You asked (1) how many programs for seniors the state has implemented since 1985 and (2) for descriptions of these programs.

SUMMARY

We have identified 28 programs for seniors that the state has implemented since 1985. They include ConnPACE, the Connecticut Home Care Program for Elders, personal care assistance programs, several assisted living programs for moderate and low-income seniors, the Alzheimer's respite program, Elderly Rental Assistance Program, a municipal option elderly tax freeze program, several elderly transportation programs, the Connecticut Partnership for Long-Term Care insurance program, and a reverse mortgage program.

We identified programs where (1) age is one criterion for eligibility or (2) a large proportion of the clients are elderly. Some of them are means tested, several are federally funded, and some also serve younger people with disabilities.

HEALTH CARE

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

ConnPACE is a state-funded program that pays for prescription drugs for people age 65 and over and younger people with disabilities. In 1985, the legislature created ConnPACE within the Department on Aging as a 15-month pilot, beginning on April 1, 1986. The legislature made the program permanent in 1987. In 1993, it moved the program to its current location in the Department of Social Services (DSS). Over time, the program's income limits, copays, and other features have seen a number of changes.

Applicants' annual income currently must be under $ 22,300 if single, and $ 30,100 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 has over 48,000 enrollees.

As of January 1, 2006, with the implementation of the federal Medicare Part D prescription drug program, state law requires ConnPACE participants who are also eligible for Medicare to enroll in a Medicare Part D private plan. The law coordinates ConnPACE benefits with Part D so that participants do not pay more than ConnPACE's $ 30 annual registration fee and a $ 16. 25 per-prescription copayment for drugs on their plan's formulary. (They may pay less than the $ 16. 25 copay if their federal copays are lower. )

A plan can choose which Part D covered drugs to put on its formulary (“formulary drugs”) and does not generally have to pay for Part D drugs that are not on its formulary (“non-formulary” drugs). ConnPACE participants can use a federal appeals process to obtain coverage for their non-formulary drugs.

If a Part D plan denies the ConnPACE participant coverage for a nonformulary drug, 2006 state legislation requires DSS to pay for an initial 30-day supply of the drug, subject to the applicable copay, out of a special Medicare Part D Supplemental Needs fund the legislature created in 2005. Pending an appeals process outcome, DSS must continue to pay claims for the denied drug until the earlier of when the plan approves it or, in some situations, the end of the calendar year.

Prescription Coverage for Medicare-Medicaid Dually Eligible

Consistent with the new federal Medicare Part D prescription plan program, seniors and disabled people covered by both Medicare and Medicaid (the “dually eligible”) now receive the bulk of their prescription drug coverage through the private Part D plans in which federal and state law requires them to enroll. Medicaid previously covered this group's prescriptions, but it no longer covers drugs for which the new Part D program could pay (Part D covered drugs). Medicaid continues to cover prescriptions it previously paid for that are not covered by Part D.

The federal government provides extra help for dually eligible people to pay for formulary drugs, and the state pays the $ 1 to $ 5 federally required prescription co-pay for them. Patients can request coverage for nonformulary drugs from their plan through a federal appeals process.

The state's new Medicare Supplemental Needs Fund, which covers ConnPACE recipients' medically necessary, non-formulary drugs and the 2006 state legislation requiring DSS payments for nonformulary drugs, also applies to the Medicare-Medicaid dually eligible group.

Connecticut Home Care Program for Elders (CHCPE)

The CHCPE currently 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. The program now serves over 15,500 clients.

The CHCPE program is currently administered by the DSS, where the legislature placed it in 1993 as a result of the consolidation of the old departments of Aging, Human Resources, and Income Maintenance (DIM). Several precursor programs had already been consolidated under DIM in 1992 and were moved to DSS when it was created in 1993. (these were the Promotion of Independent Living Program run by the Department on Aging since 1985, Preadmission Screening and Community Based Services Program, run by DIM since the mid-1980s, and the Medicaid-funded Home Care Demonstration Project, which had received approval for a Medicaid home care waiver in 1987).

Financial eligibility differs for the two portions of the program. For the Medicaid-funded portion, the income limit is currently $ 1,809 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 $ 21,508 per couple, or higher if the couple undergoes a “community spousal assessment” (CSPA ) if only one receives services.

The state-funded portion has had no specific income limit since 2000 for people who would be Medicaid-eligible in a nursing home; asset limits are $ 19,908 for an individual and $ 29,862 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. 2005 legislation increases the asset limits for the state-funded side of the program to 150% and 200% starting April 1, 2007.

Nursing Facilities Transition Grant Program

This small program, begun in 2001 with federal grant funds and now funded by state money since the federal grants have expired, helps elderly and disabled people who are in nursing homes move out to live more independently in the community and helps them obtain needed support services to do so successfully. So far, the program has helped 130 people make the transition to community living.

State-Funded Elderly Personal Care Assistance Pilot

Since 2000, DSS has administered a state-funded “consumer-directed” personal care assistance (PCA) pilot program that allows seniors to hire their own attendant instead of going through a home health care agency. To be eligible, people must be age 65 or over and meet CHCPE's functional and financial qualifications. The program has been expanded several times, and 2006 legislation increased the maximum number of participants from 150 to 250.

PCA services are an alternative to nursing homes or home care services provided through an agency. In such a program, the client chooses his own assistant to help 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.

Expansion of Medicaid PCA Waiver for the Disabled to Include People Age 65 and Over

2006 legislation removed the upper age limit in the state's Medicaid PCA waiver program for disabled people aged 18 to 64 (the legislature originally authorized this waiver in 1995 and this program has been operational since 1998 after receiving federal approval for the waiver). This recent change allows (1) participants to continue in the program after turning age 65 and (2) new applicants age 65 or over to enter the program if they qualify for the Medicaid waiver. Previously, people who “aged out” of this program could continue their PCA services only by applying for the purely state-funded pilot PCA program for people age 65 and older.

Removing the age cap also applies to working disabled people currently receiving PCA services because they are participating in the Medicaid for Employed Disabled “buy in” program.

Medicaid for Employed Disabled (MED) Program Age Change

2006 legislation also lets DSS allow older, working individuals participate in the MED “buy-in” program. Previously, the program, (originally authorized by legislation in 2000), limited eligibility to adults under age 65. The MED program provides affordable health care coverage to working people (including those working part-time) with severe disabilities. (Medicare pays for most of these individuals' health care; Medicaid generally covers everything else. )

Alzheimer's Respite Program

The Connecticut Statewide Respite Care Program, established in 1998, 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. DSS runs the program in partnership with the Area Agencies on Aging (AAAs). Alzheimer's patients are eligible for this program if they have annual incomes under $ 30,000 and assets under $ 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.

Alzheimer's Drug Settlement Program

In FY 06, the state devoted some funds it received from a 2005 settlement with drug companies to two programs: the Mulberry Gardens Project and the New England Cognitive Center's Brain G. Y. M. M. Program.

The Mulberry Gardens Project uses a multifaceted approach to care for people with Alzheimer's by offering adult day care with flexible hours, short term respite, a senior fitness program, a geriatric assessment and resource center, and educational programming and support groups for their families In FY 06, 126 individuals received direct services.

The New England Cognitive Center's Brain G. Y. M. M. Program uses a two-tiered non-pharmaceutical approach to addressing the needs of people with Alzheimer's disease. It evaluated two primary interventions--computer exercises i that target specific areas of cognition and hands-on cognitive training in a small group or workshop environment-- to determine whether the program could maintain cognitive functioning levels in these individuals. In FY 06, 1,046 individuals participated in one-on-one cognitive workout sessions, and 144 group training sessions were held.

Connecticut Medicare Assignment Program

The Connecticut Medicare Assignment Program (ConnMAP), begun in 1987 in the Department on Aging and now run by DSS, prohibits medical providers from “balance billing” enrollees for charges above Medicare's “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. ) ConnMAP's income limits 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.

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 two people and does not accept new applicants.

The legislature created the program in 1993 in the Department on Aging, but then moved to DSS later that year.

National Family Caregiver Act Program

The National Family Caregiver Support Act, passed by Congress in 2000 as an amendment (Title IIIe) to the federal Older Americans Act (OAA), gives grants to states to provide information and referral, training, counseling, respite care, and other supportive services to (1) people caring at home for chronically ill, frail, elderly relatives or relatives with mental retardation or other developmental disabilities and (2) grandparents and other relatives caring for children at home. Although the funding for this program is entirely federal it is distributed through the states. The states must provide the services through their area agencies on aging.

States must give priority to services to older people with the greatest social and economic need (with particular attention to low-income older people) and to older people who are taking care of relatives with mental retardation or other related developmental disabilities.

The DSS Bureau of Aging, Community, and Social Work Services' Aging Services Division allocates the money to the five area agencies on aging (AAAs) in the state through the existing OAA spending process and distribution formulas. AAAs or their contractors provide the services, which include caregiver counseling, help in accessing services, respite services, limited supplemental services not available through other programs, and information and referral services. Each AAA must coordinate its activities with community agencies and voluntary organizations providing similar services.

Health Insurance Counseling – CHOICES Program

DSS and the AAAs, assisted by the nonprofit Center for Medicare Advocacy, 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. ( CHOICES stands for Connecticut's programs for Health insurance assistance, Outreach, Information and referral, Counseling and Eligibility Screening). In 2005 and 2006, this year they have also provided individual counseling for Medicare beneficiaries trying to choose a Medicare Part D prescription plan.

A precursor of the CHOICES program (then called the Health Insurance Counseling and Assistance Project) was begun in 1992 by the Department on Aging with the Center for Medicare Advocacy. When the departments were consolidated in 1993 theprogram was moved to DSS and renamed CHOICES. . 2001 legislation specified that the program must be a comprehensive Medicare advocacy program that not only provides information and advice for Medicare beneficiaries, but also legal representation where appropriate in the appeals process (the Center for Medicare Advocacy's Medicare Legal and Educational Assistance Project was already doing this in practice).

HOUSING PROGRAMS

Rental Assistance Programs (RAP)

Low-income seniors could be eligible for rental assistance under one of two programs. The Department of Economic and Community Development's (DECD) 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.

RAP began in 1985 when the legislature enacted a two-year rent subsidy pilot program for lowincome families living in privately owned rental units. It made the program permanent in 1987 and broadened it to include elderly people living in state-assisted elderly rental housing and AFDC recipients. In 1993 administration was transferred from the then-Department of Housing to DSS. A 1997 law transferred administration of the elderly portion of RAP from DSS to DECD.

Assisted Living in Congregate Housing

In 2000, the legislature authorized all 24 state-assisted congregate housing projects to offer more extensive “assisted living” services and permitted CHCPE to pay for these service for those who qualify financially. Fifteen elderly congregate housing projects currently offer the services. 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.

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.

State Moderate-Income Assisted Living Demonstration Program

In 1998, the legislature authorized a pilot assisted living demonstration program for low- and moderate-income seniors living in up to 300 units of government subsidized elderly housing f in several locations DSS chose throughout the state. CHCPE pays for the services for those who qualify financially. The law permits a combination of subsidized and unsubsidized units in the same facility and allows DECD to set the rental subsidy for the pilot at any percentage of the annual aggregate family income and define income and eligibility for these subsidies. DSS, DECD, and the Connecticut Housing Finance Authority (CHFA) are cooperating on the project. Of the four locations ultimately chosen, three are currently open: Herbert T. Clarke House in Glastonbury, The Retreat in Hartford, and Luther Ridge in Middletown. Smith Street Assisted Living in Seymour is scheduled to open in October 2006.

State Assisted Living Demonstration in HUD-funded Elderly Housing

As a result of 2001 legislation, 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.

Private Assisted Living Pilot

The state has operated two pilot programs since January 2003 (authorized by legislation in 2002) 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.

DECD Homeowners' Emergency Repair Assistance for Seniors Program

DECD's Homeowner's Emergency Repair Assistance for Seniors Program, begun in 1987, gives grants or low-interest loans to repair homes owned by low-income people who are at least 62 years old. The Community Renewal Team in Hartford has administered the program since 1999.

Reverse Annuity Mortgages

CHFA's Reverse Annuity Mortgage (RAM) program, first authorized by legislation in 1993, makes loans to lower-income elderly homeowners to help pay for medical or long-term care needs. Eligible costs include those associated with hospitals, nursing homes, residential care homes, in-home care, adult day care, durable medical equipment, medically needed home alterations, long-term care insurance premiums, and uninsured recurring or catastrophic medical and prescription drug expenses. 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 $ 77,100. DSS also engages in outreach and provides the public with information on the program.

LONG-TERM CARE OMBUDSMAN PROGRAM EXPANDED TO ASSISTED LIVING

As a result of 2004 legislation, the Long-Term Care Ombudsman's Office, 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.

The Ombudsman's Office, which is in 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.

PROPERTY TAX RELIEF

New Municipal Option Seniors Property Tax Freeze

2006 legislation allows towns to freeze property taxes on homes owned by people age 70 or older who have lived in the state at least one year. The freeze can also apply to a surviving spouse who is at least age 62 when the homeowner dies. Homeowners must meet the income limits for the long-standing “circuit breaker” program, which gives elderly homeowners a credit against their property taxes. Those income limits are currently $ 27,700 for individuals and $ 33,900 for married couples and are adjusted annually for inflation. People whose taxes are frozen can also qualify for other property tax relief programs.

Unlike the circuit breaker program, the act does not provide state reimbursement for revenue a town loses by freezing taxes, but it allows the town to put a lien for the amount of the foregone taxes on the property and to set asset limits for eligibility.

TRANSPORTATION

Handicapped Access Program/ADA Paratransit/Dial-a-Ride

The Handicapped Access/ADA Paratransit Program provides transit districts the funds to meet the mandates of the federal Americans with Disabilities Act of 1990 (ADA). The ADA requires every entity receiving public funds for fixed-route bus transit to offer equivalent services to ADA-eligible people.

Most providers meet their ADA requirement through door-to-door services. 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 per ride. Services are limited to those who cannot ride buses or get to bus stops, but seniors can qualify if they meet ATA certification rules.

The Handicapped Access Program was first funded by the state in FY 1988.

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 allocates 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.

The Department of Transportation approved a total of 66 programs in March 2006 based on its request for proposals (133 towns applied but a number of them collaborated with other towns). The first funds were distributed in July 2006.

Community Based Regional Transportation Systems for the Elderly Programs

2005 legislation requires DSS to provide grants to up to four towns with 25,000 or more people or to nonprofit organizations located in them to plan and develop 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 secure at least $ 25,000 in matching private funds. 2006 legislation increases the maximum grant for each recipient from a one-time $ 25,000 in FY 06 to $ 50,000 during the two-year period covering FY 06 and FY 07.

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.

MISCELLANEOUS

Long-Term Care Partnership Insurance Program

The Connecticut Partnership for Long-Term Care is a public/private initiative under which the state approves special long-term care insurance policies sold by private companies. The policies must meet certain state standards. People who buy them can later qualify for Medicaid and still keep assets equal to the amount the policy has paid for their care. Only Partnership-approved policies have this feature, called Medicaid asset protection.

The legislature created the Partnership as a pilot program in 1989. The program began in 1992 after receiving federal approval. State legislation in 1994 made it permanent. Around 40,000 policies have been purchased since 1992.

Grandparents as Parents

Begun in 1998, a statewide network of local grandparents as parents support (GAPS) programs has been established as a result of a private foundation grant to DSS. Network members provide advocacy, support, respite, and other services. They are now funded through a mix of local, private, and some state funds.

Kinship Navigator Program

2006 legislation requires the Department of Children and Families (DCF), in consultation with other agencies, to establish, within available appropriations, a kinship navigator program to help people caring for their relatives' children find services. The program must ensure that grandparents and other relative caregivers get information on the array of state services and benefits for which they may qualify, including the subsidized guardianship program. It also assumes DCF's role to tell relative caregivers how they can become foster parents. The new program's information must be available through 2-1-1 Infoline, a general state-wide information hotline that provides information on all types of programs not just elderly programs.

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