The Determination of Need assessment in Illinois is the in-home evaluation the state uses to decide whether you qualify for Medicaid-funded long-term care services at home instead of in a nursing facility. A trained assessor scores your ability to perform 15 everyday tasks, tests your cognitive function, and measures how much of your care is already covered by family or friends. You need a combined score of at least 29 points, with at least 15 of those points coming from the unmet-need column, to qualify for the Community Care Program or the Home Services Program.1Illinois Department of Human Services. Program Eligibility Determination
The Illinois Department on Aging runs the DON for residents age 60 and older. The Department of Human Services runs it for younger adults with disabilities applying through the Home Services Program.2Illinois Department of Human Services. Home Services Program
What the Assessor Scores
The DON evaluates 15 tasks split into two groups. The first six are Activities of Daily Living: eating, bathing, grooming, dressing, transferring between a bed and a chair, and managing incontinence. The other nine are Instrumental Activities of Daily Living, which cover the more complex skills needed to live independently: preparing meals, staying safe when alone, using a telephone, managing money, handling routine health tasks like taking medication, handling specialized health tasks like injections or wound care, traveling outside the home, doing laundry, and keeping up with housework.3Legal Information Institute. Illinois Code 89-240.715 – Determination of Need
The assessor also administers a Mini-Mental Status Examination, a short cognitive test covering orientation, memory, and attention. A score below 14 on the MMSE automatically adds 10 points to your functional impairment total, which can push a borderline applicant over the eligibility line. Cognitive issues like confusion, poor judgment, and a tendency to wander carry serious weight because they threaten your safety even when you can physically perform daily tasks.4Legal Information Institute. Illinois Administrative Code tit. 89 Section 679.30 – Scoring of the DON Except for Respite Cases
How the Scoring Works
Each of the 15 tasks is scored twice, in two parallel columns.
Part A — Functional Impairment. This column measures how much difficulty you have with each task, regardless of whether anyone helps you. The scale runs from 0 to 3:
- 0 (None): you can handle the task independently, with or without an assistive device
- 1 (Minimal): you can do most of it but need some supervision or hands-on help to finish
- 2 (Moderate): you need substantial help to complete the task
- 3 (Severe): you cannot do any part of the task on your own
Part B — Unmet Need. This column measures the gap between what you need and what family, friends, or other informal caregivers currently provide:
- 0 (None): you need no help, or your existing support fully covers it
- 1 (Minimal): your needs are met at least half the time, but gaps create some health or safety risk
- 2 (Frequent): your needs are met less than half the time, creating moderate risk
- 3 (Constant): your needs are met less than 10 percent of the time, or not at all, creating extreme risk
The two-column structure matters more than most applicants realize. Someone with serious physical limitations who has a devoted spouse covering every gap may rack up high Part A scores but low Part B scores, pulling the total below 29. Someone with moderate impairments and no family nearby may qualify easily. The DON is measuring danger, not just disability.
Your final score adds Part A, Part B, and any MMSE bonus points together. The threshold to qualify is 29 total points, and at least 15 of those must come from the Part B unmet-need column.1Illinois Department of Human Services. Program Eligibility Determination The Community Care Program uses the same tool and the same cutoff.5Illinois Department on Aging. Community Care Program
How to Schedule the Assessment
The process starts with a phone call. If you are 60 or older, contact the Senior HelpLine at 1-800-252-8966 or your local Case Coordination Unit, which connects you with the Illinois Department on Aging.6Illinois Department on Aging. Contact Us If you are under 60 and have a disability, contact your regional Department of Human Services office to apply through the Home Services Program.2Illinois Department of Human Services. Home Services Program
After you make contact, the agency schedules a trained assessor to visit your home. The visit typically takes an hour or more. The assessor conducts a face-to-face interview with you and anyone who helps with your daily care, observes how you move through your living space, asks about each of the 15 scored activities, and administers the MMSE. They also look at your environment, including whether grab bars are installed, whether medications are organized, and whether features like steep stairs or cluttered walkways create hazards.
How to Prepare for the Visit
Gather these items before the assessor arrives:
- A current medication list with every prescription, its dosage, and the condition it treats
- Contact information for all physicians and specialists involved in your care
- Recent medical records, including hospital discharge summaries, ER visits, and diagnostic reports from the past year
- Your state ID and Social Security card, with the name and address matching what appears on your application
- Financial documents, including bank statements, proof of income, and insurance information
Small clerical mistakes cause real delays. A misspelled name or an outdated address can stall your application or trigger a denial on administrative grounds. Having a family member or legal representative present during the visit helps catch those errors and gives someone who sees your daily struggles a chance to speak directly to the assessor.
The Mistake That Costs People Their Eligibility
The single most common reason borderline applicants score below 29 is downplaying their limitations. Families often tidy up the house, help the applicant get dressed before the visit, and present a picture that looks far more independent than reality. This works against you. The assessor is building a care plan around your worst days, not your best ones. If you normally struggle to bathe, if you cannot prepare a meal without help, if you leave the stove on, the assessor needs to see or hear about that. Answer honestly, and let whoever provides your care describe what they actually do for you.
What Happens After the Assessment
The state must decide on your eligibility within 30 calendar days after you submit the Participant Agreement and Consent Form. You then receive written notice of the decision within 15 calendar days after it is made.7Illinois General Assembly. Illinois Administrative Code Title 89 Part 240 – Community Care Program In practice, expect the written notice roughly six weeks after you turn in your paperwork.
If you are approved, your assessor works with you to build a person-centered care plan that specifies which services you will receive, how many hours per week are authorized, and which providers will deliver the care. The specific mix depends on where your points came from. Someone who scored a 35 with most of their unmet need in meal preparation and bathing gets a different package than someone who scored a 42 with cognitive impairments requiring constant supervision.
The plan is not permanent. Illinois requires a face-to-face reassessment at least once a year to determine whether your needs have changed and whether services should be adjusted.8Illinois General Assembly. Illinois Administrative Code Title 89 Part 240 – Community Care Program – Section 240.260 You can also request a reassessment any time your condition worsens between annual reviews.
If You Are Denied
A denial notice must explain the reason and tell you how to appeal. You can request a Notice of Appeal form through the Senior HelpLine at 1-800-252-8966.9Illinois General Assembly. Illinois Administrative Code Title 89 Part 240 – Community Care Program – Section 240.400 The appeal triggers a fair hearing, an administrative review where you can present evidence that the original assessment underestimated your needs.
Under federal Medicaid rules, the state must reach a final decision on your fair hearing within 90 days of receiving your appeal, except in unusual circumstances such as a delay you requested or an emergency beyond the agency’s control.10eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries If you scored close to 29 and believe the assessor missed something, bring medical records, caregiver statements, and hospital records that document the severity of your condition. A borderline denial is worth appealing, especially if your health has declined since the assessment date.
A Note on Financial Eligibility
Clearing the 29-point threshold is only half of what the state requires. You also have to meet Illinois Medicaid’s income and asset limits, which are a separate screening with their own rules on countable resources, spousal protections, and the five-year look-back on asset transfers. For 2026, the individual asset limit for long-term care programs is $17,500, with your primary home, one vehicle, and certain personal property generally excluded while you live in them.11Illinois Department on Aging. 2026 Illinois Medicaid Income Standards and Resource Limits A high DON score alone will not get you services if the financial side has not been cleared, so plan for both tracks at the same time.