Connecticut Medicaid Definition
Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, it provides health coverage for various groups of Connecticut residents, including pregnant women, parents and caretaker relatives, adults with no dependent children, disabled individuals, and seniors. However, this page is focused strictly on Medicaid eligibility for Connecticut elders, aged 65 and over, and specifically for long term care, whether that be at home, in an adult foster care home, in a nursing home, or in an assisted living facility.
Medicaid in Connecticut is also called HUSKY Health, and Medicaid for state residents who are aged, blind & disabled is called HUSKY C.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Connecticut seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status, geographic location within the state, and that Connecticut offers multiple pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement program. This means anyone who meets the requirements will receive assistance, which is provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – with these programs, there are a limited number of participant enrollment slots. Therefore, wait lists may exist. Benefits are provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Elderly and Disabled – this is an entitlement program. Benefits are provided at home or adult day care.
The table below provides a quick reference to allow Connecticut seniors to determine if they might be immediately eligible for long term care from a Medicaid program.
|2018 Connecticut Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||Income must be less than the cost of nursing home||$1,600||Nursing Home||Income must be less than the cost of nursing home||$3,200 (each spouse is allowed up to $1,600)||Nursing Home||Income must be less than the cost of nursing home||$1,600 for applicant & $123,600 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,250 / month||$1,600||Nursing Home||$4,500 / month (Each spouse is allowed up to $2,250 / month)||$3,200 (Each spouse is allowed up to $1,600)||Nursing Home||$2,250 / month for applicant||$1,600 for applicant & $123,600 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$972.49 / month in SW CT & $862.38 in N, E, and W CT||$1,600||None||$1,483.09 / month in SW CT & $1,374.41 in N, E, and W CT||$2,400||None||$972.49 / month in SW CT & $862.38 in N, E, and W CT||$1,600||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. For married couples, with non-applicant spouses’ with insufficient income in which to live, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA). The MMMNA is intended to ensure non-applicant spouses have sufficient income in which to live. Basically, if the non-applicant spouse, also called a community spouse or well spouse, has income under $2,057.50 / month, as of 7/1/18 (this figure changes each year in July), he or she is entitled to a portion of the applicant spouse’s income. If the well spouse has income equivalent to $2,057.50 / month or income in excess of this amount, the applicant spouse generally cannot allocate any money to the non-applicant spouse.
As mentioned above, for a senior to be eligible for nursing home Medicaid, their income must be less than the cost of care in a nursing home. All of a senior’s income except for a small personal needs allowance must be applied towards their cost of nursing home care.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, promissory notes, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are not counted. In other words, they are exempt. Exemptions include personal belongings, such as clothing, household furnishings, an automobile, a burial plot, a prepaid funeral contract (limited to $8,000 in 2018), term life insurance with no cash surrender value, and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the equity value is under $858,000 (in 2018). For married couples, as of 2018, the community spouse can retain half of the couples’ joint assets (up to a maximum of $123,600), as the chart indicates above. This is referred to as the Community Spouse Resource Allowance (CSRA) and is intended to prevent the non-applicant spouse from becoming impoverished.
It is vital that one does not give away assets or sell them for less than fair market value in an attempt to meet Medicaid’s asset limit. This is because Connecticut has a Medicaid Look-Back Period, which is a period of 60 months (5 years) that dates back from one’s Medicaid application date. During this time frame, Medicaid checks all past transfers to ensure no assets were sold or given away for less than they are worth. If one is found to be in violation of the look-back period, one will be penalized with a period of Medicaid ineligibility.
Qualifying When Over the Limits
For Connecticut elderly residents (65 and over) who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – In Connecticut, the Medically Needy Pathway, also called the Medical Spend-Down Program, allows seniors who would otherwise be over the income limit to qualify for Medicaid if they have high medical expenses. This program is intended for those that are categorically aged, blind and disabled, and in simple terms, one may still qualify for Medicaid services by “spending down” their income to the medically needy income limit. As of 2018, the income limit is $633.49 / month for a single senior applicant in Southwestern CT and $523.38 / month in Eastern, Northern, and Western CT. For married couples with both spouses applying for Medicaid benefits, the income limit is $805.09 / month in Southwestern CT and $696.41 / month in Eastern, Northern, and Western CT. For this program, one’s “excess income,” (the amount that is over the medically needy income limit), is used to cover medical bills. This may include private health insurance, unpaid medical bills, and medical expenses that Medicaid does not cover. Once one has spent their income down to the income limit, Medicaid will kick in for the remainder of the spend down period, which is six months in Connecticut.
Make note, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in “spending down” extra assets. However, one can “spend down” assets by spending excess assets on non-countable assets, such as home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. When spending down assets, it’s important that one does not give away assets or sell them for less than market value. This is because in Connecticut, Medicaid has a “Look-Back” period of 5 years, and if one is in violation, a period of Medicaid ineligibility may result.
2) Medicaid Planning – the majority of persons considering Medicaid are over the income limit, or over the asset limit, or over both limits, yet still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Connecticut Medicaid Programs
1. Personal Care Assistance (PCA) Program – also called the PCA Waiver, this program provides assistance with activities of daily living, such as bathing, dressing / undressing, and eating. Program participants are able to hire the personal care attendant of their choosing, including some family members. Other benefits include adult day care and personal emergency response systems.
2. Community First Choice (CFC) Option – this is a state plan option that provides services that enable a senior to live in their home independently rather than a nursing home facility. Assistance with daily living activities (cooking, light housecleaning, mobility, etc.), meal delivery, and home modifications, are available benefits.
3. Assisted Living Program – Formerly called the Connecticut Home Care Program for Elders (CHCPE), this program provides assistance to assist elders in living at home, in assisted living, or in an adult foster care home. Benefits may include adult day care, home delivered meals, light housecleaning, minor home modifications, personal care assistance, and personal emergency response systems.
4. Adult Family Living (AFL) – Similar to adult foster care, a senior moves in with a relative or friend (or vice versa) and the senior is provided supervision, personal care assistance, and transportation. This option pays caregivers for their services and is available via the PCA and CHCPE programs.