You asked for (1) a description of the Connecticut Home Care Program for Elders (CHCPE), (2) how people apply for it, and (3) what the procedure is in the Department of Social Services’ (DSS) Alternate Care Unit and the access agencies involved in the program when people apply. You also asked what other activities the Alternate Care Unit performs.

SUMMARY

The CHCPE program has both Medicaid- and state-funded components that pay for home- and community-based services for infirm elderly individuals over age 65 who might otherwise require nursing home care. The program provides services such as in-home health care, care management, adult day care, adult foster care, homemaker services, transportation, meals-on-wheels, minor home modifications, and certain assisted living services. To apply, people can call a toll-free 800 number at DSS’s Alternate Care Unit, which administers the program, or if they are in a hospital or other health care facility, that entity can make the referral for them.

The unit determines financial eligibility, does a quick health screen, and then refers the applicant to an access agency. The access agency’s care manager performs a thorough assessment of the patient’s situation, provides information about the program, helps the patient fill out

required forms, and develops a care plan for the patient. If the patient agrees to the plan, the agency arranges for the services, monitors the provision of services, and modifies them as needed over time.

There are three access agencies in the state, which operate under contract with DSS: the South Central Area Agency for Aging and the Southwestern Area Agency for Aging, which cover their respective regions, and Connecticut Community Care, Inc. (CCCI) for the rest of the state.

In addition to its CHCPE functions, the 28-person Alternate Care Unit, located in DSS’s Medicaid Division, also:

1. administers a 150-person personal care assistance (PCA) program for seniors;

2. conducts program planning and policy development, including regarding assisted living services in certain state- or federally-funded senior housing and a private assisted living pilot and pays for such services through the state- or Medicaid-funded portions of the CHCPE for people who qualify;

3. performs certain initial mental illness and mental retardation preadmission screenings for nursing home entry; and

4. develops standards for adult day care center certifications together with that industry’s association.

CONNECTICUT HOME CARE PROGRAM FOR ELDERS (CHCPE)

Eligibility Requirements

Financial eligibility differs for the two portions of the CHCPE program. The income limit for the Medicaid waiver -funded portion is currently $ 1,737 a month for the individual who receives the services, which is adjusted for inflation every January. Assets are limited to $ 1,600 per individual, $ 3,200 per couple if both receive services (not adjusted annually), and $ 20,620 or higher for a couple that undergoes a federally authorized “community spousal assessment” (CSPA) when only one receives services (the CSPA amount is adjusted annually). There is currently no specific income limit under the state-funded portion 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 (adjusted annually). These asset limits, respectively, represent 100% and 150% of the minimum CSPA amount that a Medicaid-eligible nursing home resident's spouse living in the community can keep. Recent legislation will increase these limits for the state-funded side of the program starting April 1, 2007 to 150% and 200% of the minimum CSPA (PA 05-280, § 9). Higher income participants must contribute to the cost of their care. The state also can recoup funds from an individual's estate after he dies.

CHCPE Services

Depending on an individual’s health and living circumstances, a person may be offered home health, homemaker, visiting nurse, adult day center, adult foster care, and chore services; care management; home delivered meals; companion services; emergency response system; minor home modification depending on funds availability; and assisted living services in approved managed residential communities.

CHCPE Procedures

DSS Alternate Care Unit. To apply for the CHCPE, an individual or family member can call 1-800-445-5394 at the Alternate Care Unit to start the screening process. A hospital, a nursing facility, or a home health agency involved with an individual in the community may also make the referral for the patient and will give him a “Home Care Request Form”. That form provides information on the program’s income and asset limits to help people decide if they might qualify. The hospital or other facility staff can help them complete the form, or the Alternate Care Unit staff can help people who call the toll-free number do this.  

A nurse or social worker in the Alternate Care Unit’s Hartford office handles referral calls. The nurse or social worker first determines if the individual meets the program criteria. The criteria are: the person must be over 65 years of age and must meet the above financial eligibility requirements and certain functional requirements, such as being limited in certain activities of daily living. A person must undergo a quick “health screen” to determine if he functionally qualifies. The screen can be done by the hospital staff if the patient is in a hospital, or it can be arranged by the Alternate Care Unit staff. Once the unit receives or completes the health screen, its clinical staff will take a day or two to review it and will notify the applicant if he qualifies for an assessment by an access agency. Someone who is not already on Medicaid will have to complete an “Eligibility Determination Document/Application” (W1F Form). The access agency care manager doing the assessment will provide the form and inform the person how to complete it.

The Home Care Request Form is available at: http: //www. ct. gov/dss/LIB/dss/pdfs/w-1487. pdf. The Connecticut Home Care Program for Elders Brochure is available at:

http: //www. ct. gov/dss/lib/dss/PDFs/chcpe_052002. pdf

Access Agency Functions. Once the Alternate Care Unit completes the initial referral process (self-reported financials, self-reported functional status) it refers people who are potentially eligible for either the state-funded components of the program (Levels 1 & 2) or the Medicaid component (Level 3), to the access agency in the region in which the person lives. Access agencies are charged with serving three primary functions (coordination, assessment and monitoring, (CAM)) for the program. The access agency, according to Kate McEvoy, assistant director of the South Central Area Agency on Aging, assigns a care manager who:

1. makes a comprehensive, in-home assessment of the individual's health and functional status, support system, and needs for services and supports;

2. assists the applicant, as needed, with processing of the W1-F (Medicaid application);

3. confirms or makes an alternate recommendation concerning the level of care based on financial criteria and functional status;

4. in consultation with the client and caregivers, establishes a plan of care from the established service array and within cost caps established for the level; and

5. monitors the client and, as needed, modifies the plan of care over time.

The access agency does only the assessment and care management itself; it arranges with home health agencies and other entities to provide the direct services.

Two agencies on aging (South Central AAA for the south central region; Southwestern AAA for the south west region) have been serving as access agencies for the CHCPE since 1996. CCCI serves as access agency for the remaining regions of the state.

The CHCPE program has about 15,000 clients. The South Central Area Agency on Aging serves almost 3,500 clients; the Southwestern Area Agency on Aging serves about 1,500. Each agency employs both clinical (care management) and data processing and billing staff in support of the CHCPE contract. CCCI serves about 10,000 clients.

OTHER ALTERNATE CARE UNIT ACTIVITIES

The Alternate Care Unit has 28 staff. They are cross-trained to be generalists in all the programs the unit administers, according to the unit head, Michele Parsons. The unit also develops plans, policies, and procedures.

It administers a limited, state-funded, consumer-directed personal care assistance pilot program that allows up to 150 seniors to hire their own attendant instead of going through a home health care agency. PCA services are a “consumer-directed” alternative to nursing homes or home care through an agency. Clients must meet all financial and functional criteria for CHCPE. The client employs, trains, supervises, and may fire the attendant, but a financial intermediary takes care of the paperwork.

The unit also develops policy and procedures for assisted living services in (1) the state’s four newly built state-funded assisted living demonstration programs in the state, (2) the 16 state-funded elderly congregate housing complexes that offer assisted living, (3) four federal Housing and Urban Development elderly housing complexes that offer assisted living, and (4) the 75-person private assisted living pilot. It pays for such services through the CHCPE program for people who qualify for it. It also conducts preadmission screenings for mental retardation and mental illness for people entering nursing homes. Finally, it develops, together with the Connecticut Adult Day Care Association, standards for certifying adult day care centers and keeps a list of all the certified centers with which DSS has contracts to provide services to its clients.

HN: dw