DEPARTMENT OF SOCIAL SERVICES
CONNECTICUT HOME CARE PROGRAM FOR ELDERS*
Effective March 1, 2017

Service Level

Description

Functional Need

Financial Eligibility

Care Plan Limits

Funding Source

Intake Status

Category 1
CHCPE

Limited home care for moderately frail elders 65+

At risk of hospitalization or short term nursing home placement
(1 OR 2 critical needs deficit)

Individual Income
= No Limit*

Assets:
Individual = $36,270
Couple = $48,360

<25% NH Cost
($1,486/mo)

STATE

2-year wait-list (except for those grandfathered in)

Category 2
CHCPE

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
= No Limit*

Assets:
Individual = $36,270
Couple = $48,360

<50% NH cost
($2,973/mo)

 

(NOTE:  9% 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
= $2,205/Month* (or if more, diverted to pooled trust)

Assets:
Individual = $1,600
Couple =
(both as clients) = $1,600 each
(one as client) =$25,780
(MCCA rules apply to possibly increase assets allowed**

a) 100% NH Cost
($5,945/mo)

b) 115% NH Cost ($6,837/mo)
c) 100% Subacute***

($13,525/mo)

d) 115% Subacute***
($15,553.80/mo)

 

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:  $36,270/individual

Couple:  $48,360

<50% NH cost

($2,973/mo)

STATE

Wait-list, limited to 100 slots

Category 5

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:  $1,508

Assets:  $1,600

 

50% federal reimbursement

OPEN

CT Home Care Plan for Elderly / Disabled - Notes:

1. Clients in the higher income range ($2,010+) are required to contribute the excess as "applied income" to the cost of their care.

*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.