DEPARTMENT
OF SOCIAL SERVICES
CONNECTICUT HOME CARE PROGRAM FOR ELDERS*
Effective
March 1, 2023
(changes 3/1 except for Cat 3 income cap which changes 1/1)
|
Service Level |
Description |
Functional Need |
Financial Eligibility |
Care Plan Limits |
Funding Source |
Intake
Status |
|
Category 1 |
Limited home care for moderately frail elders 65+ |
At risk of
hospitalization or short term nursing home placement |
Individual
Income Assets: |
<25% NH
Cost° |
STATE |
NO NEW
APPLICATIONS |
|
Category 2 |
Intermediate home care for very frail elders 65+ with some assets above the Medicaid limits |
In need of short or long term nursing home care ("nursing facility level of care") |
Individual
Income Assets: |
<50% NH
cost° (NOTE: 3% co-pay) |
STATE |
OPEN |
|
Category 3 CHCPE |
Extensive home care for very frail elders 65+ who would otherwise be in a nursing home on Medicaid |
In need of long term nursing home care ("nursing facility level of care" or "NF LOC") |
Individual
Income Assets: |
a) 100% NH
Cost° (2023) |
MEDICAID WAIVER (state/federal) |
OPEN |
|
Category 4 CHCPD (DISABLED,
NOT ELDERLY) |
Intermediate
home care for individuals UNDER 65 with a degenerative neurological
condition, not eligible for Medicaid |
In need of
short or long term nursing home care ("nursing
facility level of care") |
No income
limit Asset:
$44,586/individual Couple:
$59,448 |
<50% NH
cost° ($3,685/mo) |
STATE |
Wait-list,
limited to 100 slots |
|
Category
5 1915(i) |
Same as
#1; also active on Husky C; must be age 65 or
older
|
At risk of
hospitalization or short term nursing home placement (1-2 critical
needs) |
Individual
income: $1,699 Assets:
$1,600 |
|
50%
federal reimbursement |
OPEN |
CT Home Care Plan
for
Elderly / Disabled - Notes:
1. Clients in the higher income range ($2,430+) are required to
contribute the
excess as "applied income" to the cost of their care. Currently
this can be avoided using a pooled trust. (based on 200% of FPL,
changes 3/1)
*2. There is no income limit for the State Funded portion. The Medicaid
Waiver
income limit remains at 300% of SSI.
3. CHCPE Services available at all categories include the full range of
home
health and community based services.
*1915(i) State Plan Option has limited PCA
services
to 14 hours weekly and homemaking services are limited to 6 hours
weekly.
4. Care plan limits at all categories are based on the total cost of
all
state-administered services.
5. 1915(i) State Plan option covers
individuals on
Medicaid but who qualify for category 1 services. CT will claim
50%
reimbursement from the federal government for home and community based
services
not reimbursable under Medicaid.
6. Some individuals under category 2 may become financially eligible
for the
Medicaid Waiver. In these cases, the client must apply for Medicaid and
cooperate with the application process.
** 7. Married
couples who
are over this asset limit for category 3 may be eligible based on the
special
spousal asset protection rule.
8. Functional need is a clinical determination by
the
Department about the applicant's critical need for assistance in the
following
areas / Activities of Daily Living (ADLs): Bathing, Dressing,
Toileting, Transferring, Eating/Feeding.
Needs factors: 1. Behavioral Need - requires daily
supervision to
prevent harm. 2. Medication supports - Requires assistance
for
administration of physician-ordered daily medications, includes
supports beyond
set-up.
9. "Nursing facility level of care" or NF LOC is defined as:
1. Supervision or cueing for 3 or more
ADLS + a
needs factor
2. Hands-on assistance with 3 or more ADLs
3. Hands-on assistance with 2 or more ADLs + a needs factor
4. A cognitive impairment which
requires
daily supervision to prevent harm.
***10. Subacute LOC is defined as:
1.
Participant requires comprehensive medical monitoring but does not
require
intensive diagnostic and/or invasive procedures
2.
Participant requires intense medical supervision and therapy such as
nursing
intervention intermittently throughout the day and/or the need for
ancillary or
technological services (such as laboratory, pharmacy, nutrition,
diagnostic)
3.
Participant may require services such as brain injury rehabilitation,
high
intensity stroke or orthopedic programs, ventilator programs, complex
wound
care or specialized infusion therapy.
11. Care Plan limits are for CHCP fee for service only.
12. For contracted Access Agencies use only.
°13. "NH
cost" means average expenditure by state on nursing home resident after
deducting for average applied income contribution by resident.