How Illinois pays for disability services

Waiver inventory

No 1915(i), 1915(j), 1915(k)/Community First Choice, or DD-specific 1115 authority was identified for Illinois. Excluded: Persons with Disabilities Waiver (0142), HCBS Waiver for Persons Who are Elderly (0143), Medically Fragile Technology Dependent (0278), Persons with Brain Injury (0329), HIV or AIDS (0202), and Supportive Living Program (0326).

State-only funded programs

Non-Medicaid lines within IDHS Division of Developmental Disabilities, Developmental Disabilities Grants and Program Support (GRF), with FY2026 and FY2027 request amounts. Source: dhs.state.il.us

• Respite Grants: $6,744,300 FY2026, $6,744,300 FY2027 request. Funds In-Home Respite (87D) and Residential Respite (89D), both flagged in the DDD rate table as not HCBS Medicaid waiver services.
• Epilepsy Services: $1,750,000 FY2026, $3,000,000 FY2027 request.
• Special Services: $7,675,800 FY2026 and FY2027 request.
• DD Transitions: $5,201,600 FY2026, $25,201,600 FY2027 request (a $20 million increase).
• Project For Autism: $4,800,000 FY2026, $4,320,000 FY2027 request.
• DCFS CILAs: $2,471,600 FY2026 and FY2027 request.
• Dental Grants: $715,900 both years.
• Best Buddies: $977,500 FY2026, $879,700 FY2027 request.
• Arc of Illinois Life Span Project: $471,400 FY2026, $424,300 FY2027 request.
• St. Mary's Hospital: $1,500,000 FY2026, $1,350,000 FY2027 request.
• DD Grants & POC (DHS Community Services): $85,000,000 FY2027 request. dhs.state.il.us

Also state-only in effect: CLF-Not Waiver (68 people in Illinois, 27 out of state) and State-Operated Developmental Centers (1,552 residents in FY2025), which carry substantial non-federal cost. dhs.state.il.us

All administered by the Illinois Department of Human Services, Division of Developmental Disabilities.

County / regional / local funding

Community Mental Health Boards, commonly called "708 Boards." Authorized by the Illinois Community Mental Health Act, 405 ILCS 20/, originally House Bill 708. Counties, townships, and municipalities may hold a referendum to levy a property tax dedicated to mental health, intellectual and developmental disability, and substance use services. The maximum levy is 0.15% of assessed valuation, though most boards levy far less (published illustrative rates range from 0.0214% to the 0.15% cap). Boards are appointed by the county board chair, meet at least quarterly, and award grants to community nonprofit providers rather than funding whole programs. Geography is county-by-county and voluntary, so coverage is uneven across Illinois's 102 counties.

• Mechanism and levy cap: piattmhc.org
• Statutory framing and DD scope: kendallcountyil.gov
• Example of a long-standing board (Jackson County, referendum approved November 1964; funds mental illness, intellectual and developmental disabilities, and substance abuse): jacksoncounty-il.gov
• Example of scope language (LaSalle County allocates to providers of mental health, substance use, intellectual and developmental disabilities, child welfare, and related services): lasallecountyil.gov

Aggregate statewide 708 levy revenue attributable to developmental disabilities was not found in any state source.

Funding scale

• Total IDHS Division of Developmental Disabilities appropriation, all funds: $2,575,447,000 in FY2026, with a $2,741,953,600 FY2027 request. GRF portion: $2,262,800,000 FY2026, $2,419,700,000 FY2027 request. dhs.state.il.us and dhs.state.il.us
• The single largest line, DD Grants, Purchase of Care and Long Term Care: $2,348,966,600 in the FY2027 request. Same source.
• Adult DD waiver services (Appendix J): $1,414,405,514.50 in waiver year 1 across 25,250 participants. hfs.illinois.gov
• Per participant, adult waiver: Factor D $56,016.06 (WY1), $77,555.80 (WY4, FY2026), $81,368.97 (WY5, FY2027). Waiver plus other Medicaid (D + D') reaches $80,880.35 in WY4. The ICF/IID comparison (G + G') is $174,591.20 in WY4. Same source.
• Children's Support Waiver per participant: Factor D $16,638.12 (WY1) rising to $18,974.13 (WY5); D + D' $31,831.28 in WY4. hfs.illinois.gov
• CILA program specifically: $1,381,064,926 total annualized DHS funding, of which 24-hour CILA is $1,312,497,518, across 10,906 approved and placed rates (9,766 24-hour at 89.5%, 250 Host Family at 2.3%, 890 Intermittent at 8.2%). Averages: 24-hour CILA $134,395, Host Family CILA $92,662, Intermittent $51,013 and up. dhs.state.il.us
• State versus federal share: Illinois FMAP is 51.82% for FY2026, so the state share is 48.18%. The Guidehouse rate study modeled a 49.04% state share. kff.org and dhs.state.il.us
• People served as of June 30, 2025: 25,174 in waiver (ISSA), 10,938 in CILA of all types, 12,739 adults in Home-Based Support Services, 3,939 in private ICF/DD, 1,552 in State-Operated Developmental Centers, 218 in CLF-Waiver, 1,135 children in the in-home waiver, 92 children in the residential waiver, 954 in day programs only. dhs.state.il.us
• Waiting list: 17,912 people on PUNS as of August 1, 2026. Of these, 14,975 are "seeking services" (8,949 adults, 6,026 under 18) and 2,937 are "planning for services." 6,521 adults are eligible for adult selection; 30% have waited under one year, 27% for 12 to 24 months, with a small share past four years. dhs.state.il.us
• Selection pace under Ligas: a minimum of 630 individuals entering service each year, funded at $33.9 million for 630 FY2026 placements plus 630 more in FY2027. dhs.state.il.us

Residential funding detail

Illinois's residential system is built on the Community Integrated Living Arrangement (CILA), with three distinct models paid three different ways, plus private ICF/DD, Community Living Facilities, and State-Operated Developmental Centers.

1. 24-Hour CILA (program code 60D), the group home model. Paid as an individualized client-day rate, computed by DHS for each person from an ICAP score plus Health Risk Screening Tool result, up to 365 days per year. The Guidehouse model uses a "Zero-Hour" minimum staffing assumption for 24-hour CILA, adjusts nursing hours by health care level score, and includes 181 temporary DSP hours per person per year. Statewide floor is $129 per day (about $47,000 annually); Chicago metro floor is $147 per day (about $53,700). The waiver's approved average daily rate rose to $375.11 effective January 1, 2026. 9,766 24-hour rates were approved and placed as of June 30, 2025.
2. Host Family CILA (also 60D), Illinois's host home / shared living model. The family receives a per diem stipend tiered by ICAP score: $100.00 (ICAP 70 to 100), $110.00 (ICAP 40 to 69), $120.00 (ICAP 1 to 39) statewide, and $115.00 / $126.50 / $138.00 in the Chicago metro region. 250 host family rates were placed as of June 30, 2025, averaging $92,662 annualized to the agency.
3. Intermittent CILA (61H, 62H, 63H), supported living in a person's own home or apartment. Paid hourly by staffing ratio: 1:1 $60.48 statewide / $68.96 Chicago; 1:2 $30.24 / $34.48; 1:3 $20.16 / $22.99, all effective January 1, 2026. 890 intermittent rates were placed.
4. 24-Hour Stabilization Services, a short-term crisis residential service, paid per day at $1,062.00 effective January 1, 2026, down from $1,117.25 because DHS changed the calculation to reflect all available beds rather than reported occupants. The new rate still incorporates a $0.80 per hour DSP wage increase.
5. Community Living Facility (CLF), a licensed residential category with both waiver (218 people) and non-waiver (95 people) participants. CLF rates increased 9% effective January 1, 2025.
6. Private ICF/DD, 3,939 people in FY2025. Rates are set by HFS. As of the December 17, 2025 DDD communication, ICF/DD rate updates remained pending federal approval and could not be implemented.
7. State-Operated Developmental Centers (SODCs), 1,552 residents in FY2025, funded outside the waiver.

Payment structure summary: 24-hour and Host Family CILA are acuity-tiered per diems; Intermittent CILA is hourly by ratio; 24-Hour Stabilization is a flat per diem; Home-Based Support Services carry a monthly individual budget cap.

Room and board: the CILA rate methodology contains five components: Room and Board, Program, Transportation, Administration, and Individual Supports. DHS computes Medicaid claims from the Program, Transportation, Administration, and Individual Supports components only. The waiver states plainly that "the Room and Board Component is excluded when calculating waiver claims." Room and board therefore falls to the participant's SSI and other income, with the state's contribution flowing through the non-Medicaid side of the CILA rate rather than a separate room and board subsidy. Illinois does not reimburse rent and food for an unrelated live-in caregiver.

Home-Based Support Services budget cap: Public Act 104-0002 raised the limit, effective January 1, 2026, to 1.05 times 300% of the monthly federal SSI payment for an individual residing alone (or 1.05 times 200% if the adult is enrolled in a local education agency special education program), amending 405 ILCS 80/2-1.

Rate structure link: dhs.state.il.us and the CILA Estimated Rate Calculator at cilaratecalculator.dhs.illinois.gov

Comparable service rates

All rates below are from the IDHS DDD Rate Table effective January 1, 2026, cross-checked against the CMS waiver amendment IL.0350.R05.04. The rate table carries the caveat "All Rates and Wages Shown are subject to Federal CMS approval of Technical Amendments to DDD Waivers"; CMS approval of the 2026 amendments was announced December 17, 2025 except for ICF/DD.

Additional January 1, 2026 rates from the same table: Enhanced Residential $27.67 statewide / $31.82 Chicago; 24-Hour Stabilization Services $1,062.00 per day; Nursing RN $45.00/hour, LPN $37.50/hour; Counseling for Unpaid Caregivers $33.13/hour; Transportation $0.67/mile capped at $500/month. Embedded wage floors effective 1/1/2026: DSP hourly wage reimbursement $21.30 statewide / $24.50 Chicago; relief and vacation staff same; job coach $22.94 / $26.38.

Official rate schedule links

• DDD Rate Table effective January 1, 2026: dhs.state.il.us
• DDD Rate Table effective January 1, 2025: dhs.state.il.us
• Index of all historical DDD rate tables: dhs.state.il.us
• CILA Rates Update 06-30-25 (rate counts, averages, total annualized funding): dhs.state.il.us
• CILA Estimated Rate Calculator: cilaratecalculator.dhs.illinois.gov
• IDHS DDD Rates Information index: dhs.state.il.us
• Approved Adults with DD Waiver, IL.0350.R05.04, with Appendix I rate methodology and full rate-change history from 2022 through 2026: hfs.illinois.gov
• Support Waiver for Children and Young Adults, IL.0464.R03.02: hfs.illinois.gov
• Guidehouse DD Services Rate Study, November 30, 2020: dhs.state.il.us

Notable features and flags

• January 27, 2026: the Ligas Court Monitor filed the CY2025 annual report and found defendants "not in substantial compliance." Ligas class members in ICFs/DD rose from 359 in FY2024 to 444 in FY2025, with those awaiting transition rising from 182 to 261. At least 100 class members waiting to leave State-Operated Developmental Centers have waited an average of 5.8 years; average SODC stay is 3.8 years. Before SODC admission, 44% of class members had been in CILA and 17.1% in their own homes. The Monitor set seven FY2026 priorities including a maximum 60-month PUNS wait and a minimum 630 annual entries. thearcofil.org
• January 1, 2026: rate increases under Public Act 104-0002 took effect, approved by CMS as amendment IL.0350.R05.04. 24-hour CILA average daily rate $364.50 to $375.11; DSP wage reimbursement $20.50 to $21.30 statewide and $23.58 to $24.50 in Chicago, Cook and the collar counties; CDS On-Site $17.75 to $18.38; supported employment individual $49.00 to $50.92; Enhanced Residential $22.20 to $27.67, a 25% jump. The same amendment raised the Home-Based Support Services budget cap under 405 ILCS 80/2-1. hfs.illinois.gov
• December 17, 2025: ICF/DD rates remain stranded. DDD announced CMS approval of the 2026 waiver amendments but stated ICF/DD rates "remain pending Federal approval and cannot be implemented until final clearance is granted." dhs.state.il.us
• FY2026 budget contained an offsetting cut. Alongside $20.0 million for a $0.50 per hour DSP increase on 1/1/2026, $14.3 million in Ligas annualization, $16.9 million in new Ligas placements, and a 5% Home-Based Support increase, the Governor's FY2026 budget included a 50% rollback of the CILA adjustment factor, minus $32.0 million. dhs.state.il.us
• FY2027 proposal continues the Guidehouse phase-in: $24.0 million for a $0.60 per hour DSP increase effective 1/1/2027, $37.5 million for the Guidehouse Zero Hour Staffing Model effective 1/1/2027, $33.9 million for 630 PUNS placements in each of FY2026 and FY2027, and $13.3 million for Home-Based Services including a 2.5% SSI-linked increase. dhs.state.il.us
• The Guidehouse rate study is still the governing framework and is underfunded relative to its own benchmark. The November 30, 2020 study projected $744.4 million in new spend required in FY2026 ($365.1 million state share) to reach benchmark rates, assuming a statewide DSP wage of $22.50 per hour and $25.88 in Chicago. Actual FY2026 reimbursed DSP wage is $21.30 statewide and $24.50 in Chicago. dhs.state.il.us
• No DD managed care carve-in was identified in the FY2026 or FY2027 IDHS budget documents or in the January 2026 waiver amendment. DD waiver services continue to be administered fee-for-service by IDHS DDD as the operating agency, with HFS as the single state agency.

Confidence

Solid: waiver structure and CMS-approved capacity, the full 2022 through 2026 rate-change history (which the waiver application recites line by line), the January 1, 2026 rate table, CILA counts and average annualized values, PUNS totals and wait distribution as of August 1, 2026, FY2026 and FY2027 budget lines including the non-Medicaid GRF grants, FMAP, the 708 board mechanism and 0.15% levy cap, and the Ligas Monitor's January 2026 findings.

Estimated: nothing material. Where a rate is individually determined (24-hour CILA, Host Family CILA agency rate, Personal Support), that is stated rather than substituted with an average.

Could not find: the CMS-approved participant limit and Appendix J figures for the children's Residential Waiver (IL.0473); HFS published the file at a URL that now returns a 404 and an alternate path served the Support Waiver instead. Also not found: current ICF/DD per diem rates (rate updates were still awaiting federal approval as of December 2025, and the most recent posted ICF/DD-LTD rate page dates to December 2015); Independent Service Coordination payment rates, which do not appear in the DDD rate table; aggregate statewide 708 board revenue attributable to developmental disabilities; and the total current Ligas class size, which the Monitor's report does not state.