THE CONNECTICUT HOMECARE PROGRAM FOR ELDERS (CHCPE) & THE NEW ONLINE REFERRAL PROCESS

Transcription

1 THE CONNECTICUT HOMECARE PROGRAM FOR ELDERS (CHCPE) & THE NEW ONLINE REFERRAL PROCESS Presented by: SWCAA June 5, 2013

2 YOUR PRESENTERS: Mary Donnelly, Director of Care Management and the CT Homecare program Bill Schempp, Operations Manager for the CT Homecare Program Facilitator: Christina Crain, Director of Programs

3 WHAT WE WILL COVER All categories of CT Home Care Program Eligibility criteria Service Options How to make a referral What happens after the referral

4 WHAT IS CHCPE? Connecticut s home and community based services program for CT s frail seniors who are institutionalized or at risk of institutional placement. Funded by both Medicaid and state dollars applicants must have functional limitations as well as meet financial guidelines Administered by CT Dept. of Social Services through contracts with access agencies who assess the needs of participants and coordinate and manage the care provided.

5 CT S HOME CARE PROGRAM DSS Department of Social Services responsible for the Medicaid Waiver and State funded parameters ACU Alternate Care Unit- Division of DSS that oversees CHCPE Access Agency SWCAA (Southwestern CT Area Agency on Aging) administers CHCPE in the Southwestern Region

6 MEDICAID WAIVERS. WHAT ARE THEY? Medicaid waivers called 1915(c) waivers are Medicaid funded service packages that allow to individuals who meet a skilled nursing home level of care to receive services in the community as opposed a nursing home. CT has seven 1915 (c) waivers approved by CMS each serving specific groups of individuals. Medicaid waivers permit states to receive federal matching funds.

7 THE SEVEN MEDICAID WAIVERS IN CT CT Homecare Program for Elders (CHCPE) - for those aged 65 or older Personal Care Assistance Waiver (PCA)- for those age * Acquired Brain Injury Waiver (ABI)- for those 18 and older with acquired brain injury * WISE waiver- for people with chronic mental illness (through DMHAS) Developmental Disabilities- two waivers * Katie Beckett Waiver (for children under 18) * * These waivers have extensive waiting lists

8 FINANCIAL ELIGIBILITY FOR THE 1915 (C) MEDICAID WAIVERS Income: Max. income for waivers: $2,130 / month (based on applicant s income) Assets: $1,600 Exemptions apply including primary residence, vehicle needed for transportation.

9 CHCPE IS A MANDATORY MEDICAID WAIVER PROGRAM What does this mean? Individual must be willing to complete a Medicaid application and disclose financial information If individual is eligible for Medicaid, they must apply. If person is found eligible for Medicaid, they can only get services through Category 3 or 5. State has a right to recoup monies that they paid for the individual s care

10 CT HOMECARE PROGRAM S CATEGORIES Category One state funded Category Two- state funded Category Three Medicaid waiver (1915) (c) Category Four- CT Homecare Program for Disabled (under 65) Category Five 1915(i) waiver

11 FUNCTIONAL ELIGIBILITY Based on Activities of Daily Living (ADL) Activities crucial to live independently and safely Bathing, dressing, toileting, meal preparation, eating/feeding, medication management, and ability to transfer At least one ADL is required to qualify for CHCPE (Critical needs) Instrumental Activities of Daily Living (IADL) Activities related to being able to live independently Not considered crucial to your health Housework, shopping, laundry, financial management, ability to use the phone and ability to travel from home

12 CATEGORY ONE (STATE FUNDED) Limited Home Care for Moderately Frail Elders Functional Eligibility At risk for hospitalization or short term rehab (STR) One or two critical needs Financial Eligibility Individual Income =No Limit Assets: Individual=$34,776 Married Couple= $46,368 Client pays 7% of the cost of care provided Applied income also applies for individuals with incomes above 200% of the Federal Poverty Level ( which is $1,915/ month in 2013) Level of Services provided: less than 25% of cost of nursing home care.

13 CATEGORY TWO (STATE FUNDED) Intermediate home care for very frail elders Must have minimum of 3 critical needs Financial Eligibility: same as Category 1 Cost Share of 7% applies Applied income for higher income folks also may apply Level of services provided: less than 50% of cost of nursing home care

14 EXAMPLE OF A STATE FUNDED CLIENT Mrs. Smith needs help with bathing, meal prep and medication management. Her gross income is $2300 per month Care plan is skilled nursing 2x/ month = $188 Meals on wheels 7 x/ week = $270 Home Health Aide 1.5 hours 3/ week = $ 473 Care management = $150 In Kind (child ) shopping, financial mgt, transport Total monthly care = $1,081 7% Monthly Cost share = $ Applied income = $385 - $ (Part B) = $ (minus any medical expenses) Total monthly cost to client = $355.77

15 CATEGORY 3 (MEDICAID WAIVER) Extensive homecare for very frail elders who meet nursing home level of care. 3 or more critical needs ( ADLs) Financial Eligibility: Medicaid eligible Income of $2,130 /individual Liquid assets of $1,600 for individual $3,200 for couple if both are on the program Community spouse protected assets rules apply for couples with one spouse on the program No cost sharing on part of client Level of services provided: up to 100% of nursing home cost

16 SPECIAL NEEDS OR POOL TRUSTS Individuals with incomes above the Medicaid waiver amounts may do a special needs trust to meet income eligibility for waiver. Special Needs trust allow disabled and aged individuals to transfer income or assets into these trusts and remain eligible for Medicaid. Trust must be administered by a non-profit organization PLAN of CT is the only 503 organization that provides this service in the state of CT. For more information visit

17 QUESTIONS? We will pause here for questions, please type in your question if you have not already done so and the facilitator will address them one at a time.

18 COVERED SERVICES UNDER CHCPE Adult day care Home health aide Homemaker/Chore Companion Care management Meals on wheels Emergency response system ( Lifeline) Personal Care Attendant (PCA) Skilled Nursing visits Some home modifications Respite Mental health counseling

19 CATEGORY 4- CT HOME CARE PROGRAM FOR DISABLED State funded pilot Enrollment capacity is 50 however fewer than that are being served due to budget constraints. There is a wait list Eligibility criteria: Must be between years of age Diagnosis of degenerative neurological condition such as MS, Alzheimer s, Parkinson s, Huntington s, ALS, Pick s disease. Must require assistance w/ 3 or more critical needs. Primary dx cannot be mental illness or developmentally disabled

20 CATEGORY (I) MEDICAID WAIVER At risk of hospitalization or short term nursing home placement, need assistance with only one or two critical needs. Must be on Medicaid Financial Eligibility: Individuals with incomes up to 150% of FPL ( $1,436.25/ month) Liquid Assets: $1,600 No cost share

21 ANYONE CAN MAKE A REFERRAL Necessary Information you will need to have DOB Social Security Number Income Assets (to the best of your knowledge) Title 19 Yes/No-Insurance Information Basic Health Information Call Alternate Care Unit at or Press option #4 New online referral process through Ascend

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24 WHAT HAPPENS AFTER YOU MAKE REFERRAL? Someone will contact the referral source to verify information submitted on referral. Once information is verbally verified, referral is sent to appropriate access agency. At SWCAA it will then be assigned to the appropriate team. Contact is made within 24 hours Client/ caregiver is sent list of necessary documents to gather for care manager s initial visit.

25 Home visit to complete assessment is made by care manager After in home assessment, paperwork submitted to Alternate Care Unit verifying appropriate financial and functional level of care. Care Manager determines whether client is appropriate for state funded or waiver services and Medicaid app is submitted accordingly- To DSS for Medicaid To ACU for state funded

26 HOW SOON CAN SERVICES BEGIN? If client is already on Medicaid, services can begin the day after the assessment. Exceptions: Client is in a spend down or Client requires a 5 year look back by DSS If client is not Medicaid eligible The W-1F is submitted with the assessment to ACU by the care manager Determination is made by ACU on financial eligibility and functional recommendation by care manager for client to be deemed eligible for state funded services.

27 CASE EXAMPLE #1 Shirley is an 88 year old woman, lives alone in senior housing. Resident Service Coordinator notices Shirley is looking thinner these days, comes downstairs dressed inappropriately for the weather. Has become more forgetful in last 6 months forgetting to pay the rent on several occasions. Shirley has Medicaid. She sometimes goes to the senior center and eats lunch at their congregate meal site. Could Shirley benefit from the CT Homecare Program?

28 CASE EXAMPLE #2 Fred and Linda live in their own home and their neighbors called the Town Social Services Dept. expressing concerns about this couple. The Social worker made a homevisit to meet with Fred and Linda. Linda was confused, repeating herself throughout the interview. Fred seemed completely exhausted and overwhelmed in trying to care for his wife. The home was in need of cleaning, there was little food in the house and a strong urine odor was coming from Linda. Her hair appeared to need washing. Fred said he gets no help and does the best he can to take care of his wife. Combined they get $3,000 / month in social security and a small pension. Should SW make a referral to CHCPE?

29 THINGS TO REMEMBER. Anyone is entitled to an assessment There is no charge for the initial assessment. The individual being referred has a right to say no to services You shouldn't t hesitate to make a referral, but please make sure you have discussed this with the individual you are referring or with their primary caregiver.

30 HOW TO CONTACT US Call us at: us at: Mary Donnelly Bill Schempp Chris Crain Visit us at Eligibility criteria is on our website

31 UPCOMING WEBINARS June 20 th - DMEPOS, the durable medical equipment and diabetic mail order competitive bid program begins on Fairfield County on July 1 st. Join us to learn what this means for Medicare beneficiaries. July 17 th - CT Connect, the new online service offered by the CT Dept. of Social Services to help streamline eligibility and benefits for DSS programs. July 30 th - CT Partnership for Long Term Care, what you need to know about paying for long term care and the Partnership. August 14 th - Access Health CT, Connecticut s Health Insurance Exchange, helping CT s uninsured obtain affordable health insurance.

32 MEDICAID WORKSHOPS Medicaid September 10, a.m. to 12 p.m. at SWCAA 10 Middle Street, Bridgeport Registration flyer will follow in August Thank you for attending our webinar on the CT Homecare Program. We hope you found this Webinar informative.

33 Q & A Please remember you have to type in your questions in the chat box. If you wish, you can any of the presenters directly after this webinar to get any questions answered.