Medicaid Nursing Home Rates by State

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Illinois

Medicaid nursing facility payment · Hybrid · researched October 2026

Illinois’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Hybrid

Case-mix level

Facility average

Classification

PDPM

Rate updates

Quarterly

Managed care (LTC)

Yes

Quality program

Quality Incentive Payment (QIP)

Paid outside the rate

Moderate

Bed hold

Not paid

Published rates

Rates and build‑ups

Assisted living

Covered

Personal needs allowance

$60 / month

Overview

• Each home gets its own per diem, the sum of three parts.
• Nursing: a statewide base of $92.25 x the home's average Medicaid PDPM nursing case-mix index x a regional wage adjuster (floor 1.06), plus add-ons (staffing add-on tied to PBJ hours vs the STRIVE target, Medicaid Access Adjustment for homes with >=70% Medicaid days, dementia/SMI/TBI add-ons).
• Support: the home's own inflated cost, capped at the 75th percentile of its rate region.
• Capital: a blended building value (historical cost and a uniform value) x rate of return, spread over 93% occupancy.
• The Oct 1, 2026 rate list covers 644 nursing facilities: median total $253.73/day (range $120.16-$320.63); median nursing $171.58, support $64.86, capital $16.84.
• Quality and CNA wage payments come as separate quarterly lump sums.

What matters in Illinois

• Median posted Medicaid rate is $253.73/day (Oct 2026, 644 homes); about two-thirds is the case-mix nursing component.
• Staffing add-on worth up to $38.68/day goes to homes at 70%+ of the PBJ-based STRIVE staffing target; 42 homes get $0.
• Bed tax runs $10.67-$22.40 per non-Medicare day by Medicaid day volume; mid-sized Medicaid homes pay the most.
• About 78% of Medicaid nursing home days are paid by managed care plans; fee-for-service paid about 22% in CY2025.
• Quality and CNA wage lump sums add roughly $170M a year (about 5% of base) on top of posted rates.
• From 1/1/2027 the Medicaid Access Adjustment rises from $4.75 to $10.30/day for high-Medicaid homes meeting 70% of STRIVE.

Frequently asked

Does an Illinois nursing home's Medicaid rate change with each resident's own PDPM assessment?

No. Each home gets one nursing rate per quarter from the average PDPM nursing case-mix index of its Medicaid residents, and every Medicaid resident is paid that rate (89 IAC 147.310(c)(1)). The average uses residents on record 30 days before the rate period who were present on the last day of the second quarter before it, at 78.58% of CMS PDPM nursing weights. The $92.25 statewide base is multiplied by that index and a regional wage adjuster (floor 1.06); support and capital are not case-mix adjusted.

Which Illinois nursing homes pay the highest Medicaid bed tax per day, and why is it not the most Medicaid-heavy?

Homes with 15,001-35,000 paid Medicaid days a year pay the most, $22.40 per non-Medicare occupied day (305 ILCS 5/5B-2(a-1)). The tiers follow Medicaid day volume, not Medicaid share: the rate falls to $19.20 at 35,001-55,000 days, $13.86 at 55,001-65,000 and $10.67 above 65,000, the same as homes under 5,000 days. County-owned homes and nonprofits without Medicaid beds pay $7.00. Tiers reset each calendar year; CY2026 uses 4/1/2024-3/31/2025 days.

Can an Illinois home lose its whole staffing add-on even with staffing above 70% of the target?

Yes, through its PBJ data. A home with unvalidated PBJ staffing data loses 10 percentage points of STRIVE (CMS footnotes 6/25), which can push it under the 70% cutoff, and a home that did not submit drops to 0% (footnote 23). The add-on pays $9.00/day at 70% of the PBJ-based target, rising in steps to $38.68 at 125% or more, and nothing below 70% (305 ILCS 5/5-5.2(d)(6)-(6.5); 89 IAC 147.310(c)(3)).

How much is paid outside the posted rate in Illinois?

Moderate, about 5% of base from quality and CNA lump sums, plus certified-cost payments to 16 county homes.

What does Illinois Medicaid pay on Medicare coinsurance days?

Paid under Department standards, read as lesser-of the Medicaid rate; homes usually receive little or nothing.

Does Illinois require a minimum share of spending on care?

No spending floor; CNA tenure payments require a posted pay scale paying the increments.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

Illinois state-specific Long Term Care Facility cost report filed annually with HFS; used for the support and capital components (89 IAC 140.543, 140.561, 140.570).

Base year and rebasing

Statute (305 ILCS 5/5-5.2(d)(2)) says costs are 'annually rebased', but in practice the support component moves by legislated updates: 7/1/2019 support update using the most recent cost reports on file ($170M/yr; P.A. 101-10), then +12% over the 6/30/2023 rate from 1/1/2024 (P.A. 103-102). HFS states the 2022 reform did not change the support or capital methods. The date of the last full support rebase on cost reports was not confirmed.

Components

Component	Method	Notes
nursing (direct care)	Statewide PDPM nursing base $92.25 x facility average Medicaid PDPM nursing CMI x regional wage adjuster (HSA groupings of 4/30/2012, none below 1.06), plus Medicaid Access Adjustment ($4.75 x CMI for homes with >=70% Medicaid days), staffing add-on ($9.00-$38.68) and dementia ($0.63)/SMI ($2.67)/TBI ($5.00) add-ons.	Oct 2026 median nursing rate $171.58 (range $54.33-$225.62). Price-like (statewide base), not cost-based, despite the statute's wording.
support (general service + administration)	Facility cost per diem from the cost report, inflated to the rate year, capped at the 75th percentile of the rate region. Homes between the 35th and 75th percentile get cost plus 50% of the gap to the 75th percentile (efficiency 'profit' payment).	Oct 2026 median $64.86 (range $39.23-$80.04). Cut 1.7% from 7/1/2012, raised 8.17% 7/1/2014 and 12% 1/1/2024.
capital	Blend of inflated historical building cost per bed and a uniform per-bed value by age and region, x rate of return, divided by 339 days (93% occupancy), plus an ERVWC factor (equipment, rent, vehicle, working capital; at least $1.75/day) and real estate tax.	Oct 2026 median $16.84 (range $4.45-$47.51).

Inflation

Support costs are inflated to the rate year with nursing-home-specific indices (Global Insight/DRI Health Care Cost Review; 89 IAC 140.551/140.553). The nursing base has no automatic inflator; it moves only by statute (+$7.00 on 7/1/2022).

Verified October 11, 2026

Case mix

System

PDPM

Applied at

Facility average

How it works

Each home gets one quarterly nursing rate from the mean of its Medicaid residents' PDPM nursing weights, the same for every Medicaid resident (89 IAC 147.310(c)(1)).

Classification

PDPM nursing component only: CMS PDPM nursing case-mix weights in effect 3/1/2022 x 0.7858 (89 IAC 147.310(a)(2); 305 ILCS 5/5-5.2(d)(4)). PT, OT, SLP and NTA components are not used.

Applies to

Nursing component and the Medicaid Access Adjustment ($4.75 x CMI). Support and capital are not case-mix adjusted.

Acuity measured from

Medicaid-enrolled residents on record in MMIS 30 days before the rate period, present on the last day of the second quarter before the rate period, using their latest MDS (147.310(c)(1); 5-5.2(d)(2)).

Updated

quarterly

Move to PDPM

RUG-IV 48 was used 1/1/2014-9/30/2023. PDPM started 7/1/2022 (P.A. 102-1035) with a hold-harmless blend: greater of PDPM or a RUG/PDPM blend of 100/0, 80/20, 60/40, 40/60, 20/80 over five quarters; 100% PDPM from 10/1/2023.

Verified October 11, 2026

Low-acuity residents

None found. Illinois pays one facility-average nursing rate, so low-acuity residents only lower the average CMI; there is no flat or reduced rate for low groups. Related: (1) under RUG-IV an Illinois default group AA1 took the PA1 weight (147.310(a)(3)); (2) an SMI add-on of $2.67/day goes to residents with S1200 psychiatric items in the lowest RUG groups (PA1, PA2, BA1, BA2), and the 2022 reform budgeted a $15M 'SMI (low 4 RUGs) increase'; (3) payment stops for residents found at an improper level of care (89 IAC 140.503). Checked: 89 IAC 147.310, 305 ILCS 5/5-5.2, HFS 2023 interim review.

Verified October 11, 2026

Capital

Blended building value (not fair rental value, not actual cost): historical inflated cost per bed blended with a uniform per-bed value for the same age and region, x a rate of return, / 339 days (93% occupancy), + ERVWC factor (greater of $1.75/day or calculated) + real estate tax; never below 115% of the FY1991 capital rate for the same licensee (89 IAC 140.570-140.572). Cut 1.7% since 7/1/2012. Unchanged by the 2022 reform. Oct 2026 median $16.84/day.

Verified October 11, 2026

Budget adjustment factor

No current across-the-board budget factor found. Legacy cuts remain embedded: capital and support components reduced 1.7% from 7/1/2012 (305 ILCS 5/5-5.2(g)); IMD/SMHRF rates reduced 2.7% in total (5-5.2(h)). The nursing base is fixed in statute ($92.25) with no inflation update.

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

moderate

Estimate

About 5% of base, plus county certified-cost payments. Derived: QIP about $84M/yr (Oct 2026 quarter $20.96M x 4) + CNA tenure/promotion about $85M/yr (HFS 2023 estimate) = about $170M against about $3.2B of annual per diem claims (HFS interim review: $3.22B at SFY2023 rates).

Components

QIP lump sums about $84M/yr; CNA tenure/promotion payments about $85M/yr; county home certified expenditures for 16 homes (interim $41.64-$342.18/day; annual total not found). The staffing add-on and Medicaid Access Adjustment are inside the per diem and not counted.

Source

https://hfs.illinois.gov/content/dam/soi/en/web/hfs/medicalpr…

Verified October 11, 2026

Payments by owner type

Applies

yes

Detail

County-owned or operated homes (16 on the Oct 2026 list) are paid allowable costs above the standard rate, certified from their cost reports: interim county contribution rates $41.64-$342.18/day (median $153.39) on top of standard rates of $196.75-$276.09. They also pay the lowest bed tax ($7.00/day). Private homes get neither.

Funding

Certified public expenditures by the county; HFS draws the federal match and pays it to the county (89 IAC 140.860). No lease or management arrangement for private operators found.

Source

https://www.ilga.gov/commission/jcar/admincode/089/089001400F…

Verified October 11, 2026

Quality program

Active

Yes

Program

Nursing Facility Quality Incentive Payment (QIP) under 305 ILCS 5/5-5.2(l)(1), started 7/1/2022 (P.A. 102-1035). The older 2015 'QUIP' measures (CNA retention, consistent assignment; 89 IAC 147.345(a)-(b)) remain in rule text, but current HFS lump sums follow the star-rating method.

Funding

Part of the 2022 reform, funded by new general revenue and the higher bed tax; paid from the Long-Term Care Provider Fund. Not carved from base rates.

Size

Statute: no less than $70M/yr ($17.5M per quarter). The Oct 2026 quarter paid $20.96M after a 'Quality Tier Adjustment Factor' that restores per-day floors from 7/1/2022: $8.37 (5-star), $5.98 (4-star), $3.59 (3-star), $1.79 (2-star) per Medicaid day.

Paid as

Quarterly lump sum, paid monthly; split between HFS (FFS days) and each MCO/MMAI plan (its days).

Measures

Measure	Source	Weight	How points are earned
CMS Five-Star long-stay quality measure (QM) star rating	CMS Provider Information File (MDS QM)	100%	Star weights: 0-1 star 0; 2 stars 0.75; 3 stars 1.5; 4 stars 2.5; 5 stars 3.5. A home that cannot show timely federal data submission drops one star.

Scoring period

The Oct 1, 2026 quarter uses the CMS Provider Information File published July 2026 and Medicaid days for CY2025. HFS posts estimated payments 45 days before the quarter.

Payment formula

Quality-weighted score = home's Medicaid days x star weight; share of pool = score / sum of all scores; then x the tier adjustment factor (about 1.19-1.20 in Oct 2026) so each tier meets its 7/1/2022 per-day floor.

Eligibility

Excludes CMS Special Focus Facilities and hospital-based nursing homes; 0-1 star homes earn $0.

Cadence

Scored quarterly; paid monthly in proportion to the quarterly total.

Scores published

Yes: per-facility star rating, weight, days and payment by payer, posted quarterly as xlsx on https://hfs.illinois.gov/medicalproviders/medicaidreimburseme…

Notes

HFS may change metrics by rule from 7/1/2023 after consulting stakeholders; no change found.

Verified October 11, 2026

Provider tax

Charged

per non-Medicare day

Standard amount

Tiered by annual paid Medicaid resident days, effective 7/1/2022 and reset each calendar year (CY2026 rates use 4/1/2024-3/31/2025 days). Medicare Part A days (including MMAI days where Medicare would be primary) are not taxed.

Tiers

Who	Test	Amount
0-5,000 paid Medicaid days/yr	volume	$10.67
5,001-15,000 paid Medicaid days/yr	volume	$19.20
15,001-35,000 paid Medicaid days/yr	volume	$22.40
35,001-55,000 paid Medicaid days/yr	volume	$19.20
55,001-65,000 paid Medicaid days/yr	volume	$13.86
65,001+ paid Medicaid days/yr	volume	$10.67
County-owned or operated nursing facilities	public	$7.00
Non-profit facilities without Medicaid-certified beds	other	$7.00

Lower for high-Medicaid homes

yes

Returned in the rate

Not returned as a separate per diem allowance; the revenue funds the 2022 reform (base rate, staffing add-on, access adjustment, QIP, CNA payments). The discount is by Medicaid day volume (55,001+ days pay $13.86 or $10.67), not by Medicaid share.

Source

https://www.ilga.gov/Documents/legislation/ilcs/documents/030…

Verified October 11, 2026

Provider tax notes

Long-term care provider assessment (305 ILCS 5/5B-2(a-1)) from 7/1/2022: per occupied non-Medicare bed day, $10.67-$22.40 by the home's annual paid Medicaid days; $7.00 for county-owned homes and nonprofits without Medicaid beds. It replaced the $6.07 per occupied bed day tax plus the $1.50 per licensed bed day license fee. HFS projected about $208M/yr more; collections rose from $161M (SFY2022) to $298M (SFY2023). Not returned as a separate add-on; it funds the 2022 rate increases.

Verified October 11, 2026

Supplemental payments

(1) County-owned or operated homes: rates include certified allowable costs above the normal rate, with federal match drawn on the county's certified expenditures (89 IAC 140.530(c)(2), 140.860); Oct 2026 interim county contribution rates $41.64-$342.18/day across 16 homes (median $153.39). (2) Quality Incentive Payment: about $84M/yr ($20.96M in the Oct 2026 quarter), lump sums by FFS and MCO directed payment. (3) CNA tenure and promotion payments: Medicaid's share of $1.50-$6.50/hour tenure increments and $1.50/hour promotion increments, estimated $85M/yr at full take-up (HFS interim review, 2023); paid by FFS and MCOs.

Verified October 11, 2026

Other add-ons

(1) Staffing add-on (5-5.2(d)(6)-(6.5); 147.310(c)(3)): reported total nurse HPRD from the CMS Provider Information File divided by a PDPM STRIVE target (0.7122 x the home's case-mix HPRD, indexed to the national average). Pays $9.00 at 70% of target, rising in steps to $16.52 (80%), $25.77 (92%), $30.98 (100%), $36.44 (110%) and $38.68 (125%+); $0 below 70%. No more than a 5% cut in two consecutive quarters. Oct 2026: median $29.68/day, 42 of 646 homes at $0. +$2.25 for homes at 80%+ from 1/1/2027 (P.A. 104-470). (2) Medicaid Access Adjustment: $4.75 x facility CMI for homes with >=70% Medicaid days (299 of 646 homes qualify on CY2025 days); from 1/1/2027 $10.30 for qualifying homes at >=70% of STRIVE that meet staff training rules, with the Medicaid threshold cut to 65% outside Rate Areas 6-8. Sunsets 12/31/2029 (one statute version says 1/1/2028). (3) Dementia $0.63/day (MDS I4200/I4800) and SMI $2.67/day (S1200 items in PA1/PA2/BA1/BA2). (4) TBI $5.00/day for TBI residents not in a TBI tier.

Verified October 11, 2026

Units paid separately

(1) Ventilator: enhanced add-on $481/day per qualifying resident from 1/1/2024 (was $208) (89 IAC 147.335(a); 5-5.2(e-4)). (2) Traumatic brain injury tiers: Tier I $264.17, Tier II $486.49, Tier III $767.46/day (147.335(b)). (3) Specialized Mental Health Rehabilitation Facilities (SMHRFs; 21 on the Oct 2026 list) and former IMDs have their own rates. (4) County homes: 16 on a separate list with interim county contribution rates. (5) Out-of-state placements negotiated case by case (140.566).

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

yes

Detail

HealthChoice Illinois MCOs (QIP file lists Aetna Better Health, Blue Cross/Blue Shield of Illinois, Cook County Care, Meridian, Molina, among others) plus MMAI plans for duals paid about 78% of Medicaid NF days in CY2025; FFS about 22%.

Verified October 11, 2026

Who pays

mixed, mostly managed: HealthChoice Illinois MCOs cover most Medicaid nursing facility residents; dual eligibles were in MMAI plans. HFS's Oct 2026 Medicaid utilization file (CY2025 days) shows 3.37M fee-for-service days (22%), 10.07M MCO non-MMAI days (66%) and 1.96M estimated MMAI days (13%). Quality and CNA lump sums are paid by HFS for FFS days and by each MCO/MMAI plan as a directed payment for its days.

Verified October 11, 2026

Managed care rate floor

Partly confirmed. The quality incentive and CNA tenure/promotion lump sums are directed payments each MCO and MMAI plan must pay by its share of the home's Medicaid days (FY2023 Rate Calculation Handbook p.3; 89 IAC 147.345(d): 'Payments for managed care qualifying days will be paid through the MCOs'). No statute or rule found that requires MCOs to pay at least the FFS per diem for in-network nursing facility days; 305 ILCS 5/5-30.1 sets an FFS-rate-plus-add-ons minimum only for out-of-network payment resolutions. Sources: https://hfs.illinois.gov/content/dam/soi/en/web/hfs/sitecolle… ; https://www.ilga.gov/commission/jcar/admincode/089/0890014700…

Verified October 11, 2026

Included in the daily rate

Included (89 IAC 140.511): all staff, routine equipment and supplies, oxygen if under one tank a month, room and board, laundry, food substitutes and nutritional supplements, OTC drugs and physician-ordered items on the LTC handbook list. Prescription drugs covered by the HFS drug program are paid to pharmacies separately. How therapy, lab/x-ray and DME are billed was not confirmed.

Verified October 11, 2026

Bed hold

Hospital stays

Not paid for nursing facilities since 7/1/2012 (89 IAC 140.523(a); 305 ILCS 5/5-5e(a)(2)).

Leave days

Not paid, except therapeutic home visits for residents scoring as TBI on the MDS: 75% of the per diem, up to 10 days per calendar month.

Occupancy rule

The TBI exception applies only in homes with at least 90% occupancy and at least 80% Medicaid residents.

Notes

ICF/DD and pediatric facilities have separate, more generous bed reserve rules; SMHRFs list leave-day rates on the rate file.

Source

https://www.ilga.gov/commission/jcar/admincode/089/089001400E…

Verified October 11, 2026

Personal needs allowance

Per month

$60

Effective

2024-01-01

Notes

Was $30 before 1/1/2024; $120 per couple residing together. Separate amounts for some veterans ($90 VA disregard) and Supportive Living residents ($120 from 1/1/2025).

Source

https://www.ilga.gov/commission/jcar/admincode/089/089001200C…

Verified October 11, 2026

Medicare coinsurance days

Method

lesser_of

Rule

89 IAC 140.21(b): for dual eligibles and QMBs, HFS pays crossover deductible and coinsurance 'in accordance with Department standards for the service(s) provided', i.e. limited by the Medicaid rate; the full Medicare rate applies only to pharmacy and DME items. The rule does not spell out the SNF calculation, and no Medicare Advantage rule was found.

Effect

Because Illinois per diems (median about $254) are far below Medicare's SNF rate, the home usually receives little or none of the day 21-100 coinsurance from Medicaid.

Confidence

likely

Source

https://www.ilga.gov/commission/jcar/admincode/089/089001400B…

Verified October 11, 2026

Required care spending

Applies

no

Rule

No rule requiring a share of revenue to be spent on care, with recoupment. Related conditions: CNA tenure/promotion payments are paid only for hours under a posted pay scale paying at least the set increments ($1.50-$6.50/hour tenure; $1.50/hour promotion); the staffing add-on depends on PBJ hours, not spending; from 1/1/2027 the higher access adjustment requires staff training compliance.

Source

https://www.ilga.gov/commission/jcar/admincode/089/0890014700…

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

Capital: per-day cost uses the greater of actual occupancy or 93% (capital value divided by 339 days). Operating (support and nursing cost): occupancy below 93% is adjusted by one-third of the gap to 93%. Separately, the Medicaid Access Adjustment needs at least 70% Medicaid days (65% outside Rate Areas 6-8 from 1/1/2027), and the TBI bed hold needs 90% occupancy.

Source

https://www.ilga.gov/commission/jcar/admincode/089/089001400E…

Verified October 11, 2026

MDS accuracy penalties

Yes (89 IAC 147.340): HFS reviews MDS accuracy electronically and on site (at least 20% of assessments, minimum 10). If more than 25% of classifications change, the review expands; two expanded reviews in 24 months bring reviews every 6 months for 18 months. If verified data lowers the direct care rate by more than 1%, the rate is cut back to the start of the rate period; if it falls by more than 10%, an extra $1.00/day penalty applies for each whole percentage point above 2%. The rule text still refers to RUG-IV. Separately, homes with unvalidated PBJ staffing data lose 10 percentage points of STRIVE (CMS footnotes 6/25) or drop to 0% if they did not submit (footnote 23).

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

quarterly

When

Jan 1, Apr 1, Jul 1 and Oct 1: nursing CMI, staffing add-on and Medicaid Access Adjustment eligibility are recalculated each quarter; support and capital change only with legislated updates or capital events; the bed tax tier resets each calendar year.

Verified October 11, 2026

When rates change

Quarterly rate lists effective the first of Jan/Apr/Jul/Oct (latest Oct 1, 2026, posted 10/1/2026). Statutory changes usually take effect Jan 1 or Jul 1 (e.g. support +12% 1/1/2024; access adjustment and staffing increases 1/1/2027). Capital changes carry their own effective-date column.

Verified October 11, 2026

Posted rates

Home-level rates published

Yes

Where

https://hfs.illinois.gov/medicalproviders/medicaidreimburseme…

Format

xlsx (some quarters also pdf)

Cadence

Quarterly

History

Current year on the LTC page plus an 'Archived Medicaid Rate Lists' page (depth not checked).

Home identifier

IDPH building/facility ID (7 digits, e.g. 6000020) and name; the staffing and QIP files add the CMS CCN.

Verified October 11, 2026

Rate build-ups

Published

Yes

Where

https://hfs.illinois.gov/medicalproviders/medicaidreimburseme…

What they show

Per-facility staffing add-on calculation (reported HPRD, case-mix HPRD, % of STRIVE, add-on, 5% protection) and Medicaid utilization % by FFS/MCO/MMAI days; QIP calculation (star rating, weight, payment by payer); CNA incentive payments by payer; bed tax rate per facility. No per-facility build-up of the nursing CMI or support cost is posted. The FY2023 Rate Calculation Handbook explains the steps.

Format

xlsx / pdf

Example file

https://hfs.illinois.gov/content/dam/soi/en/web/hfs/medicalpr…

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

yes

Program

Supportive Living Program (SLP), a 1915(c) waiver for supportive living facilities, administered by HFS.

What is paid

Services per diem; room and board paid by the resident, who keeps a $120/month allowance from 1/1/2025.

Rate

July 1, 2026: regular SLP $133.74 (South) to $154.03 (Chicago) per day; dementia care settings 150% of regular (e.g. $226.59 Chicago). Set at 54.75% of the regional average NF per diem, plus quality and nutrition add-ons.

Limits

Seven rate regions; enrollment cap or waitlist not checked.

Source

https://hfs.illinois.gov/medicalproviders/medicaidreimburseme…

Verified October 11, 2026

Sources

1. 305 ILCS 5/5-5.2 Payment (nursing facility rates; P.A. 104-470 and 104-571 versions) · statute
2. 305 ILCS 5/5B-2 Long-term care provider assessment · statute
3. 305 ILCS 5/5-5e Adjusted rates (bed reserves) · statute
4. 305 ILCS 5/5-30.1 Managed care protections · statute
5. 89 IAC 147.310 Implementation of a Case Mix System · regulation
6. 89 IAC 147.335 Enhanced rates (ventilator, TBI) · regulation
7. 89 IAC 147.340 Minimum Data Set On-Site Reviews · regulation
8. 89 IAC 147.345 Quality Incentives (incl. CNA tenure/promotion) · regulation
9. 89 IAC 140.523 Bed Reserves · regulation
10. 89 IAC 140.582 Cost Adjustments (occupancy) · regulation
11. 89 IAC 140.860 County Owned or Operated Nursing Facilities · regulation
12. 89 IAC 140.84 Long Term Care Provider Fund (assessment) · regulation
13. 89 IAC 140.511 Long Term Care Services Covered By Department Payment · regulation
14. 89 IAC 140.21 Reimbursement for QMB and dual-eligible recipients · regulation
15. 89 IAC 120.61 Long Term Care (personal needs allowance) · regulation
16. HFS Medicaid Reimbursement - Long Term Care page · agency page
17. Medicaid Rate List for NFs, County NFs and SMHRFs effective 10/1/2026 · rate file
18. Staffing Add-on and Medicaid Utilization Report, 10/1/2026 · rate file
19. October 1, 2026 Estimated Quarterly Quality Incentive Payment Calculation · rate file
20. Provider Assessment Rates for Calendar Year 2026 · rate file
21. HFS Interim Review of the 2022 Nursing Home Payment Reform (Dec 2023) · agency page
22. HFS Nursing Home Rate Calculation Handbook FY2023 · agency page
23. HFS Supportive Living reimbursement page · agency page
24. Supportive Living Program rates effective 7/1/2026 · rate file
25. MACPAC Nursing Facility Payment Policies compendium (2019 baseline, out of date) · secondary

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