Connecticut Medicare assistance program options

The page provides information on financial assistance programs for Medicare coverage as well as information on how Medicaid may cover long-term care – a service not paid for by Medicare.

MSP asset limit: The asset limit for QMB, SLMB and ALMB is $9,230 for single beneficiaries and $14,600 for married beneficiaries.

Many QMB and SLMB enrollees also receive full Medicaid benefits or have a Medicaid spend-down, but ALMB enrollees cannot be enrolled in any other Medicaid program.

Medicaid ‘spend-down’ for regular Medicaid for the aged, blind and disabled and LTSS in Connecticut

In Connecticut, individuals with incomes too high to qualify for Medicaid ABD or Long Term Services and Supports (LTSS) programs can enroll in the Medicaid spend-down program.

Medicaid spend-down enrollees activate their coverage by submitting medical bills equal to their “excess income,” which is the amount their income exceeds the spend-down program’s income limit.

Connecticut will approve spend-down benefits in six month increments; additional coverage periods require new medical expenses to be submitted.

Enrollees must satisfy the same asset test as other Medicaid ABD enrollees.

Income eligibility: The income limit is the same as regular Medicaid ABD benefits – which varies by region.

• Southwestern Connecticut – the income limit is $984.49 a month if single and $1,507.09 a month if married.
• Northern, Eastern, and Western Connecticut – the income limit is $874.38 a month if single and $1398.41 a month if married.

Asset limits: The asset limit is $1,600 if single and $2,400 if married.

Here is more information on using the Medicaid spend-down in Connecticut. 

How does Connecticut regulate long-term services and supports (LTSS)?

Twenty percent of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015, and the percentage of enrollees who need those services is expected to keep increasing as the population ages. While Medicare beneficiaries increasingly need long-term care, Long Term Services and Supports (LTSS) are not typically covered by Medicare.

Medicaid fills the gap in Medicare coverage for long-term care, but its complex eligibility rules can make qualifying for benefits difficult. Additionally, eligibility rules vary significantly from state to state.

Medicaid nursing home coverage in Connecticut

Most seniors used to receive long-term care in nursing homes. Today, many enrollees receive LTSS in their homes. But some enrollees’ medical or living situations make nursing home care a better option.

Income limits: An applicant’s income must be less than the cost of nursing home care.

Nursing home enrollees can only keep a small portion of their income, including a personal needs allowance (of $60 each month) and money to pay for health insurance premiums (such as Medicare Part B and Medigap). Enrollees have to pay the remaining income toward their care.

When only one spouse needs nursing home benefits, the state may only count that spouse’s income toward the either the eligibility limit (equal to the cost of care), or what must be paid toward care.

Assets limits: The asset limit is $1,600 if single and $3,200 if married (and both spouses are applying). If only one spouse needs Medicaid, spousal impoverishment rules allow the other spouse to keep up to $128,640.

Note that some assets are never counted, including many household effects, family heirlooms, some prepaid burial arrangements, and one car.

Connecticut requires Medicaid nursing home enrollees to have less than $893,000 in home equity.

Home and Community Based Services (HCBS) waiver programs in Connecticut

Medicaid also covers community-based long-term care. Medicaid programs that pay for this care are called Home and Community Based Services (HCBS) waivers because recipients continue living in the community, rather than entering a nursing home.

In 2020, the income limit for Connecticut’s most commonly received Medicaid HCBS waiver – Connecticut Home Care Program for Elders (CHCPE) – is $2,349 a month. However, once enrolled, recipients have to pay nearly all their income above 200 percent of the federal poverty level – or $2,126.66 a month – toward their care. This payment is reduced by what an enrollee pays for Medicare premiums, health insurance (e.g. Medigap), private long-term care insurance, and medical co-pays.

The CHCPE program covers the following services:

• Care management services
• Adult day health services
• Companion services
• Home delivered meals
• Homemaker services

Income limits for HCBS waivers fall into three categories:

• Age 65 or older – with an income less than $2,349 a month per applicant (but above $1,472 a month, as described below). This benefit pays for up to about $5,800 of HCBS each month – which equals the cost of care in a nursing home.
• Age 65 or older – with an income less than $1,472 a month per applicant. This benefit pays for an unlimited amount of HCBS each month. Enrollees must be at risk for hospitalization or short term placement in a nursing home.
• Under age 65 – income below $2,349 a month. Connecticut also covers HCBS for enrollees under 65 if their incomes are less than $2,349 a month per applicant.

Asset limits: The asset limit is $1,600 if single and $3,200 if married in 2020.
Connecticut requires Medicaid HCBS recipients to have less than $893,000 in home equity.

The state also has two state-funded HCBS programs for individuals with higher incomes:

• Age 65 or older – income above $2,349 a month per applicant. This program provides home care benefits to very frail elders who meet a different asset limit ($38,592 if single and $51,456 if married).
• Under age 65 – income above $2,349 a month per applicant. This program provides home care services to disabled enrollees with higher incomes who have a disabling neurological condition and don’t already qualify for Medicaid. Recipients have to meet an asset limit ($38,592 if single and $51,456 if married).

More information about HCBS eligibility categories and income limits is located under “CHCPE – Connecticut Home Care Program for Elders” on this website.

Spousal impoverishment rules in Connecticut

Only the applying spouse’s income is factored into determining eligibility for Medicaid LTSS. (Normally with Medicaid benefits, the income of both spouses is counted – regardless of who is applying).

Spousal impoverishment rules allow spouses of Medicaid LTSS recipients to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s monthly income, along with resource and housing allowances. These rules apply when one spouse receives Medicaid coverage for long-term care, and the other spouse doesn’t have Medicaid.

In Connecticut, these “community spouses” are allowed to keep:

• An MMMNA that is between $2,155 and $3,216 per month.
• A Community Spouse Resource Allowance (CSRA) that is between $25,728 and $128,640.
• A housing allowance of $646.50 a month.

These amounts will change again after June 30, 2021.

Permitted home value in Connecticut

Federal law requires states to cap home equity value for Medicaid nursing home and HCBS enrollees. Applicants with more home equity than this are not eligible for Medicaid LTSS benefits. In 2020, states set their home equity limits based on a federal minimum of $595,000 and a maximum of $893,000.

Connecticut uses the highest limit on home equity allowed under federal law – meaning that applicants are not eligible for Medicaid LTSS benefits if their home equity is greater than $893,000.

Penalties for transferring assets in Connecticut

Because long-term care is expensive, individuals sometimes consider giving away or selling assets to a sympathetic party for an artificially low amount so they can become eligible for Medicaid LTSS benefits.

To counter this activity, states have a penalty period for Medicaid nursing home applicants who give away or transfer assets for less than their value; establishing this type of penalty is a federal law and in force in all states. States can choose to also have a penalty period for HCBS.

Connecticut has a 5-year Medicaid look-back period – for nursing home benefits and HCBS – during which time asset transfers and gifts are penalized. An applicant’s penalty period is calculated by dividing the amount given away or transferred for less than its value during this look-back period by the cost of nursing home care (which is $13,512 a month in Connecticut in 2020).

Estate recovery in Connecticut

A state’s Medicaid agency must attempt to recover what it paid for long-term care related costs beginning at age 55. States can choose to also recover the cost of all Medicaid benefits received by those enrollees. This is called estate recovery.

Prior to the ACA’s expansion of Medicaid benefits in 2014 to non-disabled adults under age 65, more states had estate recovery programs that recovered the cost of all Medicaid-covered services. This was seen as unfair to enrollees between 55 and 64 years old, because applicants in that age range with slightly higher incomes received subsidized exchange coverage – which is never recovered after an enrollee’s death. Connecticut is one of several Medicaid expansion states that changed their estate recovery rules to address this inequity.

Connecticut has chosen to only recover Medicaid’s payments for long-term care related services for enrollees who had Medicaid in 2014 or later. But the state recovers the cost of all Medicaid-covered services received before then.

Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery beginning with benefits paid after December 31, 2009. However, when an MSP recipient receives Medicaid LTSS, Connecticut will attempt to recover its spending on those services.

---

Josh Schultz has a strong background in federal health care programs. He coordinated a Medicare technical assistance contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked with hospital, insurer and technology clients.