Find Out if You Qualify for CCP | Safe Life Home Health Care

State-funded support for seniors aged 60+ to remain independent and safe in their own homes.

Fill out this short eligibility form. Our intake team will follow up within 1–2 business days. All information is confidential and used to determine your potential fit for the program.

Eligibility Questionnaire

    Are you 60 years of age or older?

    YesNo

    Do you currently reside in Illinois?

    YesNo

    Are you a U.S. citizen or a qualified non-citizen?

    YesNo

    Do you have Medicaid?

    YesNo

    If NOT, would you like our help in applying for Medicaid?

    N/AYesNo

    Would you like help applying for Medicaid if needed?

    YesNo

    Contact Information




    Preferred Time to Contact:



    What Happens After Submission?

    We're Here If You Need Us

    Call us at

    or email

    Your questions are always welcome

    Ready to Begin?

    Want to find out if you or a loved one qualifies for CCP?