Home Care in Connecticut

Everyone hopes their elderly loved ones can remain at home as they age. That is true even when a great deal of care is needed to keep them safe at home. The cost of that care is the problem that families face. Connecticut has some of the strictest rules for eligibility for Medicaid and for the Connecticut Home Care Program for Elders, but the good news is that funding does exist to pay for significant home care, even around the clock care, if the one needing care and a spouse can meet the eligibility rules. The following is an outline of those rules.

The first program, which is solely paid for by Connecticut, is for those who need a modest amount of help. The state evaluates them for their care needs, and then assets and income. Care needs are evaluated by what is called Activities of Daily Living (ADLs) which are help with bathing, dressing, feeding, toileting and transferring (on/off a bed, toilet, etc.) or safety risks (falling, wandering, leaving the stove on). If a person cannot do three or more of those activities, or is an overall safety risk, then the physical eligibility requirement is met.

Financial eligibility for the state funded program is $41,220 for a single person and $54,460 for a couple. That does not include the person’s house, as long as the house is worth less than $955,000. So far no one in this neck of the woods has ever had a house ever close to that value, maybe Greenwich. Once eligibility is established, the person can get up to $2,973 per month. There is a 4.5% co-pay the applicant is required to pay, but for those who need a modest amount of care, and can qualify, it can make the difference in affording the care.

The second program is Medicaid, and the rules are stricter, but the funding is greater. The applicant cannot do three activities of daily living or is an overall safety risk and can only have $1,600 in assets with income below $2,523 per month. The healthy spouse, called the “community spouse,” cannot have more than $137,400 in “countable” assets. The quotation marks are to emphasize “countable,” because Medicaid does not count certain assets. So the process to become eligible is to “spend down” to the healthy spouse’s limit of $137,400 by making the assets not countable.

The spenddown can be paying down the mortgage on the house or making needed improvements. It could be buying prepaid funeral contracts for both spouses. Or buying a new car to replace that ancient car everybody loves. For most married couples that may get the healthy spouse below $137,400 limit. If assets are still greater, then the healthy spouse could buy what is called a Single Premium Immediate Annuity (SPIA), which is a non-countable asset, and the sick spouse is eligible. There is a giant potential downside, however, because the rules requires that the State of Connecticut be named as the beneficiary of the annuity if the healthy spouse dies with money still left in the annuity. These should only be done if there is no other option and with sound legal advice from someone who is not the seller of the annuity.

Medicaid in Connecticut can pay for 8 to 10 hours of care per day, and in some cases can pay for live-in care as long as the caregiver can get at least 5 hours of uninterrupted sleep each day. Get sound advice if home care is needed to avoid a nursing home, as it may very well be possible.