You asked about the (1) differences between the two components of the Connecticut Home Care Program for Elders (CHCPE) and (2) number of providers who serve participants under both components.

SUMMARY

The CHCPE program has both Medicaid waiver- 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 components differ in the income and asset limits that determine clients' eligibility and the level of services they fund. Currently 9,170 participate in the Medicaid side of the program; 4,603 people are state-funded.

CHCPE operates under a three-tiered service structure that provides a range of home and community-based services, depending on the applicant's condition. Two tiers are state-funded; the third is Medicaid-funded. They cover services such as in-home health care (e. g. , visiting nurses), care management, adult day and foster care, homemaker services, transportation, meals-on-wheels, minor home modifications, and certain assisted living services.

The Department of Social Services (DSS) contracts with three access agencies to provide these services. These agencies evaluate clients' functionality, establish a service plan for each client, and contract with other agencies to provide needed services. The access agencies currently contract with 374 service providers (some providers contract with more than one access agency, so this count may be inflated).

All providers serve clients regardless of the funding source. DSS sets the maximum allowable rates for each type of service; providers are paid the same rate for a service regardless of the funding source.

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 $ 1,869 a month (federal law sets the limit at 300% of the Supplemental Security Income benefit). It is adjusted for inflation every January. Only the applicant's income is counted; spousal income is not considered. The state-funded portion has no income limit. Higher income participants must contribute to the cost of their care.

Participants in the Medicaid portion can have no more than $ 1,600 in assets for a single person, $ 3,200 per couple if both receive services, and $ 21,928 when just one spouse receives services (a couple that undergoes a federally authorized “community spousal assessment” (CSPA) when only one receives services can retain more assets). Under the state-funded component, an individual can keep assets of $ 30,492, and a couple can keep $ 40,656, regardless of whether one or both are receiving services. (Both the CSPA and the asset caps for state-funded participants are adjusted annually. )

CHCPE Services and Providers

Service Determination and Funding Source

DSS and the three access agencies with which it contracts assess CHCPE clients' functional level. Clients fall into one of three categories, which determine the source of funding for their services.

1. Category 1 provides limited, state-funded care for moderately frail people who are at risk of hospitalization or short-term nursing home placement. Per-client expenditures must be less than 25% of what nursing home care would cost.

2. Category 2 provides state-funded services for people who would otherwise need short- or long-term nursing home care. Per client expenditures for these clients must be less than 50% of the nursing home cost.

3. Category 3 uses Medicaid funds to pay for people who would otherwise be in a nursing home where Medicaid would pay for their care. Care costs cannot exceed 100% of the nursing home cost.

Medicaid also pays for the home health services (i. e. , nursing care) of a person functionally eligible for category 1 or 2 who qualifies for Medicaid while state funds would pay for any unskilled services (e. g. , day care).

Based on its assessment, the access agency establishes a service plan for each individual. The services may include skilled home health care; homemaker, adult day or foster care, and chore services; care management; home delivered meals; companion services; emergency response system; minor home modification (depending on funds availability); and certain assisted living services.

Service Providers

The access agencies contract with various agencies to provide direct CHCPE services. Home health agencies are the only providers of skilled services, such as nursing and physical therapy, and some also provide unskilled “waiver” services. Other agencies, such as companion- homemaker and adult day care centers, provide only unskilled services. DSS sets the maximum allowable rates these providers may charge for each service. The rate is the same regardless of whether the agency is paid from the state or Medicaid part of the program.

(Home health agencies also provide services to other Medicaid clients, for example people not in CHCPE and those discharged from hospitals. The crux of the current budget question appears to be whether PA 07-1, June Special Session, increased the rate for these services. )

DSS provided the number of agencies with which the three access agencies currently contract for services. Connecticut Community Care contracts with 196 providers, 56 home health agencies, and 140 others providing unskilled care. The SouthCentral Area Agency on Aging contracts with 117 providers, 44 home health agencies and 73 others. The Southwestern Area Agency on Aging contracts with 61 providers, 22 home health agencies and 39 others. As providers may serve more than one access agency, these numbers may be inflated.

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