You asked a series of questions about the State Supplement Program (SSP) which is also referred to as the Aid to the Aged, Blind, and Disabled Program. We answer the questions separately in the order you asked them. We consolidated questions that were duplicative.

1. What is the rationale for reducing SSP benefits when a disabled adult moves from a group home or residential care home (RCH) to the community, when the price of food, clothes, and other living necessities remain the same?

The answer to this question is complex. In general, the services provided to people living in more restrictive settings, such as RCHs, in addition to their room and board, are factored into the SSP benefit. The benefits are based on costs facilities report to the Department of Social Services (DSS) and are adjusted for inflation. The benefit for people living alone or in shared housing in the community is based solely on housing costs (which are capped) and a personal needs allowance. And these costs have not been adjusted for inflation for over 10 years (see OLR Report 2002-R-0343 for a more in-depth explanation of this disparity).

2. What department administers the Supplemental Income Program in Connecticut?

We assume you mean the SSP when you refer to the Supplemental Income Program. In Connecticut, DSS administers the SSP. The federal Social Security Administration administers both the Social Security Disability Insurance (Title II) and the Supplemental Security Income (SSI)(Title XVI) programs, for which many SSP recipients are typically eligible.

3. What laws govern the administration of the SSP?

Both state and federal laws govern the SSP. State laws:

1. designate DSS as the state agency for administering the SSP, pursuant to the federal Social Security Act (CGS § 17b-2);

2. require the DSS commissioner to exclude burial funds when determining program eligibility, allow her to exclude from the asset limit other personal or real property, and establish that federal laws governing the program that conflict with state law prevail (CGS § 17b-9);

3. make the state responsible for the SSP's (among other programs) administrative costs to the extent they are not covered by federal grants (CGS § 17b-98);

4. establish the program's benefits standards and disregards (The actual benefit and disregard amounts are not in statute but can be found in state regulation (DSS Uniform Policy Manual, various sections); the statute contains language that freezes both. ) (CGS § 17b-106); and

5. govern the rates DSS pays to SSP recipients living in RCHs (CGS § 17b-340(h), CGS § 17b-244, and Conn. Agency Regulations, 17-311-52, et. seq. ).

The federal law governing state supplements to SSI is found in Title 16 of the Social Security Act (42 USC § 1382e, et. seq. ) and its implementing regulations (20 CFR § 2001, et. seq. ). Federal law does not require states to have supplement programs, and currently, six states offer none. States that do can either run their own or they can contract with the SSA to administer them.

The law essentially says that if states exercise the option of running a supplement program, they can apply income disregards and impose residency requirements, but they cannot use more restrictive income disregards than those used for SSI eligibility and benefit determination. In addition, states must meet the federal "pass-along" requirement. This requires them to ensure that their supplement payments reflect SSI cost-of-living adjustments. (See earlier OLR Report 2002-R-0209). States not meeting this requirement risk losing federal Medicaid reimbursements.

4. How many disabled adults in Connecticut are receiving SSP?

As of January 31, 2002, 21, 284 people were receiving SSP benefits. Of these, 15,067 (71%) were people with disabilities other than blindness. The remaining people were elderly or blind.

5. What percentage of these adults are physically or mentally handicapped?

We cannot provide a complete breakdown by disability type. But we can extrapolate some figures. DSS monthly caseload data shows 21% of the disabled caseload (3,228 in January) lived in licensed boarding homes, with the remaining 79% (11,838) living in the community. Of the 21% in boarding homes, two-thirds were DMR clients, the vast majority of whom were living in group homes. Another 5% were people with mental illness. We cannot tell precisely what the disability was for the remaining 30% (see copy of DSS spreadsheet, attached). Nor do we know the disability type of the remaining 11,838 people with disabilities.

6. What percentage are "other"?

We do not know what is meant by the term "other. "

7. What is the difference between "boarding home" and "residential care home" beds?

"Boarding home" is an older general term, which is used in various contexts but not defined in the statutes.

SSP recognizes several types of boarding facilities:

a. RCHs (formerly called homes for the aged), licensed by the Department of Public Health (DPH);

b. community living arrangements and community training homes, licensed by the Department of Mental Retardation (DMR); and

c. residential living centers, halfway houses, and alcohol and drug dependency facilities, licensed by the DPH and funded to some extent by the Department of Mental Health and Addiction Services (DMHAS).

8. How many of each of these facilities are there in Connecticut?

DPH licenses 109 RCHs. A list is enclosed.

DMR licenses 787 group homes, also known as community living arrangements (CLAs); 649 are privately operated and 138 are publicly operated. We have enclosed a list of the agencies that operate them and a list of the 319 DMR-licensed community training homes (CTHs).

DMHAS funds 110 mental health residential treatment programs, of which 18 are group homes and the rest are supervised or supported apartments. DMHAS also provides funding for 104 addiction services residential programs in the state, but people in these facilities are apparently less likely to be receiving SSP, since addiction by itself is not a qualification for receiving federal SSDI. We have enclosed a list of these facilities, which, although funded by DMHAS, are licensed by DPH.

9. Who are the primary owners?

See enclosed lists, which show the licensees.

10. How many of these companies or individuals own more than one facility?

RCHs

From the enclosed list, it appears that:

· Church Homes, Inc. is the licensee for Avery House in Hartford, Noble Horizons in Salisbury, and Seabury Retirement Community.

· Martland Management Inc. is the licensee for Elton Residential Care Home in Waterbury and Park City Residential Care Home in Bridgeport.

· Fernwood Manor, Inc. is the licensee for Fernwood Manor in Hartford and Fernwood West in West Hartford.

Some RCHs are connected to, or part of nursing homes or are owned by companies that also own nursing homes.

DMR Group Homes

Most private agencies licensed by DMR to run group homes operate more than one. One (CIB) operates as many as 80 group homes. See the enclosed listing.

DMHAS Residential Programs

Twenty-six entities run more than one DMHAS-funded mental health residential program while 22 agencies run more than one addiction services residential program. Most of them are nonprofit entities. See the enclosed lists for details.

11. Federal SSI checks and state supplement checks are sent directly to the housing owner (RCH or group home). The owner receives approximately $ 1,700 for each recipient and gives each of them an allowance ranging from $ 100 to $ 125. The recipients do not receive a clothing or transportation allowance even though the government factors a clothing allowance into their benefit amounts. Does the state further subsidize these housing owners?

We believe the allowance you are referring to is the personal needs allowance, which, combined with the unearned income disregard, adds up to about $ 120 per month. This is the amount that someone living in a licensed boarding facility would receive each month. Contrary to what some may believe, generally, the supplement is paid directly to the recipient each month and he turns all of the money, except this allowance, over to the boarding facility.

The amount that is turned over is considered to be payment in full for RCH owners. DMR and DMHAS provide additional funding to RCHs and group home operators as appropriate for additional or specialized services provided beyond room and board, such as personnel costs.

Also, see numbers 12 and 13 below.

12. Does the state provide funds (i. e. , low-interest loans) to build these homes?

RCHs

The Department of Economic and Community Development, which funds a number of different types of low-income and elderly housing, does not provide any state housing funds or low-interest loans to these entities. On the other hand, DSS takes capital costs into account to some extent when it sets the rates these facilities can charge people receiving SSP.

DMR Group Homes

The agencies that operate CLAs usually own the home or lease it, using either an operating lease or a capital lease. Mortgages are usually financed with local banks and lenders. The Connecticut Housing Finance Authority (CHFA) is a lender through a mortgage program in conjunction with DSS and DMR. A DMR Revolving Loan Fund Program offers a 6% mortgage interest rate. Homes with capital leases are leased from the Corporation for Independent Living (CIL). CIL, in coordination with DMR and DSS, developed a housing program in which CIL developed homes to be used as CLAs. The homes are leased to private agencies under 25-year leases. At the end of the lease period, the agency receives title to the home. Homes leased from private landlords usually have operating leases.

DMHAS Residential Programs

DMHAS administers a Substance Abuse Revolving Loan Fund to make loans to private nonprofit agencies for the cost of establishing group homes for four or more people recovering from substance abuse problems (CGS § 17a-674). In 2001, the legislature authorized a Supportive Housing Pilots Initiative (PA 01-8, § 5, June Special Session) to provide up to 650 units of affordable housing and support services to people with special needs, such as mental illness, chronic chemical dependency, homelessness, or risk of homelessness. It authorized $ 10 million in bond funds for DECD to use for initiative-funded projects and requires CHFA to set aside $ 1 million a year in tax credits for them.

13. Are there tax breaks for these housing owners?

Owners organized as federally qualified nonprofit corporations are not subject to state or federal income tax. For DMR CTHs, which are like foster homes, the income is not taxed. And for the DMHAS-funded facilities, the new Supportive Housing Pilots Initiative does provide some tax credit, as noted above.

14. What is the income from these homes?

RCHs

We asked DSS for information on incomes, but have not yet received a response.

DMR Group Homes

We do not have specific information on the incomes of these individual group homes. Most agencies with which DMR contracts are nonprofit. Only a small number, around six, are for-profit. The homes are subject to a cost settlement process in which DMR annually compares the funds it has provided to the agencies to their operating costs, based on the Audited Consolidated Operational Report that the agency submits annually to DMR. If the agency spent less than it was awarded, DMR recovers 50% of the surplus. If the agency overspent, the loss is theirs and they are not reimbursed for the difference. Most agencies overspend and consequently have no net income. DMR does not appear to keep records on the profitability of the few "for profit" agencies; that information could potentially be determined from the audited financial statements on file with DMR.

DMHAS-funded Residential Programs

We have no information on overall income for specific entities, but the enclosed lists show the funding DMHAS provides to each entity. Again, most of these entities are nonprofit.

15. Who monitors these facilities?

DPH licenses and inspects RCHs. DSS monitors certain aspects of their financial situation and, to some extent, bases what they can charge and its reimbursement to them to some extent on their costs. DMR licenses and inspects the group homes and community training homes for people with mental retardation. DPH licenses the DMHAS-funded mental health and substance abuse residential facilities.

16. What are the state licensing requirements and the extent of care administered in these facilities?

Residential Care Homes

RCHs provide their residents with a single or double furnished room, a private or shared bath and toilet, and shared common areas such as a lounge or recreation area. Residents receive three meals a day in a common dining area and some limited personal services. The homes also provide housekeeping, laundry, social and recreational programs, transportation, and a 24-hour emergency call system. Residents are mainly elderly or disabled people who cannot live independently in the community.

State regulations set detailed requirements for the buildings licensed as RCHs and some requirements for the services that have to be offered. DPH inspects the homes periodically. (Conn. Agencies. Reg. § 19-13-D6, enclosed).

To obtain a license, a proprietor or licensee's initial and renewal license application must contain character references from three responsible people not related to him and a certificate of physical and mental health signed by a physician. The owner must employ sufficient capable personnel of good character and suitable temperament to provide satisfactory care for the residents. The management, personnel, equipment, facilities, sanitation, and maintenance of the home must reasonably ensure the residents' health, comfort, and safety at all times.

The RCH must have one staff member per 25 residents on the premises 24-hours a day and one on duty from 7 a. m. to 10 p. m. per 25 residents.

Staff provides some personal services, but historically residents had to be able to self-administer medicine with supervision. A recent change in the law now allows unlicensed personnel to become trained and certified to administer medication (CGS § 19a-495a).

DMR-licensed Group Homes and Community Training Homes

DMR licenses the CLAs and CTHs (which are like foster homes for people with mental retardation). The level of care depends on the individuals' needs, as outlined in that person's individual overall plan of services.

CLAs provide residential services to 15 or fewer people with mental retardation. To become licensed, the CLA operator must apply in writing to DMR and submit a number of required items such as a local fire marshal's certificate, insurance, various health-related reports, and a plan for direct contact personnel to complete training in various aspects of residents' care by the CLA's opening. The license must be renewed annually. DMR inspects the facilities at least every two years.

The licensing regulations specify detailed requirements for the physical facilities and staff. Each facility must have sufficient direct care personnel at all times to ensure that residents' essential requirements for health and safety are met. The facility's administrator must specify training requirements for direct contact staff. The training must include an initial orientation on specified subject matter followed by repeated training in these areas every two years. The subjects include signs and symptoms of disease and illness, communicable disease control, resident basic health and behavioral needs, routines of the residence, and emergency procedures. The facility must have an emergency plan in place. In addition, the regulations require in-service training in first aid, residence policies and procedures, abuse and neglect prevention, service planning and provision, and behavioral emergency techniques. One staff person certified in cardiopulmonary resuscitation must be on duty per shift. The facility must also comply with regulations protecting residents' rights (Conn. Agencies Reg. § 17a-227-1 to 20).

CTHs are private family homes that DMR licenses to provide care, treatment, or lodging to people with mental retardation. They are licensed to serve up to three people. The families receive training specific to the needs of the individual placed with them, but they do not need to undergo the DMR certification training as a medication aide. To become a CTH, the potential licensee must apply in writing to DMR and provide requested information such as a physical description of the home, character references, verification of conviction records, and a three-year employment history. The home must undergo a fire safety inspection and the licensee must obtain a local fire marshal's certificate if the building contains more than two living units. The licensee must demonstrate the capacity to maintain a healthy and safe living environment, complete DMR's approved training for CTH operators, and demonstrate competency in specified areas. The licensee must also have emergency plans and keep specified routine records. The regulations further specify residents' rights (Conn. Agencies Reg. § 17a-227-23 to 30).

DMHAS-funded Group Homes

The DMHAS-funded group homes and other community-based mental health and substance abuse residential facilities must be licensed by DPH. DPH regulations require mental health residential living centers to provide a supervised, structured, and supportive group living arrangement that includes psychosocial rehabilitation services and that may include assistance in obtaining necessary community services to people in need of mental health services. The license applicant must apply in writing and provide requested information, such as evidence of compliance with local zoning ordinances and building codes, a fire marshal's certificate, insurance, current organizational chart, a description of services provided, and evidence of financial capacity. Every residence must have a governing body that must adopt policies, provide for a safe physical plant and maintenance, and employ a qualified executive director. And each must have written personnel policies and appropriately qualified staff to meet the residents' needs. The regulations further contain detailed requirements for the physical plant, accident reports to DMHAS, program evaluations, and various procedural aspects.

DPH further licenses "community residences," which house up to eight mentally ill adults. These facilities must have a 1: 4 staff-to-resident ratio. Otherwise, they must generally follow he same rules as the residential living centers (CGS § 19a-507a, Conn. Agencies Reg. § 19a-495-550, 551, 560).

DPH also licenses DMHAS-funded substance abuse residential treatment facilities, with detailed licensing requirements similar to those for the mental health facilities (Conn. Agencies Reg. § 19a-495 to 570).

17. Who administers medications and are they qualified?

RCHs

PA 99-80 directed DPH to adopt regulations by July 1, 2000 that require certification of unlicensed personnel for administering medications in RCHs. DPH issued the regulations in April 2002. Previously, the residents had to be able to self-administer medication with some minimal assistance.

DMR-licensed Group Homes

Staff certified to administer medication does so in CLAs with up to 15 people. In homes with 15 or more residents, licensed nursing staff administer medications. In CTHs, the licensee receives some training in administering medication, but does not have to be certified as a medication aide.

DMHAS-funded Residential Facilities

Medications are either self-administered or administered by licensed or trained personnel, depending on the level of care (CGS § 20-14i).

18. How many physically and mentally handicapped people are living in boarding homes, residential care homes, independently, with a roommate, or with a family?

We cannot provide this type of breakdown. But Table 1 provides the number of monthly cases DSS pays.

Table 1: State Supplement-

Aid to the Disabled-Monthly Paid Cases

*According to DSS, this category encompasses residential care homes, mental health residential living, residential alcohol treatment, adult family living homes, halfway houses for adults, residential drug dependent children, family care homes, and permanent family residences.

19. How much SSP is paid to people in each of these living situations?

Table 2 provides monthly payment information for the paid cases described in Table 1 above.

Table 2: Monthly Payments for Aid to the Disabled Paid Cases (January 2002)

Living Arrangement	Average Cost Per Case	Total Payments
DMR Boarding Homes	$ 730. 73	$ 1,393,500
Boarding Homes-Other	1, 170. 43	1,547,310
Other Living Arrangements (community)	$ 134. 23	1,588,988
Total		4,529,798

20. The DSS mission statement says the purpose of the SSP is "to maintain recipients at a standard of living established by the state legislature. " Where is it established?

We believe the mission statement to which you refer is actually the "Financial Assistance" page on DSS's website. That page describes all of DSS's cash assistance programs. The section on SSP includes the statement you have cited. The standard of living is the SSP benefit standards, including disregards, which, as we said earlier (see Answer #3) are found in CGS § 17b-106 and its implementing regulations.

21. Another stated purpose of SSP is "to promote a higher degree of self-sufficiency by enabling recipients to remain in non-institutional living arrangements. " What is DSS's definition of "non-institutional living arrangements" and where is this definition found in the regulations?

The above quote also comes from the DSS web page referenced above. It is not clear what DSS means by the phrase "non-institutional living arrangements. " One interpretation could mean any living arrangement, short of a nursing home or DMR training school (i. e. , Southbury), since DSS appears to pay SSP to anyone living in the other types of licensed boarding facilities. Another is that only the non-licensed boarding facility

living arrangements would be "non-institutional. " DSS says it means the least restrictive setting would be community living, either alone or in shared housing.

22. DSS states in its mission that incentives are available to encourage recipients to become as self-sufficient as their ages and abilities will allow. What are those incentives?

This statement can also be found on the "Financial Assistance" part of the DSS website at http: //www. dss. state. ct. us/svcs/financal. htm.

We asked DSS about the incentives and were told they are the SSP earned income disregards. SSP allows elderly, disabled, or blind people qualifying for the program to disregard a set amount of monthly income from employment ($ 85 for the blind, $ 65 for others) plus half the remainder and lets them deduct certain impairment-related expenses that enable them to be employed.

The federal Ticket to Work and Work Incentives Improvement Act of 1999, implemented in Connecticut by PA 00-213, Work Incentives for Persons with Disabilities, allows people with disabilities to engage in employment without risking their eligibility for needed medical services through the Medicaid program. The law also allows certain individuals to keep other necessary services needed to remain employed. In general, an eligible individual who is employed can qualify for Medicaid without spending down resources while earning more income than is otherwise allowed. For more information on the program, see http: //www. dss. state. ct. us/divs/medemp. htm and for a summary of the state law, see the enclosed OLR Summary of PA 00-213.

DSS's Bureau of Rehabilitation Services' offers various services to help physically or mentally disabled people become employed. The Bureau administers programs for vocational rehabilitation; benefits counseling for those wishing to return to work; the Medicaid for employed disabled program; independent living centers that provide information, referral, and skills training to help disabled people live in the community; and the Connecticut Tech Act Project, which makes assistive technology more accessible.

HN/RC: ro