September 10, 1999
STATE ELDERLY PROGRAMS
By: Helga Niesz, Principal Analyst
You asked for a brief description of state programs for the elderly.
The state's major elderly programs cover the areas of health care, housing, energy, nutrition, property taxes, transportation, education, and cash assistance. Some of these programs are means tested. Several are funded, in part, with federal money.
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.
Connecticut Home Care Program for Elders (CHCPE)
The CHCPE uses both Medicaid and non-Medicaid funds to pay for home- and community-based services for low-income infirm elderly individuals who might otherwise require nursing home care. The state-funded portion of the program is limited by available appropriations so people are accepted on a first-come, first-served basis, and must pay a fee, based on their financial ability. An income and assets test is applied here as well. The income limit is currently $1,500 a month for the individual who receives the services. Asset limits differ depending on whether the person is eligible for the Medicaid-funded portion ($1,600 per individual, $3,200 per couple if both receive services, and $17,992 per couple if only one receives services) or the state-funded portion ($16,392 for an individual and $24,588 for a couple, regardless of whether one or both are receiving services). Services include case management, adult day health services, foster care, homemaker services, transportation, and meals-on-wheels. An “access” agency determines the most appropriate services package for each participant. The Medicaid-funded part of the program covers the poorest people with the most extensive homecare needs. The state-funded portion covers people with slightly higher assets and somewhat lesser needs.
1999 legislation established a small pilot program that lets a limited number of program recipients continue to receive homecare services if their income rises slightly above the limits.
Connecticut Pharmaceutical Assistance Program for 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 $14,500, if single, and $17,500 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 $25 registration fee and a $12 co-payment for each prescription. Certain prescriptions are not covered, such as antihistamines and diet pills.
Elderly Health Screening
DSS funds elderly health screening services in northwestern Connecticut and Bridgeport. Laboratory services, including electrocardiograms; glaucoma and blood pressure testing; pap, pelvic, breast, and rectal cancer examinations; and other health screening procedures are performed. The program also provides health education, transportation, and referral information.
Another DSS program supports health screening services for the elderly residents of the Bella Vista Housing Project in New Haven. Services include screening tests, nursing visits, health education, and follow-up monitoring visits. Twenty-four hour emergency coverage is also available.
Day Care—Alzheimer's Disease
DSS funds an adult day care program for victims of Alzheimer's disease. Approximately 29 adult day care centers participate.
Alzheimer's Respite Care 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. The program is run by DSS in partnership with the Alzheimer's Association of Connecticut and the area agencies on aging. 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. As of July 1, 1999, participants can use up to 30 days in out-of-home services, instead of the prior 21 days. And there will no longer be any limit on the use of adult day care services, other than the overall limit of $3,500 in services per year.
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. Participants are not subject to income limits but must contribute towards the program's costs according to a sliding fee scale.
Health Insurance Counseling – CHOICES Program
The Department of Social Services and the Area Agencies on Aging jointly run the CHOICES program, which provides senior citizens with health insurance information and counseling, as well as information on Medicare and Medicare managed care plans. The CHOICES health insurance hotline is 1-800-994-9422.
Low-income seniors receiving Medicare may also be eligible for the federal-state Qualified Medicare Beneficiaries (QMB) program, which uses Medicaid funds to pay Medicare premiums, deductibles, and coinsurance for people with incomes at or below the poverty level and minimal liquid assets. For people with slightly higher incomes, the Specified Low-Income Medicare Beneficiary program pays the Medicare Part B premium.
Both state and federal 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 Program (RAP)
RAP provides rental assistance to low-income families and residents of state-funded elderly housing projects. The elderly participants must be paying more than 30% of their income in rent and utilities in order to qualify. The amount of assistance is the difference between 30% of their adjusted gross income, less a utility allowance, and the base rent. A 1997 law transferred administration of the elderly portion of RAP from DSS to the Department of Economic and Community Development (DECD).
This DECD program provides grants and loans to developers for creating special housing for low-and moderate-income, frail elderly. Developments may be new construction or rehabilitation of existing structures. The department also provides an operating subsidy to offset the expense of congregate services provided to lower-income residents. A congregate housing complex contains separate living units for residents, but also provides some housekeeping, personal care, and transportation services and usually at least one meal a day in a common dining room. A recent pilot program provides more extensive “assisted living services” for the frail elderly in the congregate housing facility in Norwich. 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 or her congregate apartment and “age in place” rather than having to move to a nursing home.
Assisted Living Pilot Program
A pilot assisted living program for seniors living in government subsidized elderly housing is being planned. The original 1998 legislation would have established it in three municipalities and for up to 300 units. But changes this year allow the program to be located in more than three municipalities, permit a combination of subsidized and unsubsidized units in the same facility, and give 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 in a way that is consistent with the demonstration project. DSS, DECD, and CHFA are cooperating on the project and Medicaid funds will be used to pay for the assisted living services for low-income frail elderly who qualify. The request for proposals was issued this summer.
Project Home Share
Project Home Share typically matches elderly homeowners having financial difficulty maintaining their homes with individuals seeking affordable housing. 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. State funding provides partial support of program staff.
Home Heating Assistance
The state runs two programs that help low-income households offset their winter heating bills. The Connecticut Energy Assistance Program 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 State Appropriated Fuel Assistance 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.
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 delivered to homes or offered at congregate sites. There is no charge for the meals, although contributions are encouraged. Both federal and state funds are used to pay the program costs.
PROTECTION FROM ABUSE AND NEGLECT
A long-term care ombudsman's office within DSS is responsible for representing the interests of nursing home residents and receiving health and human services complaints about the state's nursing homes. One state and six regional ombudsmen carry out these duties.
Under this program, DSS staff investigates complaints of abuse, neglect, exploitation, or abandonment of elderly people age 60 and over living in the community. If it determines that an individual needs protective services, DSS provides them. If the investigation substantiates the abuse, the case is referred to the state's attorney for investigation and possible prosecution. Services are provided without charge, but if the person is able to pay, DSS must initiate reimbursement procedures.
Retired Senior Volunteer Program (RSVP)
The RSVP program provides opportunities to people age 60 and over to volunteer in their communities. It presently operates 13 projects, 12 federal and one state, which cover most towns throughout the state. Most participants work in nonprofit agencies.
PROPERTY TAX RELIEF
The Circuit Breaker program entitles elderly homeowners and renters to a property tax reduction or a rent rebate. To be eligible, the applicant must (1) be 65 years of age or older, have a spouse who is 65 or older, or be at least 50 years old and a surviving spouse of a person 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 1999, yearly income in 1998 cannot exceed $28,900 for married couples, and $23, 600 for singles.
The tax freeze program fixes a participant's property tax payment at a reduced level. No new participants have been allowed to enter the program since the Circuit Breaker program replaced it in 1973. The tax payment at the time 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. Homeowners may not benefit from both Circuit Breaker and freeze programs.
Handicapped Access Program
The Handicapped Access Program provides transit districts the funds to meet the requirements 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 need. They often take the form of “dial-a-ride” services, where the individual must order the transportation at least 24 hours ahead and often must pay a small fee such as $2 per one-way ride. Elderly persons who meet the criteria are also eligible for these services.
Municipal Elderly Transportation Grants
1999 legislation generally authorized state grants directly to municipalities to be used for elderly and disabled demand transportation, such as dial-a-ride. But the budget did not provide funding for this program.
Elderly Tuition Waivers
By law, the state's regional community and technical colleges must waive tuition payment 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.
State Supplement Program (SSP)—Old Age Assistance
The SSP program supplements assistance received under the federal Supplemental Security Income (SSI) program, although a person does not need to receive SSI to get SSP. The amount of aid is based on a 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, an individual must be age 65 or over, and have monthly gross income of not more than $1,500, if living alone. Assets can be no greater than $1,600 for singles, and $2,400 for married couples.
Breakthrough to the Aging
Through a contract with the Capital Region Conference of Churches, the Breakthrough to the Aging program recruits volunteers to provide services to elderly people within the 29-town capital region area. 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 (AAA)
The state is divided into five elderly planning and service areas to carry out the provisions of the federal Older Americans Act of 1965. The agencies 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 the development of programs, (4) receive and distribute federal and state funds for these purposes, and (5) carry out any additional duties and functions required by federal law. The AAAs plan, coordinate, evaluate, and act as a broker 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 who is responsible for disseminating information to them and assisting them in (1) learning about available community resources and (2) applying for federal and other benefits to which they may be entitled. The municipality's chief elected official or chief executive officer appoints the agent to a two-year term; agents can be reappointed for additional terms. DSS trains the agents.
Reverse Annuity Mortgages)
The Reverse Annuity Mortgage (RAM) program, administered by the Connecticut Housing Finance Authority, makes loans to lower-income-elderly homeowners to help them pay for long-term care needs such as home health care. The Department of Social Services 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 $52,000. The maximum loan amount is the lesser of $207,000 or 70% of the home's appraised value.