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

SUMMARY

The state’s major programs serving the elderly are in the areas of health care, housing, energy, nutrition, property taxes, transportation, 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.

Consistent with federal changes resulting from the upcoming federal Medicare Part D prescription plan program (see below), seniors and disabled people covered by both Medicare and Medicaid (the “dually eligible”) will receive the bulk of their prescription drug coverage through Medicare starting January 2006. Medicaid will no longer cover drugs that could be paid for by the new Part D program, but it will continue to cover drugs that Part D does not (PA 05-280, §18).

Connecticut Home Care Program for Elders (CHCPE)

The CHCPE has both Medicaid- and state-funded components that pay for home- and community-based services for infirm elderly individuals who might otherwise require nursing home care. 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. Qualifying people in the higher income ranges must contribute to the cost of their care.

Financial eligibility differs for the two portions of the program. For the Medicaid-funded portion, the income limit is currently $ 1,737 a month for the individual who receives the services. Assets are limited to $ 1,600 per individual, $ 3,200 per couple if both receive services, and $ 20,620 per couple, or higher if the couple undergoes a “community spousal assessment” (CSPA ) if only one receives services. Under the state-funded portion, there is currently no specific income limit for people who would be Medicaid-eligible in a nursing home; asset limits are $ 19,020 for an individual and $ 28,530 for a couple, regardless of whether one or both are receiving services. These asset limits, respectively, represent 100% and 150% of the minimum CSPA amount of assets that a Medicaid-eligible nursing home resident's spouse living in the community can keep. Recent legislation will increase the asset limits for the state-funded side of the program starting April 1, 2007 to 150% and 200% (PA 05-280, § 9).

Elderly Personal Care Assistance Pilots Consolidation and Expansion

DSS administers a limited state-funded consumer-directed personal care assistance (PCA) pilot program that, since 2000, has allowed seniors to hire their own attendant instead of going through a home health care agency. In 2004 the commissioner, using her discretionary authority, raised the program’s 50-person cap to 100. The program is for 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.

This program will soon be replaced by a larger, less restrictive state-funded pilot. 2005 legislation increases, from 100 to 150, the number of people who may participate in the new pilot program, repeals the earlier more restricted pilot, and places people from that program into the new 150-person pilot program (PA 05-209).

PCA services are a “consumer-directed” alternative to nursing homes or home care through an agency. In such a program, the client chooses his own assistant to help him with personal care and activities of daily living. The client employs, trains, supervises, and may fire the attendant, but a financial intermediary takes care of the paperwork.

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 $ 21,400 if single, and $ 28,900 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.

CONNpace Coordination with Temporary Medicare Discount Card Program. 2004 legislation made various changes to coordinate the ConnPACE program with the first stage of a new federal prescription drug benefit for Medicare beneficiaries (seniors age 65 and over and younger disabled people). That first stage created federally-endorsed drug discount cards offered by private companies since June 2004, which provide enrollees with a 10% to 20% discount on their prescriptions and a $ 600 annual federal subsidy for low-income people. State ConnPACE law currently requires ConnPACE participants with incomes below 135% of FPL to obtain a discount card that DSS designates for use in conjunction with ConnPACE. The participant pays the lower of the discount card copay or the ConnPACE copay.

The federal discount card program will end in January 2006 when the program’s second stage, a more comprehensive federal Medicare Part D prescription drug program starts.

State Response to 2006 Federal Medicare Part D Prescription Plans. In 2005, the legislature has made a number of changes in ConnPACE and Medicare-Medicaid dually eligible prescription coverage in response to the upcoming permanent federal Medicare Part D prescription program. The state changes will affect participants in these programs once the federal program starts in January 2006.

Federal Part D allows Medicare beneficiaries to enroll in private prescription plans that must offer at least a specified “standard” benefit package. People with low incomes and assets and those eligible for both Medicare and Medicaid (the “dually eligible”) will receive extra federal help with deductibles, premiums, copays, and coverage. The plans only cover prescription drugs designated “Medicare Part D covered drugs” and, to some extent, they can choose which of these they will put on their formularies.

The state act requires ConnPACE participants to (1) enroll in a Part D plan (enrollment can begin in November but benefits start in January); (2) disclose their income and assets to the Department of Social Services (DSS) to determine their eligibility for the extra federal help; and (3) appoint the DSS commissioner as their authorized representative to enroll them in a plan if they do not choose one in time and represent them in Part D appeals.

It coordinates ConnPACE benefits with Part D so that participants do not pay more than ConnPACE’s $ 30 annual registration fee and $ 16. 25 per-prescription copayment for drugs that are (1) preferred drugs on their plan’s formulary or (2) not designated a Part D covered drug. ConnPACE participants may pay less than the $ 16. 25 copay if their federal copays are lower. But they may have to pay the difference between DSS’s payment and the price of a drug that is on the formulary but not a preferred drug. DSS generally will pay nothing for Part D covered drugs that are not on a plan’s formulary, but under a federal exception procedure, if the client or DSS appeals and wins, drugs not on the formulary could be treated and paid for as though they were on it.

DSS will pay ConnPACE participants’ Part D monthly premiums. It will cover drugs to the same extent as otherwise during the federal deductible period and the gap in the “standard” benefit. The standard benefit, after a $ 250 annual deductible, pays 75% of the drug costs up to $ 2,250 and then pays nothing (this is the gap) until total drug costs reach $ 5,100, after which it generally pays 95%.

Consistent with the federal law, dual eligibles will no longer receive Medicaid benefits for Part D covered drugs, even if they are not on the plan’s formulary. For drugs on a formulary, the federal Medicare copays for this group will be $ 1 to $ 5 depending on income and drug type. They will not have to pay premiums or deductibles and will not be subject to the coverage gap. Medicaid continues to cover their drugs that are not Part D covered drugs. Dually eligible nursing home residents will not have copays (PA 05-280, §18-29).

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 four people and does not accept new applicants.

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 on 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 those 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 Programs (RAP)

Low-income seniors could be eligible for rental assistance under one of two programs. DECD’s Elderly RAP provides “project-based” rental assistance to low-income seniors over age 62 or younger disabled people living in state-funded elderly housing projects. To qualify, seniors must spend more than 30% of their income on rent and utilities. The amount of assistance is the difference between 30% of their adjusted gross income, less a utility allowance, and the base rent. Alternatively, elderly people living in the community are eligible for certificates (vouchers) for assistance in private housing under DSS’s RAP program, which helps low-income families without age restriction.

Congregate Housing

This DECD program makes grants and loans to developers for special housing for low-and moderate-income, frail elderly, either new construction or rehabilitation of existing structures. DECD also provides an operating subsidy to offset the expense of congregate services for lower-income residents. A congregate housing complex contains separate living units for residents, but also provides some housekeeping, personal care, transportation, and at least one meal a day in a common dining room.

Currently, all state-assisted congregate housing can 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 offer the 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 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 low- and moderate-income seniors living in government subsidized elderly housing is being planned in four locations in the state (for a total of up to 300 units). The CHCPE program pays 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.

Of the four chosen locations, Herbert T. Clarke House in Glastonbury opened last September and The Retreat in Hartford opened in December. Luther Ridge in Middletown is scheduled to open this summer and Smith Street Assisted Living in Seymour in January 2006.

DECD has also created assisted living demonstration programs with state money in three federally funded elderly housing developments:

Tower 1/Tower East in New Haven, Immanuel House in Hartford, and Juniper Hill in Mansfield.

In addition, the state has operated two pilot programs since January 2003 that help pay for assisted living services (but not room and board) for people in private assisted living facilities who have used up their own resources. One pilot is funded through a Medicaid waiver, the other solely with state money. They have a combined cap of 75 participants. Through these programs, the state pays for assisted living services for seniors whose assets and income otherwise qualify them for the CHCPE if the facility where they live decides to participate in the pilots.

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.

The state can also 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 if it 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, 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 represents the interests of residents in nursing homes and residential care homes and helps them resolve complaints about these facilities. One state and six regional ombudsmen carry out these duties, assisted by over 100 volunteers.

The Ombudsman’s Office, as a result of 2004 legislation, has recently developed and begun implementing a pilot program to expand its services to provide assistance and education to residents in assisted living facilities. People in state-subsidized assisted living programs have priority for these services, but the Ombudsman’s Office will also provide them in private assisted living facilities to the extent that funding is available.

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 an individual needs protective services, DSS provides them. If the investigation confirms the abuse, the case is referred to the state’s attorney for investigation and possible prosecution.

Elder Abuse Reporters

Doctors, nurses, nursing home administrators, other health care personnel, and other professionals must report suspected elder abuse to DSS. They have to report it within three days and there are penalties for failure to report. DSS must refer substantiated abuse cases involving long-term care residents to prosecutors. There are 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. An applicant must (1) be 65 years of age or older, have a spouse who is 65 or older, or be at least 50 and a surviving spouse of someone 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 2005, yearly income in 2004 cannot exceed $ 33,000 for married couples and $ 27,100 for singles.

Tax Freeze

The Tax Freeze Program fixes a participant’s property tax payment at a reduced level. It was begun in 1967, but has not accepted new participants since 1979. The tax payment 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.

TRANSPORTATION

Handicapped Access Program/Dial-a-Ride

The Handicapped Access Program provides transit districts the funds to meet the mandates 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 person orders the transportation at least 24 hours ahead and often pays a small fee such as $ 2 per one-way ride.

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

Municipal Dial-A-Ride Grant Program

2005 legislation provides $ 5 million in both FY 06 and FY 07 for the municipal demand responsive (dial-a-ride) matching grant program for the disabled and those age 60 and older, which was established by the legislature in 1999 but never implemented for lack of funding. The program will allocate matching grants to municipalities based on a formula with two equal factors: the municipality's relative share of the state's elderly population and its size compared to the total area of the state. Municipalities must apply for the grants through a regional planning organization or transit district and must collaborate on service design to determine how to use the funding most effectively (SB 2000, §§ 37 & 39).

Seed Money for Community Based Regional Transportation Systems for the Elderly

2005 legislation requires DSS, as its budget permits, to provide $ 25,000 grants each in FY 06 to up to four towns with populations of at least 25,000 or to nonprofit organizations located in them. The grants are seed money for planning and developing financially self-sustaining, community-based regional transportation systems that, through a

combination of private donations and user fees, provide rides in passenger cars for seniors who can no longer drive. Before receiving the grant, the town or entity must show that it has secured at least $ 25,000 in matching private funds.

A grant recipient must, to the extent practicable, model its system on the “ITNAmerica” model. ITNAmerica is a national nonprofit organization engaged in planning to replicate in other locations a model first developed by the Independent Transportation Network (ITN) in the Portland, Maine, area. ITN obtains its operating funds through organization memberships; riders’ fares; and support from individuals, community businesses, and private foundations. It uses passenger automobiles and operates with a combination of volunteers who drive their own vehicles and paid drivers for vehicles ITN owns. There are no restrictions on the trip’s purpose (PA 05-280, §§ 54).

CASH ASSISTANCE

State Supplement Program (SSP)

The SSP program, run by DSS, supplements cash assistance received under the federal Supplemental Security Income (SSI) program. 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.

To be eligible for benefits, an individual must be age 65 or over, blind, or disabled, and have monthly gross income of not more than $ 1,737 if living alone. Assets can be no greater than $ 1,600 for singles, and $ 2,400 for married couples.

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 an RCH in part on the facility’s costs.

2005 legislation continues the long-standing freeze on cost-of-living increases for this program for FY 06 and FY 07, but it allows the pass-through of the annual federal SSI cost-of-living (COLA) increase by

raising the SSP unearned income disregard by the federal COLA. Previously, SSP payments were reduced by whatever SSI COLAs beneficiaries received (PA 05-243, PA 05-280).

MISCELLANEOUS

Elderly Tuition Waivers

By law, 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.

Retired Senior Volunteer Program (RSVP)

The RSVP program provides opportunities to people age 55 and over to volunteer in their communities. It operates 12 projects, 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 for a two-year renewable term. The agent is responsible for disseminating information to seniors and assisting them in (1) learning about available community resources and (2) applying for benefits to which they may be entitled. 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

CHFA’s Reverse Annuity Mortgage (RAM) program makes loans to lower-income elderly homeowners to help 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 $ 76,100.

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