Connecticut Assisted Living and In-Home Care Medicaid Waiver Information for 2017

Introduction

Connecticut provides long-term care resources to seniors through its State Department on Aging. The state’s Aging and Disability Resource Centers (ADRC), known in Connecticut as “Community Choices,” provide seniors with a powerful information hub linking older adults, persons living with disabilities, and caregivers in Connecticut to the services and supports they seek. By contacting Community Choices by phone at by calling 1-800-994-9422, you can receive detailed information regarding community services through activities such as benefit screening, options counseling, and care transitions. Additionally,Community Choices regional offices can provide this information and more.

Another option is through the Connecticut Partnership for Long Term Care. The State of Connecticut works collaboratively with private insurance companies to provide Connecticut residents with: 1) unbiased information about the need for long-term care; 2) the ability to find and purchase quality, affordable long-term care insurance; and 3) a way to get needed care without depleting assets. Residents can find more information by calling the program’s number at 1-800-547-3443, or visiting the website here.

Additionally, seniors can work with their regional Area Agencies on Aging to get more information and potential services depending on where they live. Area Agencies on Aging are private, nonprofit planning agencies, each guided by its own Board of Directors and Advisory Council. Through funding provided by the State Department on Aging, each AAA receives Federal Older Americans Act (Title III) funds and State funds that are allocated to elderly service providers through a request for proposal process. AAAs fund the following services: Social Services, Nutrition Services, Disease Prevention & Health Promotion Services, Family Caregivers Support Services, Adult Day Care Aide Positions (to provide day care services to victims of Alzheimer's Disease and related dementia). The five AAAs may also provide direct services in the areas of community education, advocacy, case management, information and assistance, benefits counseling and training.

Specifically for veterans, Connecticut Veteran’s Directed Home & Community Based Services Program (VDHCBS) is a consumer directed home and community based services program designed to keep veterans in their communities. Veterans served through this program have the opportunity to self-direct their own care and receive services in their home from the caregiver of their choice. VDHCBS is a partnership between SDA, the VA CT Healthcare System and the five CT Area Agencies on Aging (AAAs). All clients served through the VDHCBS program must enter through and be pre-screened by the VAMC (Veteran’s Medical Center) If appropriate the VAMC will refer the client to the appropriate Area Agency on Aging for further assessment and service coordination.

Finally, for seniors aged 65 and older, the State offers a home-and-community based (HCBS) Medicaid Waiver program that helps eligible seniors pay for assisted living and in-home care if they would otherwise require nursing home care.

Medicaid Waiver Program for Assisted Living and In-Home Care

Connecticut Home-and-Community Based (HCBS) Elders Medicaid Waiver, the Connecticut Home Care Program for Elders (CHCPE) Medicaid Waiver

Connecticut’s Home and Community Based Services Waiver (HCBS) for Elders, known as the CHCPE program, is operated by the Department of Social Services, Community Options Unit. The CHCPE helps eligible clients continue living at home instead of going to a nursing home. Each applicant’s needs are reviewed to determine if the applicant may remain at home with the help of home care services.

Services

Services provided by CHCPE include: homemaker, companion, personal emergency response system, meals on wheels, adult day care, chore, mental health counseling, assisted living, personal care attendant, assistive technology, adult family living, care management, and minor home modifications.

Eligibility

Generally, to be eligible, applicants must be 65 years of age or older, be a Connecticut resident, be at risk of nursing home placement and meet the program’s financial eligibility criteria. To be at risk of nursing home placement means.

  1. Health: Applicants must require aNursing Home Level of Care, which, for example could mean that the applicant needs assistance with critical needs such as bathing, dressing, eating, taking medications, toileting.
  2. Financial: Connecticut is considered a 209(b) state, meaning that the requirements for Medicaid for long-term care can be more restrictive than the SSI standard. 209(b) states were grandfathered in after the passage of the 1972 amendments to the Social Security Act creating the SSI standards for Medicaid eligibility (determined at the federal level). 209(b) states may apply Medicaid eligibility requirements that are more restrictive than the SSI standards. In Connecticut, there is a strict income limit of 300% of the FBRas determined annually by the federal government. For 2017, the income limit for an individual is $2,205. While the income limit follows the SSI standard pursuant to the 209(b) ability to use different standards, the asset limit is below the SSI criteria and is $1,600 for an individualConnecticut uses the same asset limits in regards to treatment of the non-applicant spouse, or “community spouse.” For 2017, the community spouse resource allowance (CSRA) is $120,900. The waiver participant is also allowed to keep a monthly Personal Needs Allowance (PNA), which the State sets at 200% of the Federal Poverty Level, which for an individual in 2017 was $1,980, which is about $1,000 less than in a SSI-criteria state where, for 2017, the maximum monthly needs allowance was $3,022.50.

Practical Considerations

Some practical issues in the CHCPE program include the amount of cost covered by Medicaid. The cost limit on level of care is not limited to that of which it would cost at an institution. The waiver allows for a consideration of an increased limit between 100-115% of an institutional facility if approved by the Department of Social Service’s clinical staff. Services beyond the monthly cap may be authorized on a short term basis to meet health and safety needs as long as there is evidence that the plan on an annualized basis will be equal to or less than 115% of the cost of nursing facility care. Applicants whose needs cannot be met within the caps are assisted in accessing other state plan services but are determined to be ineligible for the waiver.

Furthermore, there are only 17,354 slots available for this program for 2017. The number of slots available only slightly increases to 18,858 in 2019 before the State renews the waiver or otherwise amends it.

Conclusion

There are a number of available services to seniors in Connecticut in addition to the waiver program, specifically the Veterans program. Connecticut is a good example of where the need for a Medicaid Planning specialist may significantly help an applicant needing long-term care qualify for benefits much earlier than otherwise by using the state’s 209(b) criteria and “medically-needy” provisions to create a solution for those with income that exceeds the limits set by the state.