Medicaid is a federal health insurance program. It pays medical bills for people and families with low income and few resources. In Connecticut, the state Department of Social Services (DSS) runs Medicaid.
The rules are very complicated, and there are special rules for people who are
Yes. Medicaid and Medicare are both federal health insurance programs that may help pay for nursing home care, but they do not provide the same coverage.
To learn more about Medicare, call
You should apply for Medicaid if
Medicaid covers people and families with low income and few resources. To decide if you qualify, DSS will look at your situation, including how much income, money, and property you have.
Medicaid pays for medical care for people who do not have enough money to pay their medical bills.
Nursing home care is only one type of care paid by Medicaid.
If you qualify, Medicaid will pay for your nursing home care and most of your costs while you are in a nursing home, including
Yes. If you qualify, Medicaid will pay for other medical bills, too.
Maybe. When you apply, Medicaid looks at your assets (money and property). If your assets are too high, you may not qualify.
Remember:Medicaid is a very complicated law. It is always best to talk with an attorney.
You can qualify for Medicaid if you have
You can only keep a limited amount of your income to have Medicaid pay for your nursing home care.
You can keep a small amount of income to spend on personal needs. This amount changes every year.
Married people may be able to give their spouse some of their income to pay for their living expenses. Talk to a lawyer to find out if this applies to you.
The rest of your income is paid to the nursing home each month. There are some exceptions. You can use your income to pay for
Tell your DSS caseworker when you apply. This may help you protect more assets. To learn more about the Connecticut Partnership,
No! Talk to a lawyer before giving away any money or property. Medicaid will look at your bank statements, property, and other assets over the last 5 years. If you have given away your home or money, DSS can impose a penalty period. During the penalty period you will not be eligible for Medicaid.
Maybe. When you need Medicaid for nursing home care, your house is not counted as an asset if
- Your spouse.
- Your child under 21.
- Your blind or disabled adult child.
- Your brother or sister who co-owns the house and lived there for at least 1 year before you went into the nursing home.
Exception: If the equity in your house is more than $840,000, it will count as an asset.
If any of the people listed above live in your house, the state cannot put a lien on your house or force you to sell it.
If none of these people live in your house and you are probably going to stay in the nursing home, you must sell your house for fair market value. The state will put a lien on it while you try to sell it.
As long as you are doing your best to sell the house, Medicaid will not count it as an asset.
DSS will take what you owe them for your nursing home care. You will not get Medicaid until you spend the rest of the money from your house. Once you have $1,600 or less in total assets, you can go back on Medicaid.
If you are on Medicaid, you will probably have to spend your monthly pension, Social Security, or other income to pay for your nursing home. If you do not have enough money to pay the whole bill, DSS will pay the rest.
But you are allowed to keep some money each month:
No. If you are in a nursing home, DSS only looks at your income to decide if you qualify for Medicaid, and how much you will have to pay each month. Your spouse’s income will not be counted.
If your spouse has high income, DSS may ask your spouse to help with your nursing home bills. If DSS asks your spouse to help, your spouse should talk to a lawyer before agreeing to pay.
Yes. Your spouse, called the community spouse, can keep half of your joint assets up to a maximum of $120,900.
Your spouse can also keep
Important! This amount changes every January. Ask DSS for the most current amount. Also ask DSS to do a spousal assessment.
Yes, in some cases. You and your spouse may be able to keep extra assets if
The law says the community spouse may have at least $2,030.00 in total income each month. This amount includes
If there are financial difficulties, or if monthly housing costs are more than $609.00, your spouse may be allowed a higher amount.
Your spouse probably will not be allowed more than $3,022.00 a month.
Remember: These amounts change every year!
If your spouse’s income is less than the minimum, your spouse can get a community spouse allowance from you to fill the gap.
This allowance comes from your
If you think your spouse will need more income or assets than DSS allows, you or your spouse can ask for a fair hearing to challenge their decision. It may be good to bring a lawyer to the hearing.
Deadline: You must fill out and file a request for a fair hearing within 60 days of getting the notice from DSS that explains how much you are allowed.
|Spouse Allowance Worksheet|
|If you have a spouse in a nursing home on Medicaid,
you may use this worksheet to ESTIMATE your
monthly Community Spouse Allowance, effective 7/1/2017.
|ADD Shelter Hardship (figure out using the info below)||+||$|
|SUBTRACT monthly income||-||$|
|This is the amount you may be able to keep of
the interest from you assets or from your spouse's
|Rent or mortgage||+||$|
|Add property taxes||+||$|
|Add property insurance||+||$|
|Add condo fees||+||$|
|Add standard for utilities||+||$728|
|Total shelter costs||=||$|
|Subtract shelter allowance||-||$609*|
|This is your shelter hardship to use above||$|
|*Note: These figures are effective as of 7/2017.
(The next adjustment will be 7/2018.)
|Remember, you or your representative must ask DSS for a Fair Hearing or go to court to get a higher community spouse allowance to meet your needs.|
Yes. It’s a good idea to have someone help you fill out the application. Medicaid rules are confusing.
Ask someone who knows Medicaid law, such as
Important! If someone helps you fill out your application, that person must also sign your application.
Apply as soon as you can. Fill out the application and give it to the DSS worker. DSS will also ask you for other papers. If you are eligible, your coverage can go back three months from the day you apply.
DSS will ask you for copies of your
Important: Make copies of everything you give DSS. Keep them in a safe place. You may need them later.
Yes, as long as you’ve lived in the nursing home for at least 30 days before you apply.
If DSS says you do not qualify for Medicaid, you have the right to ask for a fair hearing. At the hearing, a fair hearing officer can look at your application to see if DSS made any mistakes. You can also explain any mistakes you think DSS made.
Fill out the appeal form that is included with the denial letter. Send it to:
Department of Social Services
Office of Legal Counsel, Regulations and Administrative Hearings
55 Farmington Avenue
Hartford, CT 06105
Deadline: You must send your request for an appeal within 60 days of the denial.
Yes. A lawyer from Legal Services can look at your case and may be able to speak for you at the hearing.
Call Statewide Legal Services:
860-344-0380 (Central CT & Middletown)
800-453-3320 (all other areas)