Medicaid and State Funded Home Care
Medicaid and State Funded Home Care
The Department of Social Services administers the Connecticut Home Care Program for Elders (CHCPE) and 1915(i) State Plan Option-Fee for Service. Its purpose is to enable individuals 65 or older to remain at home in a safe environment and not be unnecessarily institutionalized.
The Department of Social Services has divided the CHCPE into different categories. These categories enable individuals to receive home care services in amounts corresponding to their financial eligibility and functional dependence.
The first two categories are funded primarily through a state appropriation with a small contribution from the federal Social Services Block Grant. Individuals in categories 3 and 5 qualify for reimbursement under the Medicaid program, so costs are equally distributed between federal and state funds.
What are the eligibility criteria for the CHCPE?
In order to be eligible for the CHCPE, the person must be 65 or older and meet two criteria: one financial, the other "functional."
What is the "financial" eligibility criteria?
As mentioned above, the Department of Social Services has divided the CHCPE into several categories. Categories 1 and 2 are the state funded programs and have the same financial eligibility requirements. Category 1 is currently closed to new applicants. Categories 3 and 5 are Medicaid programs and have more restrictive financial eligibility criteria.
To determine financial eligibility, the Department of Social Services examines the person's monthly income and assets.
Income: For the two state-funded categories 1 and 2 of the CHCPE program, there is no income limit. Anyone who would be eligible for Medicaid coverage in a nursing home is eligible for home care services.
The "Medicaid waiver" home care program (Category 3) however, has an income limit: the income limit is 300% of the Supplemental Security Income (SSI) limit. In 2016, that income limit is $2,199.00 per month for one individual.
The 1915(i) home care program (Category 5) also has an income limit of $1,437 for an individual. This program is meant for individuals who are at risk of hospitalization or short term nursing home placement, but have less critical needs that an individual in the “Medicaid waiver” home care program (Category 3).
Assets: All three programs have an asset limit. The Department defines an "asset" as "cash or any item of value which a person can use or legally convert to cash for support and maintenance." Examples of assets are equity in real estate, money in checking and saving accounts, IRAs, life insurance policies that have a cash surrender value, stocks, and bonds.
The Department of Social Services, however, does exclude certain assets in determining eligibility. The equity in a person's home, for instance, is not counted if the applicant lives in the home, provided the person’s equity is less than $828,000. Other excluded assets are irrevocable funeral contracts up to $8,000.00, life insurance polices that have a face value of $1500.00 or less, household furnishings, and one car.
The income and asset criteria for each category is found in this chart.
What is the "functional" eligibility criteria?
In order to determine whether someone is "functionally" eligible, the applicant will be screened by an access agency to determine whether they are at risk of nursing home placement if home care is not available. The Department of Social Services contracts with a private organization, the access agency, to perform that service. The Access Agency will look at activities of daily living, and will determine if the person needs assistance with critical needs such as bathing, dressing, toileting, transferring, eating or feeding, preparing of meals, or administering their medication.
Category 1: This category is targeted to individuals who are at risk of hospitalization or nursing facility placement if preventive home care services are not provided. The qualifying individual must need assistance with 1 or 2 critical needs.
Category 2: This category targets individuals who are frail enough to require nursing facility care but who are either not actively considering it at the present time or who have resources which would prohibit them from qualifying for Medicaid upon admission to a nursing facility. The qualifying individual must need assistance with 3 or more critical needs.
Category 3: This category targets individuals who would otherwise require long term nursing home care funded by Medicaid. The qualifying individual must need assistance with 3 or more critical needs.
Category 5: This category is targeted to individuals who are at risk of hospitalization or nursing facility placement if preventive home care services are not provided. The qualifying individual must need assistance with 1 or 2 critical needs.
Are there cost limits for these programs?
Yes. The access agency as part of its assessment will examine whether the applicant's needs can be provided at home for less than the cost of nursing home placement. Cost limits for each program category vary and are established so that individual care plans can increase in response to individual need.
The State of Connecticut has increased the monthly care plan caps. That amount is used as a bench mark in determining the cost limit in each program. In practice most actual care plan costs are well under the limits for each category.
Category 1: Since these are not individuals who would immediately need nursing home placement in the absence of the program, individual care plan limits are set at $1,450.00 per month -- less than 25% of nursing home cost.
Category 2: Care plan limits for these individuals cannot exceed $2,909.00 per month -- less than 50% of nursing home cost.
Category 3: This category is known as the Medicaid Waiver category. In order to assure cost effectiveness, individual care plan costs cannot exceed $5800.00 per month - 100% of nursing home cost. There is also a cost plan cap of $5818.00 per month.
Category 5: No cost cap, but personal care attendant limited to 14 hours per week and home maker no more than 6 hours each week.
Do I have to contribute to the cost of my home care services?
Yes, if you are participating in the State Funded Home Care Programs (Category 1 & 2). You must make a co-payment equal to 9% of the cost of your monthly care plan, except for individuals who reside in an affordable assisted living demonstration project. In addition, if your income is greater than 200% of the Federal Poverty Level (in 2016, $1980 per month for an individual), you may pay an "applied income." The department will consider the excess amount over 200% of the Federal Poverty Level, but will allow other deductions, such as Medicare premiums, any other types of health and medical insurance paid by you, long term care insurance, co-pays for any medication or additional home and health services that you are paying on your own behalf and any financial support that you are providing to a spouse. The amount remaining after the allowed deductions is the amount that you will contribute towards the cost of your care.
Possibly, if you are participating in the Medicaid Waiver Home Care Program (Category 3). If your income is greater than 200% of the Federal Poverty Level (in 2016, $1980 per month for an individual), you may pay an "applied income." The department will consider the excess amount over 200% of the Federal Poverty Level, but will allow other deductions, such as Medicare premiums, any other types of health and medical insurance paid by you, long term care insurance, co-pays for any medication or additional home and health services that you are paying on your own behalf and any financial support that you are providing to a spouse. The amount remaining after the allowed deductions is the amount that you will contribute towards the cost of your care.
The purpose of the CHCPE, as stated above, is to enable individuals 65 or older to remain at home in a safe environment and not be unnecessarily institutionalized. The home care program covers services such as adult day care, homemaker, companion, chore services, home delivered meals, emergency response systems, case management, and home health aides. It also covers some minor home renovations.
Only individuals eligible for Categories 3 and 5 services will receive full Medicaid benefits, including prescription drug coverage!
Where can I find more information on the CHCPE?
Contact the Department of Social Services’ Alternate Care Unit at 1-800-445-5394 or 860-424-4904.
Additional information can be found on the Department's web site: Connecticut Home Care Program for Elders.
Home Health Care Laws
Connecticut General Statutes, sec. 17b-342 et seq. Connecticut home-care program for the elderly (CHCPE).
Conn. Regs. State Agencies, sections 19-13-D66 through 19-13-D79. Home health care regulations, including patients' rights and responsibilities.
These laws can be found at: