TRANSPORTATION (GENERAL); PROPERTY TAX; NUTRITION; MEDICAL CARE; HOUSING (GENERAL); ENERGY (GENERAL); ELDERLY; EDUCATION (GENERAL);

ELDERLY;

You asked for a brief description of state programs for the elderly.

SUMMARY

The state’s major programs that serve the elderly are in the areas of health care, housing, energy, nutrition, property taxes, transportation, education, and cash assistance. We have included programs where (1) age is one criterion for eligibility or (2) a large proportion of the clients are elderly. Some of these programs are means tested. Several are funded, in part, with federal money.

HEALTH CARE

Medicaid

Medicaid is a state-federal program that provides medical assistance to low-income families and elderly and disabled individuals. For the elderly, the lion’s share of Medicaid expenditures covers nursing home costs, but it also pays medical costs not covered by federal Medicare for qualified elderly who live at home. The Department of Social Services (DSS) administers the program in Connecticut. The eligibility criteria vary, depending on the type of care required, but in most cases applicants must pass both an income and asset test.

Connecticut Home Care Program for Elders (CHCPE)

The CHCPE uses both Medicaid and non-Medicaid funds to pay for home- and community-based services for low-income, infirm elderly individuals who might otherwise require nursing home care. The Medicaid-funded part of the program (50% federal, 50% state funds) covers the poorest people with the most extensive home care needs. The non-Medicaid, primarily state-funded, portion covers people with slightly higher assets and somewhat lesser needs and there is no income limit. Services include care management, adult day care, adult foster care, homemaker services, transportation, meals-on-wheels, minor home modifications, and certain assisted living services. An “access” agency determines the most appropriate service package for each participant.

To be eligible, seniors must meet income and asset tests. The income limit is currently $ 1,656 a month for the individual who receives the Medicaid-funded services. Asset limits differ for the two portions of the program. Under the Medicaid-funded portion, asset limits are $ 1,600 per individual, $ 3,200 per couple if both receive services, and $ 19,732 per couple (or higher if the couple undergoes a “community spousal assessment) if only one receives services. Under the state-funded portion, asset limits are $ 18,132 for an individual and $ 27,198 for a couple, regardless of whether one or both are receiving services. Qualifying people in the higher income ranges have to contribute to the cost of their care.

The state also has a small pilot program that lets a limited number of people (up to 10) continue to receive home care services if their income rises slightly above the limits. Legislation in 2000 removed the set income limits and, instead, lets people receive CHCPE services if they would otherwise qualify for Medicaid in a nursing home. People at higher income levels still have to contribute something to their care costs. The change took effect in the state-funded portion on October 1, 2000, but federal approval is still needed for it to apply to the program’s Medicaid-funded portion. The pilot program continues until this federal approval is obtained.

DSS also administers a state-funded personal care assistance (PCA) pilot program that allows up to 50 seniors to hire their own attendant instead of going through a home health care agency for services. The program is available to people who (1) were receiving PCA services under a Medicaid waiver program for the disabled during the year before they turned 65 or (2) are eligible for CHCPE services but unable to access adequate home care services.

Connecticut Pharmaceutical Assistance Contract to the Elderly and Disabled (ConnPACE) Program

ConnPACE pays for prescription drugs, insulin, and insulin syringes and needles for people age 65 and over. Applicants’ annual income currently must be not more than $ 20,300, if single, and $ 27,500 if part of a married couple. This limit is adjusted annually to reflect inflation adjustments in Social Security payments. Participants must be state residents for at least six months and pay an annual $ 30 registration fee and a co-payment of $ 16. 25 for each prescription. Certain prescriptions are not covered, such as antihistamines and diet pills.

The income limits may rise even further if DSS receives a federal Medicaid waiver that, as a result of 2001 legislation, it has applied for to increase them to 300% of federal poverty level. But the federal government has not yet approved this change.

Connecticut Medicare Assignment Program

The Connecticut Medicare Assignment Program (ConnMAP) prohibits medical providers from “balance billing” enrollees for charges beyond what the federal Medicare program determines is a “reasonable and necessary” rate, of which Medicare pays 80%. Thus, any provider accepting Medicare patients may not balance bill ConnMAP enrollees beyond the 20% co-payment for the service. (Patients are also responsible for the Part B premiums and deductibles. ) The income limits for the ConnMAP program are tied to those for ConnPACE. The current maximum is 165% of the ConnPACE limits. ConnPACE recipients can use their ConnPACE cards in lieu of a ConnMAP card, and providers must accept both. Applicants must have resided in the state for at least 183 days before applying and be enrolled in Medicare Part B.

Alzheimer’s Respite Program

The Connecticut Statewide Respite Care Program gives families who care for relatives with Alzheimer’s or related disorders an occasional break by paying for up to $ 3,500 of respite services per year. The program is run by DSS in partnership with the Area Agencies on Aging (AAAs). Alzheimer’s patients are eligible for this program if they have annual incomes of no more than $ 30,000 and assets of no more than $ 80,000. They cannot be receiving or eligible for Medicaid. Participants can receive the respite care in their home, at an adult day care center, or other out-of-home service (out-of-home services other than adult day care are limited to 30 days annually). There is no age requirement for eligibility, but these diseases affect more seniors than non-elderly people.

Day Care—Alzheimer’s Disease

DSS provides funding through the state’s AAAs to pay for staff for adult day care programs for people with Alzheimer’s disease. Approximately 29 adult day care centers participate. The department’s CHCPE program also subsidizes the attendance fees for people who qualify financially.

Adult Family Living (formerly Adult Foster Care)

DSS funds a voluntary adult family living program for elderly people who are inappropriately institutionalized or who might otherwise be placed in a nursing home. The program provides room, board, and personal care services in a host home or substantially equivalent environment. There are no income limits, but participants must contribute towards the program’s costs according to a sliding fee scale. Currently, the program serves only three people and no new applications are being accepted.

Health Insurance Counseling – CHOICES Program

DSS and the AAAs jointly run the CHOICES program, which provides senior citizens with health insurance information and counseling, information on Medicare and Medicare managed care plans, and legal representation in the Medicare appeals process.

Qualified Medicare Beneficiary “Dual Eligibles”

Low-income seniors receiving Medicare may also be eligible for the federal-state Qualified Medicare Beneficiaries program, which uses Medicaid funds to pay Medicare premiums, deductibles, and some coinsurance for people with incomes at or below the poverty level and minimal liquid assets. For people with slightly higher incomes, the Specified Low-Income Medicare Beneficiary program pays the Medicare Part B premium.

Elderly Health Screening

DSS funds elderly health screening programs in four locations in the state: Hartford, New Haven, Waterbury, and Bridgeport. These serve the North Central, South Central, Western, and Southwestern regions.

HOUSING PROGRAMS

Elderly Housing

Both state Department of Economic and Community Development (DECD) and federal Housing and Urban Development funds can be used to develop various elderly housing complexes. Residents must meet certain income limits to qualify for this housing. The income limits for state-assisted elderly housing, including congregate housing, are 80% of the area median income adjusted for family size.

Rental Assistance Program (RAP)

Elderly RAP, administered by DECD, provides rental assistance to low-income families and residents of state-funded elderly housing projects. The elderly participants must spend more than 30% of their income on rent and utilities in order to qualify. The amount of assistance is the difference between 30% of their adjusted gross income, less a utility allowance, and the base rent.

Congregate Housing

This DECD program provides grants and loans to developers for special housing for low-and moderate-income, frail elderly. Developers may build new construction or rehabilitate existing structures. DECD also provides an operating subsidy to offset the expense of congregate services provided to lower-income residents. A congregate housing complex contains separate living units for residents, but also provides some housekeeping, personal care, and transportation services and usually at least one meal a day in a common dining room. Recent legislation allows all state-assisted congregate housing to offer more extensive “assisted living” services and permits the CHCPE program to pay for them for those who qualify financially. Sixteen elderly congregate housing projects are offering the new services.

Assisted living services include more “hands on” personal care, assistance with activities of daily living, nursing, and medical services that enable the resident to stay in his or her congregate apartment and “age in place” rather than having to move to a nursing home.

Assisted Living Pilot Programs

A pilot assisted living program for seniors living in government subsidized elderly housing is being planned in five locations in the state (for a total of 300 units). The CHCPE program will pay for the services for those who qualify financially. The law permits a combination of subsidized and unsubsidized units in the same facility, and gives DECD discretion to set the rental subsidy for the pilot at any percentage of the annual aggregate family income and to define income and eligibility for these subsidies.

DSS, DECD, and CHFA are cooperating on the project. Construction has not yet started, but two of the five sites are expected to begin building this summer. These are The Retreat in Hartford and Herbert T. Clarke House in Glastonbury. The other three sites are still in the process of obtaining various approvals they need before construction can begin; these are Marian Glen in New Britain, Luther Ridge in Middletown, and Smith Street Assisted Living in Seymour.

State law also authorizes the economic and community development commissioner to establish assisted living demonstration programs in up to four federally funded elderly housing developments. Three are already operational: Tower1/Tower East in New Haven, Immanuel House in Hartford, and Juniper Hill in Mansfield.

In addition, under 2002 legislation, some seniors living in private assisted living facilities who are in danger of running out of money may not have to move. The legislature authorized DSS to start two new pilot programs: a Medicaid waiver pilot for up to 50 people and a purely state-funded pilot for another 25 people. The pilot programs, which began as scheduled in January 2003, pay for assisted living services for seniors whose assets and income otherwise qualify them for the Connecticut Home Care Program for Elders (CHCPE).

Project Home Share

Project Home Share typically matches elderly homeowners having financial difficulty maintaining their homes with individuals seeking affordable housing. The program is active in the Hartford, New Haven, and New London areas. One person in each match must be at least 60 years old. The program is free for participants over 60 and younger participants’ costs are based on a sliding income-based scale. In exchange for opening his home, the elderly person may receive monetary compensation, services, or companionship. DSS funding provides partial support of program staff.

ENERGY ASSISTANCE

Home Heating Assistance

The state runs two programs, funded mainly by federal block grants and administered by DSS and local community action agencies, that help low-income households offset their winter heating bills. The Connecticut Energy Assistance Program (CEAP) is available to households with incomes up to 150% of the federal poverty level (FPL). In addition, households with incomes between 150% and 200% of the FPL can receive assistance under the program, provided at least one member of the household is age 60 or older or handicapped. Liquid assets cannot exceed $ 10,000 for homeowners and $ 7,000 for renters, unless the excess assets, when added to the household’s annual income, still leave the family within the income limits. CEAP-eligible homeowners may also be eligible for funding to provide emergency repair or replacement of unsafe or inoperable heating systems.

In addition, the state can run a Contingency Heating Assistance Program for households whose income is higher than the 200% of FPL but less than 60% of state median income. This program runs only if the state receives enough federal funding.

Weatherization

Households that are income eligible for CEAP may also qualify for the Weatherization Assistance Program, run through the community action agencies, that helps with weatherization. Priority may be given to low-income families with a young child or a disabled or elderly individual.

In addition, the Weatherization Residential Assistance Partnership (WRAP) helps low-income utility customers with high energy bills reduce their costs through several weatherization measures. WRAP is a partnership of DSS, local community action agencies, and utility companies.

NUTRITION

Elderly Nutrition

DSS is required by law to administer programs that provide nutritionally sound diets to needy elderly people. Programs must provide one meal per day, five days a week. These meals are either offered at congregate sites or delivered to homes for people too frail to come to the

congregate locations or to cook for themselves. There is no charge for the meals, although voluntary contributions are encouraged. Both federal and state funds are used to pay the program costs.

PROTECTION FROM ABUSE AND NEGLECT

Long-Term Care Ombudsman

Under the Connecticut Long-term Care Ombudsman program, a long-term care ombudsman’s office within DSS is responsible for representing the interests of nursing home residents and receiving health and human services complaints about the state’s nursing homes. One state and six regional ombudsmen carry out these duties.

Protective Services

Under the Protective Services for the Elderly Program, DSS staff investigates complaints of abuse, neglect, exploitation, or abandonment of elderly people age 60 and over living in the community. If it determines that an individual needs protective services, DSS provides them. If the investigation substantiates the abuse, the case is referred to the state’s attorney for investigation and possible prosecution. Services are provided without charge, but if the person is able to pay, DSS must initiate reimbursement procedures. Legislation in 2003 specifies that an elderly person’s refusal of treatment for religious reasons is not of itself grounds for implementing protective services.

Elder Abuse Reporters

Doctors, nurses, nursing home administrators, other health care personnel, and other professionals are required to report suspected cases of elder abuse to DSS. Legislation in 2003 shortens the time they have to report it from five days to three days and increases penalties for failure to report. It also requires DSS to refer substantiated abuse cases involving long-term care residents to prosecutors and authorizes legal remedies for anyone subjected to retaliation or discrimination for, in good faith, reporting elder abuse or complaining to DSS about care in a long-term care facility.

PROPERTY TAX RELIEF

Circuit Breaker

The “Circuit Breaker” Program entitles the elderly to a property tax reduction or a rent rebate, depending on whether they are homeowners or renters. To be eligible, the applicant must (1) be 65 years of age or older, have a spouse who is 65 or older, or be at least 50 years old and a surviving spouse of a person who at the time of his death was eligible for the program; (2) occupy the property as his home; and (3) have lived in Connecticut at least one year before applying for benefits. For applications filed in 2003, yearly income in 2002 cannot exceed $ 31,900 for married couples and $ 26,100 for singles.

Tax Freeze

The Tax Freeze Program fixes a participant’s property tax payment at a reduced level. No new participants have been allowed to enter the program since the Circuit Breaker program replaced it in 1973. The tax payment at the time was calculated by multiplying the property’s assessed value, minus $ 1,000, times the mill rate of the year in which the person first filed for and received benefits. Thereafter, the property tax was frozen, even if the mill rate rose or the assessed value of the home went up. Homeowners may not benefit from both Circuit Breaker and freeze programs.

TRANSPORTATION

Handicapped Access Program

The Handicapped Access Program provides transit districts the funds to meet the requirements of the Americans with Disabilities Act, which requires them to provide paratransit services to complement existing fixed route services as a condition for receiving federal capital and operating funds. Paratransit services include lift-equipped vans and other vehicles that can meet a disabled person’s transportation needs. They often take the form of “dial-a-ride” services, where the individual must order the transportation at least 24 hours ahead and often must pay a small fee such as $ 2 per one-way ride. Disabled elderly people are eligible for these services.

Some towns, senior centers, and other organizations also have dial-a-ride programs specifically for seniors.

EDUCATION

Elderly Tuition Waivers

By law, the state’s regional community and technical colleges must waive tuition for any state resident age 62 or older, if at the end of the regular registration period, enough other people are enrolled in the course for it to be offered and enough space is left to accommodate the senior citizens.

CASH ASSISTANCE

State Supplement Program (SSP)—Old Age Assistance

The SSP program, run by DSS, supplements cash assistance received under the federal Supplemental Security Income (SSI) program, although a person does not need to receive SSI to get SSP. The amount of state aid is based on the determination of total needs, using DSS standards. This amount is then compared to the individual’s income, and the difference (after deductions are taken) is the benefit.

Under the program, elderly, blind, or disabled people can receive state aid to help them live independently in the community or to pay for their room and board in a licensed boarding facility, such as a residential care home (RCH). RCHs (formerly known as “homes for the aged”) provide room and board, housekeeping, laundry, medication management, some personal care, and other services to seniors and younger disabled people who cannot live alone but do not need nursing home care. DSS bases the rates it pays to RCHs for SSP clients in part on the facility’s costs.

To be eligible for elderly benefits, an individual must be age 65 or over, and have monthly gross income of not more than $ 1,656 if living alone. Assets can be no greater than $ 1,600 for singles, and $ 2,400 for married couples.

MISCELLANEOUS

Retired Senior Volunteer Program (RSVP)

The RSVP program provides opportunities to people age 60 and over to volunteer in their communities. It operates 13 projects, 12 federal and one state, which cover most towns throughout the state. Most participants work in nonprofit agencies.

Breakthrough to the Aging

The Breakthrough to the Aging program recruits volunteers to provide services to elderly people. Services provided include telephone reassurance, shopping, banking, and friendly visits. The program also provides training, support, and supervision of volunteers to a cooperative network of agencies, home care personnel, and volunteer coordinators.

Area Agencies on Aging (AAAs)

The state has five AAAs, which are private, nonprofit elderly planning and service agencies that receive state and federal funds to carry out the federal Older Americans Act requirements. The AAAs must (1) represent elderly people within their geographic areas, (2) develop and administer an area plan, (3) coordinate and assist local public and nonprofit private agencies in developing programs, (4) receive and distribute federal and state funds for these purposes, and (5) perform additional federally required functions. The AAAs plan, coordinate, evaluate, and act as brokers for elderly services. They award funds to regional agencies, which in turn provide meals and related social services at local sites.

Municipal Agent for the Elderly

Each municipality must appoint a municipal agent for its elderly residents. The agent is responsible for disseminating information to seniors and assisting them in (1) learning about available community resources and (2) applying for federal and other benefits to which they may be entitled. The municipality’s chief elected official or chief executive officer appoints the agent to a two-year term; agents can be reappointed for additional terms. DSS trains the agents.

DECD Homeowners’ Emergency Repair Assistance for Seniors Program

DECD’s Homeowner's Emergency Repair Assistance for Seniors Program gives grants or low-interest loans to repair homes of low-income homeowners who are at least 62 years old.

Reverse Annuity Mortgages

The Reverse Annuity Mortgage (RAM) program, administered by CHFA, makes loans to lower-income elderly homeowners to help them pay for medical or long-term care needs such as home health care. DSS also accepts applications for the program. Unlike a regular mortgage, in a RAM, the loan is not repaid until the owner dies or the house is sold. The borrower receives monthly payments for five or 10 years. After that, interest continues to accrue at 7% a year. To be eligible, borrowers must be at least 70 years old, and their annual household income cannot exceed $ 72,500.

The program is currently not accepting new applications.

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