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Illinois - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

Illinois does not cover a distinct service named "Adult Companion Services" under its Medicaid Home and Community-Based Services (HCBS) waivers; instead, non-medical supervision and socialization are funded primarily as "Personal Support" through the Department of Human Services (DHS) Division of Developmental Disabilities (DDD) waivers, or as "In-Home Service" through the Department on Aging (DoA) Community Care Program (CCP). To bill for Personal Support, an agency must first be established as a Developmental Disability provider with DHS, which requires transmitting provider data through the Reporting of Community Services (ROCS) system or a Fiscal Employer Agent (F/EA) before any Medicaid enrollment application is accepted.

Approval to deliver these services requires enrolling in the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system and securing a formal Service Agreement with DHS Region staff. Providers must comply with DHS training requirements for direct support workers and undergo targeted desk reviews and on-site visits by the State to maintain their active Medicaid provider status.

1. Service Definition and Scope

Because Illinois does not use the term "Adult Companion Services," providers deliver non-medical care, supervision, and socialization under the "Personal Support" service definition in the Adults with Developmental Disabilities Waiver. This service ensures the health and safety of the adult while promoting community inclusion and socialization.

For older adults, similar non-medical supervision is provided under the Department on Aging's "In-Home Service" (formerly Homemaker), which assists individuals aged 60 and older with non-medical tasks to prevent premature institutionalization.

2. Regulatory and Oversight Agencies

The Illinois Department of Healthcare and Family Services (HFS) is the single State Medicaid Agency responsible for overall waiver administration and provider enrollment. HFS delegates day-to-day operation of the developmental disabilities waivers to the Department of Human Services (DHS).

Within DHS, the Division of Developmental Disabilities (DDD) manages provider qualifications, service agreements, and monitoring for Personal Support services. The Department on Aging (DoA) oversees the Community Care Program for older adults.

3. Gatekeeping Prerequisites: Who Can Even Apply

Before an agency can enroll in IMPACT to provide Personal Support, it must be established as a Developmental Disability provider with DHS. This structural precondition requires the transmission of provider data in the Reporting of Community Services (ROCS) system or through the Fiscal Employer Agent (F/EA).

Agencies providing services must also work with DHS Division Region staff to determine whether they require a formal Service Agreement or contract with the Department. Without this regional establishment and data transmission, HFS will not process the IMPACT enrollment.

4. Licensure and Certification Requirements

Personal Support is generally delivered by non-licensed providers and agency staff. Illinois does not require a specific facility license for agencies providing only in-home Personal Support, but the agency must meet DHS provider qualifications and maintain its Service Agreement.

If the agency also intends to provide residential services, such as Community-Integrated Living Arrangements (CILA), it must obtain a license from the DHS Bureau of Accreditation, Licensure and Certification (BALC) pursuant to 59 Ill. Adm. Code 115.

5. Medicaid Provider Enrollment

All waiver agencies and individual providers must enroll with the Department of Healthcare and Family Services (HFS) as Medicaid Waiver providers through the IMPACT system. HFS enrolls all willing and qualified providers who have met the DHS establishment prerequisites.

During enrollment, providers must complete the Provider Agreement for Participation in the Illinois Medical Assistance Program (HFS 1413AS). The database match between DFPR and the Medicaid Management Information System (MMIS) is transmitted monthly to verify ongoing provider status.

6. Staffing, Training and Background Checks

The Division of Developmental Disabilities has specific training requirements for direct support workers who work for community agencies. Direct support workers must be trained using a curriculum developed by the State or a comparable curriculum approved by the State.

Agencies must also meet ongoing continuing education requirements for Qualified Intellectual Disability Professionals (QIDPs). All staff must pass required background checks before providing unsupervised care.

7. Documentation, Policies and Records

Providers must maintain adequate documentation of actual service delivery to support all bills submitted. Failure to maintain these records is grounds for termination from program participation.

When terminating waiver services to an individual, providers must submit the Service Termination Approval Request (STAR) form (IL462-2028) to the PAS/ISSA agency. The Independent Service Coordinator (ISC) reviews and signs its approval before submitting it to the Division.

8. Billing, Rates and Claims

Reimbursement for Personal Support is processed through the Medicaid Management Information System (MMIS) after data is transmitted via the ROCS system or a Fiscal Employer Agent (F/EA). Providers must accept reimbursement at or below the federally-approved Medicaid rates.

Submitting false, duplicate, or fraudulent bills will result in immediate termination or suspension by HFS pursuant to 89 Ill. Adm. Code 104 and 140.

9. Approval Sequence and Timeline

The approval sequence begins with contacting DHS Region staff to establish the agency as a Developmental Disability provider and secure a Service Agreement. Once established and data is transmitted via ROCS, the agency applies through the IMPACT system.

If the agency is pursuing a CILA license for residential services alongside Personal Support, they must fulfill new provider requirements within one year of requesting the application and become operational within 18 months.

10. Common Denials and Survey Findings

The State monitors non-licensed and approved providers through targeted desk reviews and on-site visits. A common cause for termination is when a provider no longer meets the Medicaid waiver provider standards, such as falling out of compliance with contractual requirements.

Providers are frequently disenrolled if the monthly database match between HFS and DFPR finds that a required professional licensure or registration has expired, or if the provider fails to maintain adequate documentation of actual service delivery.

11. Key Contacts and Resources

Prospective providers should begin by reviewing the 'Becoming a New Developmental Disabilities Provider' guidelines on the DHS website. For Medicaid enrollment technical assistance, providers utilize the IMPACT portal resources.

Agencies seeking to provide residential services in addition to Personal Support must coordinate with the DHS Bureau of Accreditation, Licensure and Certification (BALC).

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