CT Home Care Program for Elders Elder Waiver

CT Home Care Program for Elders Elder Waiver – updated 2009 figures

Kate McEvoy for the Agency on Aging of South Central Connecticut - December, 2008

Waiver Information:

Waiver Type: 1915(c)

Current Enrollment: 9,386

Year First Approved: 1987 (authorized by C.G.S. Section 17b-342)

Latest Renewal/Term: 2005/three years

Waitlist Status: no wait list for waiver or state-funded personal care assistance pilot; wait list exists for state-funded pilot that funds ALSA services in private MRC’s

Eligibility Criteria:

Age Range: 65+

Functional status: must be in need of nursing facility care and evidence at least three “critical needs” (critical needs include bathing, dressing, toileting, transferring, eating/feeding, meal preparation, and medication administration)

Income limits effective January 1, 2009: Asset limits effective January 1, 2009:

Individual: $2,022 per month (300% SSI) Individual: $1,600

Couple: based on applicant’s income Couple: starts at $23,512 (minimum CSPA of

Comments: investigate use of a pooled trust; $21,912 + applicant’s $1,600); MCCA

VA “homebound” benefit to rules apply

surviving spouses is excluded Exemptions: MCCA rules apply

Service Delivery Method(s) (X indicates available):

METHOD		COMMENTS
Agency-Based	X	Majority of clients receive services via agencies
Agency + Choice
Self-Direct	X	Where client does not require care management
PCA	X	A state-funded pilot option for waiver and state-funded clients (2007 legislation removed the 250-person cap).
Other	X	Services can also be provided to 1) residents of state-funded congregate housing; 2) residents of assisted living pilot projects; and 3) up to a statewide total of 75 residents of private managed residential communities who spend down to program limits and require assisted living services

Covered Services: adult day care, care management, chore, companion, home health aide, homemaker, home-delivered meals, laundry, mental health counseling, minor home modifications, respite, personal emergency response systems, skilled nursing visits, transportation

Cost Caps/Cost Effectiveness Standards: Waiver can pay no more than $5,680.00 per month per individual (100% of the average monthly Medicaid cost). Within that cap, program can pay for no more than $3,972.48 per month per individual (60% of the average monthly Medicaid cost) for social services (all services other than skilled nursing visits and home health aide – the “medical services” covered by Medicaid).

Cost Sharing Requirements: Effective April 1, 2008, participants must pay applied income over $1,734 (200% FPL), adjusted for medical expenses (e.g. 2009 Medicare Part B premium of $96.40, medical insurance premiums); legally liable relative may have obligation to contribute.

To Apply: Contact DSS Alternate Care Unit at 860-424-4904 and choose option #4 for initial screening and referral to regional Access Agency.

CHCPE State-Funded Levels 1 & 2 – updated 2009 figures

Waiver Information:

Waiver Type: N/A

Current Enrollment: 5,342

Year First Approved: (authorized by C.G.S. Section 17b-342)

Waitlist Status: no wait list for Levels 1 or 2 or state-funded personal care assistance pilot; wait list exists for state-funded pilot that funds ALSA services in private MRC’s

Eligibility Criteria:

Age Range: 65+

Functional status: Level 1: must be at risk of hospitalization or short-term nursing facility placement and evidence one or two “critical needs”; Level 2: must be in need of short or long-term nursing facility care and evidence three or more “critical needs” (critical needs include bathing, dressing, toileting, transferring, eating/feeding, meal prep, and med. admin.).

Income limits effective January 1, 2009: Asset limits for Levels 1 & 2 effective January 1, 2009:

Individual: none Individual: $32,868

Couple: none Couple: $43,824

Comments: Exemptions: UPM 8040.35 follows MCCA rules but does

not require spousal assessment.

Comments: Note that as of April 1, 2007, the asset limit for an individual increased to 150% of the minimum CSPA and for a couple to 200% of the minimum CSPA.

Service Delivery Method(s) (X indicates available):

METHOD		COMMENTS
Agency-Based	X	Majority of clients receive services via agencies
Agency + Choice
Self-Direct	X	Available where a client does not require care management
PCA	X	A state-funded pilot option for waiver and state-funded clients (2007 legislation removed the 250-person cap).
Other	X	Services can also be provided to 1) residents of state-funded congregate housing; 2) residents of assisted living pilot projects; and 3) up to a statewide total of 75 residents of private managed residential communities who spend down to program limits and who require assisted living services

Cost Caps/Cost Effectiveness Standards: Level 1 can pay no more than $1,420.00 per month per individual (25% of average monthly Medicaid cost). Level 2 can pay no more than $2,840.00 per month per individual (50% of average).

To Apply: Contact DSS Alternate Care Unit at 860-424-4904 and choose option #4 for initial screening and referral to Access Agency.

DEPARTMENT OF SOCIAL SERVICES
CONNECTICUT HOME CARE PROGRAM FOR ELDERS (CHCPE)
Effective January 1, 2009

Service Level	Description	Functional Need	Financial Eligibility	Care Plan Limits	Funding Source
Category 1	Limited home care for moderately frail elders	At risk of hospitalization or short term nursing home placement (1 critical need deficit)	Individual Income = no limit Assets: Individual = $32,868 Couple = $43,824	<25% NH Cost ($1,420.00/mo)	STATE
Category 2A	Intermediate home care for very frail elders with some assets above the Medicaid limits	In need of short or long term nursing home care	Individual Income = no limit Assets: Individual = $32,868 Couple = $43,824	<50% NH cost ($2,840.00/mo)	STATE
Category 2B	Same as 2A	Same as 2A	Same as 2A	<80% NH cost ($4,544.30/mo)	STATE
Category 3	Extensive home care for very frail elders who would otherwise be in a nursing home on Medicaid	In need of long term nursing home care (deficits in 3 critical need areas or ADLs)	Individual Income = $1,911/month Assets: Individual = $1,600 Couple = (both as clients) = $3,200 (one as client) =$23,512	100% NH Cost ($5,680.00/mo) (Social Services cap = $3,972.48)	MEDICAID (state/federal)

Notes:
1. Clients with incomes of $1,734.00 (this changes April 1 of each year) and above are required to contribute to the cost of their care.
2. There is no income limit for the State-Funded levels. The Medicaid Waiver income limit equals 300% of SSI.
3. Services in all categories include the full range of home health and community-based services.
4. Care plan limits in all categories are based on the total cost of all state-administered services.
5. Some individuals may be functionally eligible for either category 1 or 2 services and financially eligible for Medicaid. In such cases, home health services will be covered by Medicaid and other community-based services covered through state funds.
6. Married couples who are over the $23,512 asset limit for category 3 may still be eligible based on spousal asset protection rules.
7. Functional need is a clinical determination by the Department concerning the applicant's critical need for assistance in the following areas: bathing, dressing, toileting, transferring, eating/feeding, meal preparation and medication administration.
8. Care plan cost limits are for CHCPE fee-for-service only.

CHCPE ALSA Options:

I. Moderate and Low-Income ALSA Demonstration Project – C.G.S. Section 17b-347e

First authorized through Public Act 98-239, and then expanded to 300 units by Public Act 99-279, the Moderate and Low-Income ALSA Demonstration Project has underwritten construction of new, stand-alone Managed Residential Communities (MRC’s) through which residents who 1) are age 65 and older; 2) are at risk of nursing home placement; and 3) meet CHCPE financial eligibility criteria receive ALSA services. This project is a partnership involving the Department of Social Services (DSS), the Department of Economic and Community Development (DECD) and the Connecticut Housing Finance Authority (CHFA). Please see table for a listing of the involved sites.

Site Name	Address	Telephone:	# of Units	ALSA
Herbert T. Clarke House	25 Risley Road Glastonbury	860-652-7623	45	Utopia
The Retreat	90 Retreat Avenue Hartford	860-560-2273	95	Community Outreach Program for Elders
Smithfield Gardens	32 Smith Street Seymour	203-888-4579	56	Utopia
Luther Ridge at Middletown	628 Congdon Street Middletown	860-347-7144	45	Employs own staff

II. ALSA in State-Funded Congregate Housing – C.G.S. Sections 8-119m & 17b-342(c)

In 2000, the Legislature extended the CHCPE to residents of state-funded congregate housing. This project also represents a partnership between DSS and DECD. The sites that are participating include: Augustana Homes Bishop Curtis (Bethel), Bacon Congregate (Hartford), D.J. Komanetsky Estates (Bristol), Ella B. Scantlebury Senior Residence (New Haven), Herbert T. Clark House (Glastonbury), Mount Carmel Congregate (Hamden), Luther Manor (Middletown), Mystic River Homes (Noank), Ludlow Commons (South Norwalk), Prospect Ridge (Ridgefield), Seeley Brown Village (Pomfret), Silverbrook Estates (Orange), Virginia Connolly Congregate (Simsbury), St. Jude Common (Norwich), The Marvin (Norwalk), and F.J. Pitkat Congregate Living (Rockville). Utopia is providing assisted living services at most of these sites.

III. State Assisted Living Demonstration in Federally Funded Elderly Housing – C.G.S. 8-206e(d)

Authorized by Public Act 00-2, then expanded in scope by Public Act 01-2, the Demonstration provides assisted living services to residents of certain designated buildings.

Site Name	Address	Telephone:	ALSA
Immanuel House	15 Woodland Street Hartford	(860) 525-4228	Utopia
Juniper Hill Village	1 Silo Circle Storrs/Mansfield	(860) 429-9933	Utopia
Tower One/Tower East	18 Tower Lane New Haven	(203) 772-1816	Utopia

IV. Private Assisted Living Pilot – C.G.S. Sections 17b-365 & 17b-366

This pilot is intended to assist a limited number of individuals who have spent down resources while living in private managed residential care (MRC’s) with payment for assisted living services (this excludes payment for room & board). Initially authorized by Public Act 02-7 for 50 individuals eligible for the Medicaid Waiver, and 25 individuals eligible for the state-funded levels of the CHCPE, Public Act 04-258 made it available to 75 individuals without respect to level of care. There is currently a substantial wait list. DSS indicates that MRC participation is very changeable.