February 3, 2005
STATE ELDERLY PROGRAMS
By: Helga Niesz, Principal Analyst
You asked for a brief description of state programs for the elderly.
The state's major programs that serve the elderly are in the areas of health care, housing, energy, nutrition, property taxes, transportation, education, 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.
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 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) 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.
2000 state legislation removed the set income limits for both parts of the program and, instead, lets people receive CHCPE services if they would otherwise qualify for Medicaid in a nursing home. But the change took effect only in the state-funded portion, because federal approval is still needed for it to apply to the Medicaid-funded portion. A state-funded pilot for up to 10 people with incomes slightly higher than the Medicaid limits continues until this federal approval is obtained.
Elderly Personal Care Assistance Pilots
Limited 50-Person Pilot Expanded to 100 in 2004. DSS also administers a limited state-funded consumer-directed personal care assistance (PCA) pilot program that initially allowed up to 50 seniors to hire their own attendant instead of going through a home health care agency for services. The law permits the DSS commissioner to increase this number to 100 if it is cost effective. In 2004 the commissioner took this step to raise the cap on participants to 100. The program is available to 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.
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 personal care 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.
New 100-Person Pilot Legislation. 2004 legislation, in addition, requires the DSS commissioner to establish and operate a state-funded pilot program, within available appropriations, until June 30, 2006 for up to 100 eligible seniors to receive such PCA services as an alternative to regular home health services agencies in order to avoid institutionalization. Under the legislation, the commissioner must also apply for a federal waiver to include the pilot in the Medicaid portion of the CHCPE. To qualify for the pilot, seniors must be age 65 or over and meet the CHCPE eligibility requirements. The act permits recipients' relatives, other than spouses, to act as PCAs in this pilot (PA 04-258). This pilot is not yet operational and there may be changes in it during the 2005 session of the General Assembly.
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. There are no asset limits and no recovery of payments from the estate when participants die.
ConnPACE Coordination with New Medicare Discount Card Program. 2004 legislation made various changes to coordinate the ConnPACE program with a new federal law that establishes a voluntary federal prescription drug benefit for Medicare beneficiaries (seniors age 65 and over and younger disabled people) in two stages: (1) federally-endorsed drug discount cards offered by private companies starting in June 2004 and (2) a more comprehensive Medicare prescription drug program starting in January 2006. People who enroll in the discount
card program may receive a 10% to 25% discount on their prescription drugs. Low-income people also receive a $600 annual federal subsidy as a credit on the card. To qualify for the credit, people must have incomes under $12,569 for one person and $16,862. These income limits apply for both 2004 and 2005, the second year of the discount card program.
The state legislation requires ConnPACE participants with incomes below 135% of FPL to obtain a discount card designated by DSS for use in conjunction with ConnPACE. For this group, the legislation combines ConnPACE benefits with the discount card benefits (which require copays of only 5% or 10% of the discounted price until the participant's $600 credit is exhausted). The participant pays the lower of the discount card copay or the ConnPACE copay. DSS gives eligible recipients an opportunity to select a designated card, but if they do not select a card within a reasonable time, DSS chooses a card for them (PA 04-6 and PA 04-101). ConnPACE participants with higher incomes are currently not required to apply for the federal drug discount cards and their ConnPACE benefits are not affected.
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 receiving 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 people 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.
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. Elderly RAP, administered by DECD, provides “project-based” rental assistance to residents of state-funded elderly housing projects who are low-income seniors over age 62 or younger disabled people. To qualify, seniors must be spending 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 RAP certificates (vouchers) for rental assistance in private housing under DSS's RAP program (which helps low-income families without any age restrictions).
This DECD program provides grants and loans to developers for special housing for low-and moderate-income, frail elderly. Developers may build new construction or rehabilitate existing structures. DECD 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.
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 have chosen to do so and are currently offering the new 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 will pay 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. The locations chosen are The Retreat in Hartford, Herbert T. Clarke House in Glastonbury, Luther Ridge in Middletown, and Smith Street Assisted Living in Seymour. Herbert T. Clarke House opened last September and The Retreat opened in December. Luther Ridge is scheduled to open in July 2005 and Smith Street is scheduled for January 2006.
State law also authorizes the DECD commissioner to establish assisted living demonstration programs in up to four federally funded elderly housing developments. Three are already operational:
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 living in private assisted living facilities who have used up their own resources. The pilots consist of a Medicaid waiver pilot for up to 50 people and a purely state-funded pilot for another 25 people. The state pays for assisted living services for seniors whose assets and income otherwise qualify them for the CHCPE if the private assisted living facility where they live decides to participate in the pilots. 2004 legislation sets a combined cap of 75 people for the two pilots instead of the separate limits to provide more flexibility in program eligibility (PA 04-258).
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.
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.
In addition, the state can 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. This program runs only if the state receives enough federal funding.
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, local community action agencies, and utility companies.
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 is responsible for representing the interests of residents in nursing homes and residential care homes and helping them resolve complaints about these facilities. One state and six regional ombudsmen carry out these duties, assisted by over 100 volunteers.
2004 legislation requires the ombudsman's office to develop and implement a pilot program, within available appropriations, to provide assistance and education to residents in certain assisted living facilities. The act specifies that the office must provide assistance and education to residents (1) who are temporarily in a hospital or long-term care facility and return to the facility, (2) who have issues relating to an admissions contract, and (3) to assure adequate and appropriate services are being provided, including services for cognitive impairments. The act gives priority for these services to people in state-subsidized assisted living programs, but allows the ombudsman to also provide these services in private assisted living facilities to the extent that funding is available (PA 04-158). The program is not yet operating.
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 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.
Elder Abuse Reporters
Doctors, nurses, nursing home administrators, other health care personnel, and other professionals are required to report suspected cases of 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
The “Circuit Breaker” Program entitles the elderly to a property tax reduction or a rent rebate, depending on whether they are homeowners or renters. 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 2005, yearly income in 2004 cannot exceed $33,000 for married couples and $27,100 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/Dial-a-Ride
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 needs. They often take the form of “dial-a-ride” services, where the individual must order the transportation at least 24 hours ahead and often pay 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.
Elderly Tuition Waivers
By law, the state's 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.
State Supplement Program (SSP)—Old Age Assistance
The SSP program, run by DSS, supplements cash 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 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.
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.
To be eligible for elderly benefits, an individual must be age 65 or over, 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.
Retired Senior Volunteer Program (RSVP)
The RSVP program provides opportunities to people age 60 and over to volunteer in their communities. It operates 13 projects, 12 federal and one state, 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. The agent is responsible for disseminating information to seniors 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.
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
The Reverse Annuity Mortgage (RAM) program, administered by CHFA, makes loans to lower-income elderly homeowners to help them 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.