Medicaid for nursing home and home care in Connecticut

Who qualifies

You must live in Connecticut and be 65 or older, or blind or disabled, and need long-term care. For home care, the Connecticut Home Care Program for Elders (CHCPE) asks that you need help with at least 3 daily activities, such as bathing, dressing, eating, moving around or using the toilet. You may qualify with 2 if you also need help with medicine or daily supervision because of memory or behavior problems.

If your income or assets are over the limit, DSS says you may still qualify by spending the extra on medical bills (a spend-down). For a married couple, the limits depend on the protected amount for the spouse at home (see below).

What counts and what does not

Assets

• Countable assets include bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts, annuities, trusts and the cash value of life insurance.
• Life insurance with a total face value of $1,500 or less is not counted.
• Your home does not count while your home equity is $1,130,000 or less.
• You may lower extra assets by paying bills you owe, paying toward your nursing home care, or prepaying funeral costs. You must get fair value for what you spend. You may not give money away.

Income

DSS counts your gross income from every source: Social Security, pensions, annuities, veterans' benefits, interest, rent and wages. A direct deposit record is not proof of gross income. Send an award letter, pension stub or 1099.

Gifts and the five-year look-back

If you have not been on a DSS Medicaid program with an asset test for at least 5 years, DSS reviews 5 years of your income and assets. It asks for 2 full years of bank statements plus December statements for the 3 years before. You must explain deposits or withdrawals of $5,000 or more. If you gave away money or property, or sold it for less than it was worth, DSS may set a penalty period when Medicaid will not pay for your care.

What you pay toward your care

• Patient liability: If you live in a nursing home, most of your income goes to the home each month. This is your gross unearned income minus your personal needs allowance and other approved deductions.
• Personal needs allowance: You keep $75 a month for clothing and personal items. This amount is set by state law.
• Deductions: You can send proof of costs such as health insurance premiums, certain medical bills, and short-term rent for a home in the community.

Protection for a spouse at home

• Assets: The spouse at home can keep half of the couple's countable assets, but not less than $50,000 and not more than $162,660.
• Income: Some of your income can go to your spouse each month. This is called the Community Spousal Allowance. It is a set needs amount, which takes your spouse's actual housing and utility costs into account, minus your spouse's own gross income. Federal law sets the lowest and highest amounts. DSS will figure it from your spouse's income and shelter costs.
• Annuities: You must report all annuities. For annuities bought on or after February 8, 2006, the state must be named a beneficiary after a spouse or a minor or disabled child.

Programs Medicaid pays for

• Nursing home care in a skilled nursing facility or chronic disease hospital.
• Connecticut Home Care Program for Elders (CHCPE): for people 65 and older. It offers personal care, homemaker and companion help, adult day services, home-delivered meals, emergency response buttons, home changes, respite for caregivers, transportation, care management and assisted living. It has a Medicaid waiver part and a smaller state-funded part with its own rules. DSS says there is no waiting list at this time. Call 860-424-4904 or visit MyPlaceCT.org.
• Money Follows the Person: helps people move from a nursing home back to the community. Call 1-888-992-8637.

How to apply

1. Get the application. Use form W-1LTSS (Spanish: W-1LTSSS) from the DSS website, or apply online at www.connect.ct.gov under "Apply for Benefits." If you apply online, you still need to mail your proofs.
2. Gather proof. Send copies of:
   • gross income statements from every source,
   • 5 years of bank, brokerage and retirement statements, as described above,
   • life insurance, annuity and trust papers, burial contracts and vehicle titles,
   • deeds and any reverse mortgage or home equity statements,
   • Medicare and other insurance cards and premium bills,
   • power of attorney or conservator papers, and your spouse's income, assets and housing costs if you are married.
3. Mail it to the right center. DSS long-term care application centers handle new applications only. For home care (waiver) programs, all new applications go to the Greater Hartford center. For nursing homes, send to the Bridgeport, New Haven or Waterbury center for the town where the home is. The form lists the addresses. Applications cannot be faxed or emailed.
4. Wait for a decision. DSS aims to decide within 45 days once it has all your proof, or 90 days if disability must be decided. If DSS asks for more proof, send it or ask for more time by the 30th day, or your application may be denied.

Medicaid can be backdated up to 3 months before the month you apply if you qualified then.

Questions: DSS Benefits Center, 1-855-626-6632 (1-855-6-CONNECT). TTY: 1-800-842-4524. Home care: DSS Community Options, 1-800-445-5394.

After you apply

• Report changes within 10 days, including an inheritance or settlement. Send renewals and changes to DSS ConneCT Scanning Center, PO Box 1320, Manchester, CT 06045, or report online.
• Appeals: If you disagree with a decision, ask for a fair hearing within 60 days of the date on the Notice of Action. If you ask before the date the change takes effect, your Medicaid may continue while you wait.
• Nursing home discharge: If a nursing home plans to move you out, ask for a hearing within 20 days of getting the notice to stop the move while you wait.

Things people miss

• Ask for legal advice before you give anything away. DSS itself suggests it. Gifts in the 5 years before you apply can cause a penalty.
• Estate recovery. If you get long-term care at 55 or older, the state may seek repayment from your estate after you die. It does not do this while you have a living spouse or a child who is under 21, blind or disabled.
• The spouse at home keeps more than you might think. Connecticut's minimum protected amount is $50,000.

Free help

• Aging and Disability Resource Centers (ADRCs): call 1-800-994-9422 to reach the one for your area. The same number reaches CHOICES, Connecticut's free Medicare counseling program.
• Long Term Care Ombudsman (problems in a nursing home): 860-424-5200 or 1-866-388-1888.
• HUSKY Health member services: 1-800-859-9889.

Read more about paying for a nursing home, Medicare, and all benefits in Connecticut.

Phone numbers: Free help lines for Connecticut agencies

Check what you may qualify for