RESIDENTIAL CARE PROVIDER IN ILLINOIS

Fatumata Kaba
Jul 18
4 min read

SUPPORTING INDIVIDUALS WITH DAILY LIVING AND COMMUNITY INTEGRATION IN A RESIDENTIAL SETTING

Residential Care Services in Illinois provide structured living environments and support to individuals with disabilities, chronic health conditions, or aging-related needs who require assistance beyond what can be offered through personal care in their own homes. These services are primarily authorized under Illinois' Medicaid Waiver programs and aim to promote community living, independence, and quality of life while reducing reliance on institutional care.

1. GOVERNING AGENCIES

Agency: Illinois Department of Healthcare and Family Services (HFS)

Role: Oversees Medicaid program administration, including waiver services authorization, provider enrollment, and reimbursement for Residential Care Services

Agency: Illinois Department of Human Services (DHS) — Division of Developmental Disabilities (DDD) & Division of Rehabilitation Services (DRS)

Role: Manages service coordination, quality assurance, and regulatory compliance for residential providers serving individuals with developmental disabilities and other eligible populations

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring Residential Care Services align with Medicaid quality, safety, and participant-centered care standards

2. RESIDENTIAL CARE SERVICE OVERVIEW

Residential Care Services provide supportive living arrangements for individuals who need assistance with daily activities, health management, and community integration but do not require skilled nursing care.

Approved providers may deliver:

Assistance with Activities of Daily Living (ADLs) such as bathing, dressing, toileting, eating, and mobility
Support with Instrumental Activities of Daily Living (IADLs) such as meal preparation, housekeeping, shopping, and managing medications
Health monitoring and assistance with basic medical needs under delegation
Socialization support, transportation to appointments, and community involvement activities
Behavioral supports and life skills training, when needed
Coordination with healthcare providers and case managers for integrated service delivery

Services must reflect each individual's Person-Centered Plan and must comply with HCBS Settings Rule requirements for community integration, autonomy, and choice.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business entity with the Illinois Secretary of State
Obtain an EIN from the IRS and a Type 2 NPI number
Secure necessary residential facility licensure (e.g., Community Integrated Living Arrangement [CILA] license through DHS DDD if serving individuals with developmental disabilities)
Enroll as a Medicaid Waiver provider through the Illinois Medicaid Provider Enrollment Portal (IMPACT system)
Maintain liability and professional insurance coverage
Develop comprehensive policies addressing residential care, incident reporting, resident rights, emergency preparedness, staffing, and quality assurance
Ensure all staff meet required background checks, health screenings, and complete mandatory training programs

4. ILLINOIS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Submit Provider Enrollment Application via the Illinois IMPACT system for Residential Services under the applicable Medicaid waiver

Application and Documentation Submission:

Upload Articles of Incorporation, proof of EIN/NPI, facility license, insurance certificates, staffing plans, training documentation, policies and procedures manuals, and individual rights documentation

Program Readiness Review:

DHS and/or HFS conduct a readiness review verifying staffing ratios, residential setting compliance, service delivery models, billing procedures, and participant protection protocols

Approval & Medicaid Enrollment:

Upon approval, providers are assigned Medicaid billing codes specific to Residential Habilitation, Supportive Living, or related Residential Care services

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (Illinois Secretary of State)
IRS EIN confirmation letter
NPI confirmation
Facility Licensure Certificate (if applicable, e.g., CILA License for DD services)
Proof of general and professional liability insurance
HCBS-Compliant Policy & Procedure Manual including:
- Participant intake, assessment, and service planning procedures
- Residential service delivery standards and emergency protocols
- Staff hiring, training, and supervision policies
- Incident reporting and participant grievance procedures
- Community integration, autonomy, and participant rights documentation
- Medicaid billing and documentation protocols

6. STAFFING REQUIREMENTS

Role: Residential Program Director / Supervisor

Requirements: Bachelor’s degree in human services or related field preferred; management experience in residential services; background clearance

Role: Direct Support Professional (DSP) / Residential Staff

Requirements: High school diploma or GED; DSP certification (for DD settings); CPR/First Aid certification; background screening clearance; health screening

All staff must complete:

HCBS Settings Rule and participant rights training
Abuse, neglect, and exploitation prevention training
Emergency preparedness, infection control, and safety training
Person-centered planning and residential support skills training
Annual competency evaluations and continuing education requirements

7. MEDICAID WAIVER PROGRAMS

The following Illinois Medicaid waivers authorize Residential Care Services:

Adults with Developmental Disabilities Waiver
Children and Young Adults with Developmental Disabilities Waiver
Persons with Brain Injury (BI) Waiver
Persons with Disabilities (PD) Waiver
Supportive Living Program (SLP) under the State Plan services

Approved providers may deliver:

24-hour supervision and assistance with ADLs/IADLs
Behavioral supports and health monitoring
Transportation and community engagement support
Life skills training and goal-oriented personal development support

8. TIMELINE TO LAUNCH

Phase: Business Formation and Licensure Preparation

Timeline: 1–3 months

Phase: Staff Recruitment, Training, and Policy Development

Timeline: 2–4 months

Phase: IMPACT Medicaid Provider Enrollment and Readiness Review

Timeline: 60–120 days

Phase: Medicaid Billing System Configuration and Service Launch

Timeline: 30–60 days

9. CONTACT INFORMATION

Illinois Department of Healthcare and Family Services (HFS)

Website: https://www.hfs.illinois.gov/

Illinois Department of Human Services (DHS)

Website: https://www.dhs.state.il.us/

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — ILLINOIS RESIDENTIAL CARE PROVIDER

WCG assists residential care providers, supportive living agencies, and community-based organizations in launching Medicaid-compliant Residential Care Services under Illinois' HCBS waiver programs.

Scope of Work:

Business registration and EIN/NPI setup
Medicaid provider enrollment and residential licensure support
Development of Residential Care Policy & Procedure Manual
Staff credentialing templates and resident intake/service tracking forms
Medicaid billing system setup and claims management
Website, domain, and email setup
Residential documentation systems and health monitoring templates
Quality assurance programs for service delivery, monitoring, and resident satisfaction
Community outreach, resident advocacy, and healthcare coordination strategies