Outside of Cook County: If you live in a nursing facility outside of Cook County and are interested in
speaking to someone about the possibility of living in the community, or if you know someone who lives
in a nursing facility outside of Cook County who wants to learn more about living in the community and
the support services that may be available there, please fill out and submit this form. Someone from
one of the state, community, or healthcare agencies that work with those wishing to learn more about
returning to the community will contact you to discuss your Medicaid eligibility and the assessment
process. This referral form is only a first step. By submitting this form, you agree to submit your
information to the Illinois Department of Healthcare and Family Services. That Department will forward
your Referral Form to the agency that will discuss the possibility of a move from the nursing facility
to the community with you or with the person that you referred.
In Cook County: If this referral is for someone currently living in a nursing facility in Cook County,
do not complete the referral form below. Instead, please click on the following link and make the
referral to the Comprehensive Program Hotline: https://www.dhs.state.il.us/page.aspx?item=125944.
Once you make the referral, staff members working with Comprehensive Program (Colbert and Williams Consent Decrees) will be in contact
with you or with the person you referred.
Please identify if the referral has any of the following:
Age 60 and over
Intellectual or Developmental Disability
Acquired Brain Injury
HIV / AIDS
Receives medical care through a Managed Care Organization (MCO)
Please check all that apply:
Currently receiving Medicaid benefits or eligible for Medicaid
Interested in moving to a community setting