You asked us to compare Connecticut’s eligibility rules for Medicaid long-term care nursing home services with those in Massachusetts. You believe that Connecticut’s rules are stricter. This report focuses on the Medicaid coverage group into which a nursing home resident would most likely fall.

SUMMARY

Eligibility criteria for Medicaid long-term care should not vary too much among the states since federal law generally governs this program. But Connecticut’s financial eligibility rules for Medicaid long-term care coverage differ slightly from Massachusetts’. This is because Connecticut is considered a “209(b)” state, which allows it to use more restrictive eligibility criteria for a certain group of applicants, while Massachusetts uses the same eligibility criteria as are used for the federal Supplemental Security Income (SSI) program, whose rules are more liberal.

So, for example, while the spouse of a nursing home resident can have the same amount of protected assets and income in both states, the spouse in the Massachusetts nursing home can keep a few hundred dollars more than he would be able to in Connecticut. And the monthly personal needs allowance (the amount of monthly income the individual in the nursing home may keep) amounts differ, albeit slightly. These amounts are set by federal and state law.

Allan Bryan of the federal Centers for Medicare and Medicaid Services (CMS) pointed to another, fairly significant difference, in how the spousal share of assets is calculated. This difference tended to benefit community spouses in Massachusetts, but, he notes, the state stopped using this method sometime within the last year or so.

Mark Shok of the Department of Social Services asserts that one of Connecticut’s rules regarding transfers of assets, specifically the transfer of annuity proceeds into trusts, tends to be more stringent than Massachusetts’ rule. Transfers of assets in some instances can affect when a person’s eligibility for Medicaid begins. Let us know if you would like more information on this topic.

MEDICAID LONG-TERM CARE ELIGIBILITY IN CONNECTICUT AND MASSACHUSETTS

Table 1 compares some of the major Medicaid long-term care financial eligibility elements in Connecticut and Massachusetts. These apply to married couples when one spouse is living in the community.

Table 1: Medicaid Eligibility in Connecticut and Massachusetts (2004)

[1]The actual limit could be higher if directed by an administrative hearing or court order.

TREATMENT OF ASSETS

To understand what was happening in Massachusetts, it is helpful to know some basics about how states are supposed to treat joint assets when someone is applying for long-term care Medicaid. When a married person is living in a nursing home and has a spouse living in the community, states are expected to combine their assets and divide them in half. One half is considered available to the spouse in the nursing home and the other half to the community spouse. But federal law limits what the community spouse can have, which the law calls the maximum community spouse protected amount (CSPA). This amount is adjusted upwards for inflation each year and is currently $ 92,760. States must also have a CSPA floor, which is currently $ 18,552. These amounts are the same in both Connecticut and Massachusetts.

Until recently, reports CMS’ Bryan, Massachusetts used an approach to determining the community spouse’s share of the combined resources that was more favorable for community spouses. It essentially looked at the couple’s assets and made them available to the community spouse until she reached the maximum. So, for example, if the couple had $ 90,000 in assets, the community spouse would be able to keep the full $ 90,000 and the institutionalized spouse’s Medicaid could start immediately, assuming all other eligibility criteria were met. In Connecticut, the community spouse would retain $ 45,000 and the rest, minus the $ 1,600 the spouse in the nursing home gets to keep, would be considered available to the spouse in the nursing home. That spouse would have to be spend those assets on care before Medicaid coverage would start.

The only time Connecticut would consider allowing part of the institutional spouse’s share to be added would be if the community spouse’s share fell below the floor ($ 18,552). So, for example, if the couple’s combined assets were $ 16,000, each spouse would be eligible for $ 8,000. But since this is below the floor, the state allows the full amount of the nursing home spouse’s assets to go to the community spouse and this money does not have to be spent on the nursing home care costs. Massachusetts is apparently now looking to the minimum CSPA first, similar to Connecticut, so the advantage no longer exists.

RC: ts