Steps: Illinois is pursuing a tiered reimbursement structure for providers, meaning the programs who provide a higher level of clinical supports (without the assistance of outside providers) would receive a higher reimbursement rate to accommodate the additional costs associated with the higher level of clinical services.
