New Resident Financial Information

The following is necessary information for a Medicaid Application. There is additional information for the Illinois Application for Benefits Eligibility (ABE) available here.

Proof of Age: One of the following: US Passport, Birth Certificate, Driver’s License           

Proof of Citizenship: One of the following: US Passport, Birth Certificate, Naturalization Papers, Alien Registration Card, Final Adoption Decree                                   

Identity: One of the following: US Passport, Photo License, School ID, US Military ID, County ID

Marital Status: All that pertain: Marriage Certificate, Separation Papers, Divorce Decree, Spouse’s Death Certificate

Copies of the Following:

• Social Security Card (front and back) Medicare Card (front and back)

• Additional Insurance Cards

• RX Card

• Insurance Premium Bill or Payment Coupon

• POA/Guardianship Documentation

Please provide five (5) years of all applicable documents from the following categories:

• ALL Financial Resources, include closed accounts

• Checking Account Statement, include closed accounts

• Savings Account Statement, include closed accounts

• Money Market Account Statement, include closed accounts

• Certificates of Deposit

• Stocks, Bonds, Annuities,

• IRA, 401K or 403B

• Keogh Accts, Cash Investments

• Title to Automobile & Value

• Deeds to Property Owned and Listing Agreement

• Property Proceeds / HUD-1

• Mortgages

• Special Needs Trusts  

• Life Insurance Policies with Cash Value Statement  

• Sale of All Property: House, Car

• Burial Plot Information and Prepaid Funeral Contracts

Income:

• Most Recent Pay Stubs          

• SSI Award Letter        

• Pension Statement    

• VA Award Letter

• Social Security Award Letter  

• Unemployment Check Stubs 

• Support/Alimony Checks or Court Order      

• Railroad Retirement Award Letter

Please provide copies of the following:

• Spouse’s ID & Cards   

• Electric/Gas/Oil Bills 

• Real Estate Tax Bills   

• Medical Bills

• Mortgage Statements Rent Receipts 

• Water/Sewer Bills     

• Home/Renter’s Insurance

• All Income Verifications (Social Security Award Letter, Pension Stub, Etc.)

New Resident Clothing Tips

Residents will be encouraged to wear their own street clothes, take part in recreational activities and therapeutic programming and to be up and about all day to the best of their abilities.

Clothing is required to be labeled, even if you choose not to use our laundry service. We recommend the Resident have at least seven days of clothing items on hand. The best way to identify clothing items is with: a sharpie laundry pen, no-iron clothing labels or printed iron on labels which are available to order online. Mark all clothing with first initial, last name or first name, last initial (example: J Smith; John S) near tag, or your full name if you prefer.

Here are suggestions that may make a resident’s stay more comfortable:

• Day Wear: Shirts, dresses, pants, shorts, sweaters, sweatshirts and seasonal outerwear

• Bedtime Wear: Pajamas, nightgown and robe.

• Undergarments: Socks, underwear, t-shirts and bras.

• Shoes: Laces or Velcro closures, if possible, with a non-slip flat sole. Slippers should have a fair amount of support and hard, flat, non-slip soles. Washable athletic shoes are also recommended.

Contraband

For your safety, and the safety of our community, residents and rooms may be searched at any time for contraband items. If staff finds contraband in your possession, whether seen by staff or found during a Safety Check, it will be confiscated. If contraband is in your possession, you may be asked to sign a behavioral contract.

NOTE: In addition to drugs and alcohol, anything that can be utilized or construed as a weapon, or any item that is not being used in the manner it was intended, and/or altered to present a danger to self, others, or facility such as belts, writing utensils, etc., will be confiscated.

List of Contraband Items

The following objects will be removed from the resident room if discovered in their position:

1. Alcohol and drugs, including, but not limited to over the counter (OTC) medication, prescription medication, dietary supplements, vitamins, laxatives, etc.

2. Illicit drugs, or anything that could be used to alter your state of mind, including, but not limited to aerosols, glue, and other inhalants.

3. Glass and sharp objects, including, but not limited to ceramic coffee mugs, picture frames with glass, mirrors, razor blades, razors, scissors or other sharp objects, etc.

4. Rope or tools of any kind, including, but not limited to a hammer, nails, screwdriver, screws, gardening shears, or any other tools, etc.

5. Weapons of any kind, including, but not limited to guns, knives, razorblade, bullets, pellets, ammunition, mace, pepper spray, extension cords, scissors or stick (other than a cane ordered by a physician), etc., or anything that may cause bodily harm; chemicals such as bleach, lighter fluid, alcohol mouth wash, rubbing alcohol, or other inhalants, etc.

6. Sporting equipment, including, but not limited to golf clubs or baseball bats or other items.

7. Chemicals, including, but not limited to cleaning supplies, aerosols such as hairspray, and any other objects that may harm.

8. Sharps and electric appliances, including, but not limited to letter openers, metal nail files, scissors, nail clippers, electric shavers, beard trimmers, hair clippers, blow dryers, curling irons or straighteners, etc. are not permitted in your room. You may label and store the following with your RSA: scissors, nail clippers, electric shavers, beard trimmers, hair clippers, blow dryers, curling irons or straighteners, and razors.