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Overview
The Department of Social Services administers
the Connecticut Home Care Program for Elders (CHCPE). 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 three 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 the third category qualify for reimbursement under the
Medicaid program, so costs are equally distributed between federal and state funds.
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Eligibility
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 three categories. Categories 1 and 2 are the state
funded programs and have the same financial eligibility requirements. Category 3 is a
Medicaid program and has 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 2008, that income limit is $1,911.00
per month for one individual.
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. Other excluded assets
are irrevocable funeral contracts up to $5,400.00, 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 the chart below.
Effective January 1,
2008
| CHCPE |
Category 1 |
Category 2 |
Category 3 |
| Monthly Income |
no limit |
no limit |
ind. - $1911
couple - $3,822 |
| Assets:
single
couple
|
$31,320.00 $41,760.00 |
$31,320.00 $41,760.00 |
ind. - $1,600 both as clients - $3,200
one as client - $20,880,
up to a maximum of $104,400 (or more subject to spousal impoverishment rules). |
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.
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Costs
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 $1,423 per month -- less than 25% of
nursing home cost.
Category 2: Care plan limits for these
individuals cannot exceed $2,845 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 $5,690.64 per month - 100% of nursing home cost. There is
also a social services cap of $3972.48 per month.
Click here for a chart of these costs.
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Do I have to contribute to the cost of my home care services?
Possibly. It depends on the amount of your
gross income after certain deductions are made.
If your income is less that 200% of the Federal Poverty Level,
you will not have to contribute towards the cost of their care.
If your income is greater however, you might
have to contribute. 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.
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Benefits
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 Category 3
services will receive full Medicaid benefits, including prescription drug coverage!
Applications
Click here for a CHCPE application in
English.
Click here for a CHCPE application in
Spanish.
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.
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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.
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