Lisa
Nachmias Davis
Davis
O'Sullivan & Priest
LLC
davis@sharinglaw.net
www.sharinglaw.net
READ THE DISCLAIMER!!
(last
updated August 21, 2024)
For those who need help in meeting the high costs
of paying for home care for a loved one, the options can be very
confusing. This is especially true if the family has started out
hiring that nice woman your neighbor knows who only wants $15 CASH per
hour. This is a brief outline of the ways the various government
benefits work in terms of getting help with home care in Connecticut,
at least, as I understand them, keeping in mind things are always
changing. Those with plenty of money have different problems --
in fact they may actually have more trouble figuring out what care is
needed and how to get it -- but they don't have to worry about
"qualifying." This is a brief rundown of the primary programs
available and how to access them. Please write if I've missed anything
important or if you can suggest improvements. Please look on the
ct.gov website, the local agency on aging website, and make a lot of
calls -- I'm only human, this is not the last word on home care.
The following is a list -- click for more
details below. I'm not a social worker, just a lawyer, so of
course I recommend that you also contact your local agency on aging.
| 1. | Respite care.
Connecticut has two "respite" programs that provide a modest grant to
give respite to the FAMILY caregiver. "Respite" means temporary
help. |
| 2. |
State-funded CT Home Care Program for the Elderly also known as "Category 2 CHCPE." (and other state-funded programs) . Only for someone 65+. Typically would cover adult day care and 10-20 hours a week. |
| 3. |
Medicaid CT
Home Care Program for the Elderly also known as "Medicaid waiver" or
"Category 3" CHCPE. Only for someone 65+; may be able
to cover 70 hours a week, or a live-in person. |
| 4. |
Community First
Choice personal care assistance services for any age. |
| 5. |
Other
"Medicaid waiver" programs for people of any age. |
| 6. |
Veterans
only: VA home care. |
| 7. |
Wartime veterans and the
widows/widowers of deceased wartime veteran: the
Aid and Attendance benefit. Wartime veteran: doesn't
mean frontline, just active duty during period of war. |
1. Respite
Programs. These are the easy, "starter" programs for
temporary, short-term help. The state of CT has two programs, the
CT
Statewide Respite Program (eligibility has asset limits; maximum
help is only $7,500 of care per year) for anyone with Alzheimer's or a
related dementia, and National
Family Caregiver Support Program (probably less support, but no
financial eligibility rules) -- for someone of any age with
Alzheimer's, or otherwise, someone 60+. You can do this yourself,
if you meet the criteria. Call 1-800-994-9422. This gets
you in the door to your local Area
Agency on Aging who will do the assessment and try to get you this
starter level of help.
2.
State-Funded Home Care for Elders (65+). 2024 financial
eligibility: $46,242/single, $61,656/couple asset limits.
To make a referral, call 800-445-5394, option 4. Or use the
w-1487
form (also in Spanish)
or apply online.
If the person needing care meets the eligibility criteria, this can
also be a do-it-yourself project. The same Agency on Aging or
other access agency staffer would come and assess the person needing
care, come up with a "plan" -- normally this is 10-20 hours per week of
care -- and handle the financial application as well. One tricky
aspect is that there is both a copay (3%) and a deductible - income
over $2,510 (2024 figure) has to be used towards care. If the social
worker doesn't find that any extra income is being used for medical
expenses (such as additional privately paid care, Depends, health
insurance, or other expenses), then the agency that oversees the
program will send a monthly bill for not only the 3% copay but also the
balance of income over the threshold. However, there is no actual
income limit for eligibility,
and no 5-year lookback (maybe 2) although gifts can still cause a
penalty, and services may start pretty quickly. Unfortunately,
where there is a couple and savings exceed the maximum, it's usually
better to try for the harder program, the Medicaid
waiver program that provides more care. NOTE: there are
some other state-funded categories -- there is one for the physically
disabled, such as those with MS; and there is also one for the very
poor elderly who may not be able to wait to get through the Medicaid
waiver process. Click for the chart,
sorry if it is not totally up to date. These extra programs may or may
not have waiting lists. That's why you will be talking to the Agency on
Aging about it. BONUS: THE STATE CAN'T ASK TO GET PAID FROM YOUR ESTATE
WHEN YOU DIE. (If it does, that's a mistake.)
3. Medicaid
Waiver Home Care for Elders (CHCPE category 3) also for those
65+ only. (There are "waiver" programs for younger people but
usually after a 2 or more year waiting list). Even for someone
very poor (income under $2,829/month (2024 figures), a single person
with assets under $1,600) this can be challenging, as it includes the
dreaded 5-year lookback financial audit -- and basically the same rules
apply as for a person in a nursing home. That means a lot of
documents. The added headache is that if income is over $2829
(2024 numbers) it's necessary to do a pooled trust
-- click for my article on this. If the assets are more than this,
especially if a couple is involved, you need legal help. Really.
Some articles on the topic of this kind of Medicaid, which as I said is
basically the same as for a nursing home: Exempt Assets
(what you get to keep); How to Spend Down;
and Medicaid
for Married people. Do get help. At least in our
office, we start with an initial consultation and try to pump you full
of information so that if you can't afford to hire our help for the
whole project, you'll be fortified with as much knowledge as we can
give you. And then you could still call us for help as
needed. BONUS: once a person qualifies for this Medicaid
waiver home care, it's essentially the same as being approved for
nursing home care, so if going to a nursing home, there's no need to
reapply. However, when you get care at home, you can keep your home
(until you die -- the state can take it then from your estate -- talk
to a lawyer if this is problematic and you'd like to figure out
alternatives) -- but not in a nursing home where it would have to be
listed for sale. ALSO, when at home, you generally keep your
income to use towards living expenses, which isn't true if you go to a
nursing home, where you can only keep $75/month.
4. Community
First Choice. This is not a program, but an "option" for
getting personal care assistance for an individual who is already on
Medicaid. And there are so many versions of Medicaid including
for people age 19-64, not on Medicare, with low taxable income, without
regard to assets (Husky D). (If married, the one with low income can
still qualify if you file taxes as married filing separately.)
There is also Husky A for caregiving parents, depending also on taxable
income. That's beyond the scope of this summary, but in any event,
assuming the person can get on or is already on Medicaid, you just apply online and then the
help you may need is in getting DSS to give you what you think you
need, but not qualifying. It's tougher if you're not already on
Medicaid. For a single person, the income limit for Husky C Medicaid
(what you need if you also have Medicare) is $1,234/month (2024
figure), that's NOT taxable income but any cash coming in including
annuities. Many people have more than this. The pooled trust can be used to address the income
problem. (Read the article. It's just crazy but it works.)
If the person is under 65, it doesn't have to be this "pooled trust"
thing, but could also be a similar trust sometimes called a
self-settled or first-party special needs trust, that can have a family
member as trustee. For the pooled trust or this other special
needs trust, unfortunately you do need legal help. The other
problem is the $1,600 asset limit. That's for someone single; for
someone married, the asset rules are same as #3, the Medicaid
Waiver approach. No 5-year lookback but the rules for married people
are the same. Read Medicaid
for Married People. You'll need help with this. The
other problem is that recently the State has gotten stingy with the
hours of care allowed, which seem to be down to state-funded home care
levels. Also, unlike the CHCPE programs, the only option for care
is personal care assistants. CFC doesn't pay for adult day care, case
management, agency services, or the "adult family care" stipend for a
live-in family member. The only positive is no 5-year lookback
applies/no penalties for gifts, and of course, you can be under age
65.
5.
PCA, ABI, DDS, DMHAS Waivers.
The financial rules for these follow the same as above for Medicaid Waiver, but you don't have to be
65+. PCA (personal care assistant) and ABI (acquired brain
injury) have waiting lists of 2+ years, but can be very
comprehensive. DDS (Department of Developmental Services -- for
those with intellectual disabilities) waivers, including the Autism
waiver, also have waiting lists. DMHAS (Department of Mental
Health and Addiction Services) may provide fewer hours but have shorter
waiting lists where arguably the need has a mental health component.
6. VA has home
care for veterans! For anyone eligible to get VA medical
care -- with or without copays -- the VA can offer substantial home
care. It's important for any veteran discharged honorably (or other
than dishonorably) to enroll, and if discharged dishonorably, to talk
to someone at the State Dept. of Veterans Affairs or other veteran aid
groups to see if it's possible to get the discharged upgraded.
Contact 860-616-3600. I have an elderly client getting
essentially 24-7 care through a combination of VA home care and the
Medicaid waiver. I have another paralyzed client getting
significant home care from the VA. This I cannot help you with,
but the VA can. If you are lucky enough to have a child or spouse
who could provide you with care if only able to get paid, that's also
possible.
7. Aid and
Attendance for Wartime Veterans. This is a cash stipend
available to wartime veterans or their surviving spouses.
Basically, the veteran can deduct from income most of their medical
expenses, and if the expenses are cutting into savings, if the
resulting net income is zero, the veteran could get up to
$2,300/single, 2729/married per month or for the veteran's widow(er),
up to $1,478/month. The amount is paid RETRO to date of
application, once approved. The asset limit is $155,356
(until 12/24); this includes a year's income but that's income NET of
medical expenses. It's very important to contact the State
Department of Veteran's Affairs. Contact 860-616-3600 to get help with the application.
There may be other private organizations that assist, but it's hard to
be sure they are not a rip-off unless the VA actually recommends them.
Don't do it alone, because if not done "completely" from the beginning,
this can take months, if not years.
FINALLY -- if home care doesn't work but you are trying to avoid
nursing home care -- click for my PDF
on the comparatively few options for getting help with assisted living
costs (or something similar).
FREQUENTLY ASKED QUESTIONS
Can a family member be paid to
provide care? In
most cases, yes, unless it's a spouse, although VA home care might even
pay a spouse in some situations. For a child or other family
member to be paid for care, the person must be hired as a personal care
assistant (PCA), or paid a weekly stipend of about $500/week for the
"adult family care" option where the family member lives with the
person eligible for the program.
Will
the state pay for 24/7 care? None of these programs pay for 24/7
care, that is, people taking care of your family member while awake,
24/7. They might pay for live-in, but only if the live-in has 8
hours set aside for sleep.
Besides personal care assistance,
what is provided? The state of CT home care
programs generally will include life alert, a case manager, and can
cover adult day care and transportation to get there. The home
care programs can also include chore services and care provided through
an agency rather than relying on a particular individual that you hire
(and who may need vacations or get sick). It can also include
"respite" care in a nursing home or in some cases in an assisted living
facility. Talk to the agency about this.
Can I hire anyone I want?
Yes and no. In theory you can hire anyone (except for a spouse)
as a personal care assistant, but at least with the state programs,
only if the person agrees to sign up with the state's payroll agency,
to have payroll deduction for payroll taxes, get paid by check, report
the payment to the IRS, etc. In other words, it depends on
whether the person you want is willing to do that, and if the pay is
too low, if there's any way to "convince" the person to stay on.
With VA aid and attendance, you get money so you can hire whoever you
want. For VA home care, you may be able to set the pay rate and
hire someone who charges more if you are willing to get fewer
hours. You get a budget and set the rate.
Can I hire any agency I want? NO (unless getting the aid
and attendance cash benefit for wartime veterans). Only some
agencies "participate" in these programs. The state rates are low
so many well-known home health or companion agencies choose not to
participate. This is important to know when starting down the path of
home care. Better not to get too attached to a particular agency
if eventually you have to drop it and switch to one that
participates. Here is my most recent list of
participating agencies (in Excel), but no guarantees. No
program except aid and attendance just gives you a blank check to spend
on any agency you want.
Will
the state take mom's house if she gets care? NO for VA benefits. NO for respite or
state-funded home care. NO for CFC. YES for Medicaid
waiver, other waivers; that is, if she owns a house and dies, there is
an "estate," and the state has a claim against the estate for the
financial value of what was provided. If this is a concern, talk
to a lawyer for some ideas beforehand. That's why some people get
interested in "protecting
assets.".
What
if there is a reverse mortgage? The money taken out from a reverse
mortgage doesn't count as income OR as an asset if placed in a
segregated bank account. This could be used to pay for the extra care
needed that the state won't cover.
What
will help the process go more smoothly? If it's a VA program, you definitely
need to have the veteran's DD-214 proof of discharge. IF lost, you can get
it from national archives. For DSS program, however you
choose to apply, you should set up an online account using connect.ct.gov so you can upload
information and check for notices, letters, etc. before the mail gets
to you. Also, if it's a waiver program with any 5-year lookback,
you will want to work on accumulating the documents before you are
asked for them. For DSS programs, these will include two full years of
monthly statements plus December statments of the prior years, plus
copies of all IDs, health insurance cards, proof of spouse's death or a
divorce decree, etc. Here is the
state's brochure on types of information needed. (PDF)
If you are
interested in a consultation with our office about long-term care
planning, we (2024) charge $395 for a 1-2 hour consultation if assets
are less than $100,000 (single) or $200,000 (couple) (not counting home
or car); for those with more, the fee is $695. We do accept
credit cards. The reason for this charge is that you may decide
the consultation is all the help you need. We don't want to be in
a situation where we only get paid if you decide to hire us for a full
application or other big project, because that could make us feel
financial pressure to "sell" you something big. You can hire us
to do an entire application for a flat fee or an hourly rate or also
just decide you want to consult with our staff on an as-needed basis
for an hourly rate.
DISCLAIMER: THIS
INFORMATION IS NOT PROVIDED AS LEGAL ADVICE