HOME & COMMUNITY BASED SERVICES AND THE MEDICAID WAIVERS IN CONNECTICUT

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1 HOME & COMMUNITY BASED SERVICES AND THE MEDICAID WAIVERS IN CONNECTICUT Presented by: Christina Crain, Director of Programs, SWCAA In Partnership with The Aging & Disability Resource Center Collaborative August 2011

2 WHY NOW?? ONE WORD REBALANCING LTC Expenditures are climbing at an unsustainable rate growth. LTC Medicaid Expenditures in CT are about $2.5 billion/ year. This makes up 13% of overall state budget Over 50 % of entire DSS budget

3 HCBS VS. INSTITUTIONAL CARE In 2009 CT spent more Medicaid $$ on institutional care vs. HCBS. Percent of Medicaid LTC Dollars Out of total $2.5 Billion Institution 65% HCBS 35% HCBS Institution

4 REBALANCING THE MEDICAID LTC SYSTEM MEANS changing the focus and funding priorities to home and community based services. Why?? It s more cost effective Consistent w/ the Olmstead Act which states people have a right to choose and receive care in the least restrictive and most appropriate environment. Honor s the individual s right to choice Consistent w/ National trends

5 WHAT WE WILL COVER The Medicaid Waivers Money Follows the Person State funded Programs Veteran s Programs Working together to do more with less

6 MEDICAID WAIVERS. WHAT ARE THEY? Medicaid waivers called 1915(c) waivers Medicaid funds that allow to individuals who meet a skilled nursing home level of care to receive services in the community as opposed to the alternative of 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 and allow for enrollment caps to sustain budget neutrality.

7 THE MEDICAID WAIVERS 1915(C) 1. CT Homecare Program for Elders (CHCPE) (Category 3) 2. Personal Care Attendant (PCA) 3. Acquired Brain Injury (ABI) 4. WISE Program 5. Dept. of Developmental Disabilities Comprehensive 6. DDS Individual Family Support 7. Katie Beckett

8 FINANCIAL ELIGIBILITY FOR ANY OF THE 1915 (C) MEDICAID WAIVERS Income: Must be at or below 300% of SSI amount of $674 (2011 SSI benefit) Max. income for waivers: $2,022 / month (based on applicant s income) Assets: $1,600 Exemptions apply including primary residence, vehicle needed for transportation.

9 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 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 organization that provides this service in the state of CT. For more information visit

10 CT HOMECARE PROGRAM FOR ELDERS MEDICAID WAIVER Eligibility Age 65 or older Must meet nursing home level of care and need assistance with at least 3 critical needs. (bathing, dressing, eating/feeding, toileting, transferring, meal prep, medication admin.) Individual Income cannot exceed $2,022 /month Individual Liquid Asset Limit of $1,600 Individuals over the income or asset guidelines may do a Pool trust to qualify. Individuals w/ income over $1,816/ month pay an applied income towards their care.

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

12 SERVICE DELIVERY OPTIONS UNDER CHCPE Agency based Self-Directed Enrollment capacity: currently over 9,000 on program statewide. No waiting list. To apply: Contact DSS Alternate Care Unit at choose option #4 Must know client s basic information including name, age, DOB, income and assets

13 PERSONAL CARE ASSISTANCE (PCA) WAIVER Eligibility: Age 18 and older Chronic, severe, permanent disability that results in needing assistance w/ at least two activities of daily living (bathing, dressing, eating, transferring, toileting) Those w/ mental illness, dementia or mental retardation do not qualify on these basis Individual must be willing and able to self-direct their care Must meet Medicaid waivers income and asset criteria Can use special needs trust to qualify financially if income is in excess of allowable amounts.

14 COVERED SERVICES & SERVICE DELIVERY OPTIONS Covered Services: Personal Care Attendant (PCA) Emergency Response System Service Delivery Options: Self-Direct only PCA must be 18 or older Cannot be spouse of client OR Conservator of client OR Related to the Conservator *Each PCA cannot work more than hours / week. PCA

15 CURRENT CAPACITY AND HOW TO APPLY Enrollment Capacity is Current Enrollment is Over 100 people on the waiting list To apply for wait list you can download an application from: PCA

16 ACQUIRED BRAIN INJURY WAIVER (ABI) Eligibility Criteria: Age 18 or older Must have an acquired brain injury (developmental and degenerative diseases do not apply) Must meet nursing home, chronic disease hospital or ICF level of care. Individual Income of $2,022/ month Liquid Assets of $1,600 Special Needs Trust can be used to qualify Must be able to self-direct or have someone who can direct your care ( conservator or family member) ABI

17 COVERED SERVICES & SERVICE DELIVERY OPTIONS: Covered Services include: Case management Personal care assistance Homemaker, chore, companion Home-delivered meals Respite care Vocational supports & supported employment Home or vehicle modifications Specialized medical equipment/ supplies Emergency response system Service Delivery: Self Direct w/ caregiver over age of 18 Cannot be spouse of client Cannot be parent of client who is under 21 years of age Cannot be Conservator or related to Conservator ABI

18 ENROLLMENT CAPACITY & HOW TO APPLY Enrollment capacity is slots Current enrollment is consumers Current waitlist exceeds 60 individuals Pays up to a % of average monthly SNF cost Up to 60% of cost for those w/ at least 2 ADL Up to 80% of cost for those w/ at least 3 ADL To apply for waitlist please download application at: estform.pdf ABI

19 WISE PROGRAM (WORKING FOR INTEGRATION, SUPPORT &EMPOWERMENT ) Eligibility Criteria Age 22 or older Reside in a nursing home Participate in Money follows the Person Have had : Two or more inpatient psychiatric hospitalizations within two years prior to applying A single inpatient psych hospitalization within 30 days of applying or Three crisis episodes within the year prior to applying WISE

20 WISE PROGRAM ELIGIBILITY CONTINUED Must also meet two of these additional criteria Must require prescription medication Be unable to work full time Require supervision & support Be homeless or at risk of homelessness Have had or be likely to have an acute episode Must not currently require inpatient care and Must need one-on-one psychiatric rehab and support coordination WISE

21 COVERED SERVICES INCLUDE: Assertive Community Treatment Community Support Program Peer Support Recovery Assistant Short-term Crisis Stabilization Supported Employment Transitional Case Management Non-Medical transportation Specialized medical equipment Home accessibility modifications WISE

22 WISE PROGRAM Administered by the Dept. of Mental Health & Addiction Services (DMHAS) Cost cap for service cannot exceed cost the state would have otherwise paid for that consumer s nursing home care To apply contact DHMAS at Visit:

23 COMPREHENSIVE SUPPORT WAIVER (DDS) For individuals who live in community living arrangements, community training homes and managed residential communities. Eligibility: Age 18 and older Individual must have been diagnosed w/ mental retardation or Prader-Willi Syndrome Individual must also have an ICF/MR level of care and show need for at least one of waiver services

24 COVERED SERVICES : Licensed residential services (community training homes, assisted living) Residential and family supports (supported living, personal support, adult companion, respite, personal ERS, home and vehicle mods) Vocational and Day services (supported employment, group day activities) Specialized and Support services ( behavioral and nutrition consultation, specialized equipment and supplies, interpreters, transportation, family consultation & support)

25 DDS INDIVIDUAL & FAMILY SUPPORT WAIVER For individuals who live in their own or family homes. Eligibility criteria same as Comprehensive waiver Covered Services are the same as Comprehensive waiver

26 ENROLLMENT CAPACITY & HOW TO APPLY Currently about 4,450 clients on Comprehensive program Approximately 3,300 on IFS program Approximately 630 currently on residential wait list (this includes applicants for both DDS waivers) To apply please call DDS Eligibility Unit at (866)

27 KATIE BECKETT WAIVER enables severely disabled children and adults to be cared for at home and be eligible for Medicaid based on the individual s income and assets alone. Without the waiver, the income of legally liable relatives is counted when the individual is cared for at home. Covered Services: Case management Home Health Care Services Care plan services cannot exceed the average monthly Medicaid nursing facility cost.

28 CURRENT ENROLLMENT, CAPACITY: Enrollment capacity : 180 slots Current Enrollment : 180 individuals Waitlist status: 400 individuals on wait list To apply contact DSS: or (860)

29 MONEY FOLLOWS THE PERSON ( MFP) Started as a $56 million federal demonstration grant in 2007 from The Centers for Medicare & Medicaid Services to the State of Connecticut It is now a $400 million project with a goal of transitioning 5200 individuals over next 5 years. Systems change project aimed at rebalancing the long term care system.

30 5 MAJOR GOALS OF MFP Increase dollars spent on home & community based services Increase the number of people living in community Increase hospital discharges to the community Increase probability of returning to community Transition people from institutions to community

31 ELIGIBILITY CRITERIA FOR MFP Individual must be in a Long-Term Care facility for a minimum of three months. Must be on or eligible for Medicaid Must have the desire to transition back to the community

32 HOW TO APPLY : To make a referral to MFP call Anyone can make a referral

33 STATE FUNDED PROGRAMS CT HOME CARE PROGRAM FOR ELDERS (state funded levels 1 & 2) CT HOMECARE PROGRAM FOR DISABLED CT STATEWIDE RESPITE CARE PROGRAM NATIONAL FAMILY CAREGIVER SUPPORT VETERANS AID & ATTENDANCE

34 CHCPE STATE FUNDED LEVELS Currently no waitlist for services Current Enrollment of 5,342 individuals Eligibility Criteria: Age 65 or older Level 1: must be at risk of hospitalization or short term nursing facility placement and evidence of one or two critical needs Level 2: must be in need of short or long-term SNF placement and evidence of three or more critical needs

35 CHCPE STATE FUNDED FINANCIAL ELIGIBILITY No income limits, however those w/ income greater than 200% of FPL have applied income obligations. Asset limits of $32,868 / individual or $43,824/ couple Services available: Same as in CHCPE Medicaid waiver Services can be through agency, self directed, PCA or other options where available including 1. Residents of state funded congregate housing 2. Residents of assisted living pilot projects 3. Up to a statewide total of 75 residents of private managed residential communities who spend down to program eligibility limits and require assisted living services.

36 COST CAPS & COST SHARING: Level 1 can pay no more than $1,398 / month Level 2 can pay no more than $2,796 / month Individuals in state funded levels 1 or 2 must pay a 7% cost share towards the cost of services received. There is no hardship exclusions to the cost share. For those w/ income over 200% of FPL applied cost share applies in addition to the 7% cost share.

37 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. Must have made 4 or more errors on MSQ Primary dx cannot be mental illness or mental retardation

38 RESPITE PROGRAMS CT Statewide Alzheimer s Respite Program National Family Caregiver Program

39 STATEWIDE ALZHEIMER S RESPITE PROGRAM State funded program to provide short term respite to family caregivers caring for a loved one with Alzheimer s or related dementia. Eligibility Criteria: No age restrictions Individual must have a diagnosis of: Alzheimer s, multi-infarct dementia, Parkinsons with dementia, Lewy Body dementia, Huntington s Disease, normal pressure hydrocephalus or Pick s disease. Individual annual income of $41,000 or less Liquid Assets of $109,000 ( Individual)

40 SERVICES OFFERED: Services can be either through and agency or selfdirected. Covered services include: Adult Day Care Home care services, ( HHA, Homemaker, companion) Skilled Nursing visit Short term in-patient respite Meals on Wheels Cost Cap: Total grant may not exceed $3,500 / year 20% co-pay required towards cost of services received. Hardship waivers are available

41 NATIONAL FAMILY CAREGIVER PROGRAM Federally funded through Title III E of Older Americans Act Provides services to: Family members caring for relatives aged 60 and older Family members caring for someone between as long as caregiver is NOT the parent. Grandparents or older relatives caring for children age 18 or younger

42 SERVICES OFFERED: Respite Care to provide caregivers a temporary break from their care giving. Adult Day Care, In home services Meals on Wheels Short term In-patient Respite Supplemental Services: items or services designed to help the caregiver care for their family member. Personal Emergency Response Medical or assistive tech equipment

43 HOW TO APPLY FOR EITHER PROGRAM: Programs are administered regionally by the Area Agencies on Aging. Call CHOICES at Visit for an application In Southwestern CT contact: Katie Regan, Respite Care Manager SWCAA 10 Middle Street Bridgeport, CT

44 VETERANS AID & ATTENDANCE PENSION Provides benefits for veterans and surviving spouses who require the regular attendance of another person to assist in activities of daily living. Can provide up to $1,644 / month to Veteran Up to $1,056 per month to surviving spouse Up to $1,949 per month for a couple Asset limits are: $50,000 (individual) $90,000 ( couple)

45 HOW TO APPLY FOR VETERANS A & A: Contact the CT Dept. of Veteran s Affairs at (860) Visit: to see what documents you need, down load application and get more information.

46 VETERANS DIRECTED HOME & COMMUNITY BASED SERVICES PROGRAM This program empowers qualifying veterans to hire their own workers, (personal care attendants) to help them with their daily needs. Assessment and assistance is provided by a Care Manager from SWCAA. VA determines eligibility based on level of need.

47 VETERANS DIRECTED HOME & COMMUNITY BASED SERVICES PROGRAM Provides veterans of all ages the opportunity to receive services in their home and avoid nursing home placement. Self directed and consumer driven For more information or to apply call: The Veteran s Administration Medical Center in West Haven, CT ext. 2140

48 WHERE SHOULD CT GO FROM HERE? Create a 1915 (i) Universal waiver Eliminating the silos and creating a Universal waiver to serve all individuals regardless of disability and age. Maintain state funding for programs that help keep individuals at home and prevent pre-mature SNF placement. (CHCPE, CHCPD, CSRP) Build capacity in HCBS need to have a strong workforce that can meet the demand and needs of these individuals that choose to receive their LTC in the community.

49 WHERE ARE WE ACTUALLY GOING? Older Americans Act funding could face major cuts under the new Debt Ceiling Deal Reductions in the amount of federal funding for community service programs for the elderly including cuts in home care, meals on wheels, medical transportation, Low-income heating assistance. If Medicaid cuts come to fruition, HCBS waivers are vulnerable to cuts in funding and enrollment caps. If all this happens we will actually reverse the national efforts of rebalancing.

50 HOW DO WE SURVIVE THIS STORM & MORE IMPORTANTLY. how do we continue to assist our clients and the rapidly increasing population of elders and persons w/ disabilities in these challenging times?

51 SOUTHWESTERN CT S AGING & DISABILITY RESOURCE CENTER Building partnerships with the disability community with our Municipal Agents Community service agencies and providers Hospitals State Agencies

52 GOALS OF THE ADRC Strengthen Information and Referral Provide Options Counseling Streamlined Eligibility for Public Programs Person-Centered Transitions Consumer Populations, Partnerships and Stakeholder Involvement Quality Assurance

53 HOW TO CONTACT US Call us at Visit us at Become a fan of SWCAA on Facebook To join the mailing list for alerts and upcoming trainings me at: ccrain@swcaa.org