Long-Term Services and Supports - LTSS

FAQs

• Am I eligible for LTSS home and community based services, including what is generally known as 'homecare' services?
  Answer: - If you are 65 and older, or less than 65 with a disability, please contact the Community Options Unit regarding the CT Homecare Program for Elders (CHCPE) at 860-424-4904. Follow this link for more information on the CHCPE - (Insert Link). The HCBS division handles four waivers at this time: CHCPE, ABI II, PCA, and Katie Beckett.  Click here for more information on these Waiver programs (Insert Link).
  -For all other Waiver programs not covered by the Community Options Unit, you should make contact with the Department of Developmental Services  or the Department of Mental Health & Addiction Services.
  -Intake for our Social Work Division is currently closed.
• Can I report changes online?
  Answer: Yes
• Can Medicaid and Cash be backdated?
  Answer: -In certain situations, we can backdate (retro) Medicaid up to 3 months prior to the date of application, if eligibility exists.
  -We can never backdate (retro) a cash application.
• Do I need a review of past assets and financial activity (look-back) when applying for Long Term Services and Supports payment?
  Answer: -If you are a recipient of a DSS Medicaid program that has an asset test for at least 5 years (for Skilled Nursing Facilities) or for at least 2 years (for Rated Housing Providers) prior to the application/admission, a look-back is NOT needed.
  -Help with Skilled Nursing Facilities and Home and Community Based Services require a five-year income and asset review if you have not been a medical recipient.
  -Help with payment of a Residential Care Home requires a two year income and asset review.  An eligibility worker will determine the length of the income and asset review if you have been a medical recipient.
• How do I become an Authorized Representative for a family member or friend through DSS?
  Answer: -Submit appointed POA, Legal Guardian or Conservatorship documentation, or a letter expressing your interest to represent someone.  Currently, you can submit a completed W-298 , which will allow the Department to disclose information based on a designated purpose described on the form.  Please be sure that the form is signed by the applicant, POA, Legal Guardian, or Conservator.
• How do I obtain information/updates regarding a Long Term Services and Supports case?
  Answer: -Create a MyAccount by visiting www.connect.ct.gov. This will allow you to access general information regarding your individual case.
  -Call the statewide Benefit Center at 1-855-626-6632 to access the Client Information Line to self-serve. If you are unable to obtain the information you are searching for, select the appropriate option and ask to speak to a Long Term Services and Supports agent.
  -If you have a pending LTSS application, contact the worker assigned to the application. Your application processing worker’s contact information is listed on your most recent correspondence received from the Department.
  
• How long does a Rated Housing Facility bed hold last?
  Answer: *Note: A W-265 must be on file requesting a bed hold.
  -An individual who leaves a Rated Housing Facility for a temporary absence and Is expected to return to the facility no later than the end of the month after the month they leave, can have his/her bed held and thereby State Supplement and SAGA payments continue for that period. 
  -Please refer to the directions on the W-265 on how to complete the form accordingly.
• How long does it take to process a new application?
  Answer: -Processing time varies based on application standard of promptness.  Our goal is to process your application within 45 days after you apply, or 90 days for disability applications.  We can only do this if we have all the information needed to determine eligibility.
• My LTSS assistance was denied /closed or is in jeopardy of being over assets. What is the asset limit and how can I reduce my assets?
  Answer: -For an individual applying for Medicaid your countable assets cannot be more than $1600.  For a LTSS applicant who is married, the applicant’s assets cannot be more than $1600 and your spouse in the community is allowed to keep one-half of the couple’s liquid assets up to the federal maximum.
  -Assets over $1600 may be reduced in several ways.  The funds cannot be given away or exchanged for something of lesser value, they must be used for your benefit and fair market value must be received.  For example, you may use your excess funds to pay outstanding bills, pay towards the cost of your care in a nursing facility, or prepay your funeral expenses.
  Follow this link to access the guide to Long Term Care Issues and Medicaid.
• What do the Qualified Medicare Beneficiary, Special Low Income Medicare Beneficiary, and the Additional Low Income Medicare Beneficiary programs cover?
  Answer: -Qualified Medicate Beneficiary (QMB) – remaining 20% that Medicare doesn’t cover, Medicare A and B premiums, co-pays, co-insurances
  -Special Low Income Medicare Beneficiary (SLMB) – Medicare B premium only
  -Additional Low Income Medicare Beneficiary (ALMB) – Medicare B premium only
• What does my Medicaid cover?
  Answer: -Call member services at 1-800-859-9889.
• What if my Patient Liability (PLA) is needed for my other expenses?
  Answer: -If you are residing in a nursing facility or you are required to pay Patient Liability (PLA) while receiving ‘home care,’ you can submit proof of your expenses, and DSS will determine if you are eligible for an income diversion, allowing you to keep more money for your own need. 
  -Examples of what can be used are as follows:
  Medical insurance premiums
  Certain medical bills
  Community Spousal Allowance
  Rent in the community (for a short-term stay)
• What is a Community Spousal Allowance (CSA)?
  Answer: -When an institutionalized individual has a spouse who lives in the community, some of his or her income can be disregarded and used for the spouse’s needs.  The CSA is determined by subtracting the community spouse’s monthly gross income from a Minimum Monthly Needs Allowance.
  - The MMNA is calculated according to a formula which uses the spouse’s actual monthly shelter costs including an allowance for monthly utilities.  The MMNA varies from case to case, but a minimum and maximum MMNA is established by federal law.  Follow this link for Long Term Services and Supports Amounts.
• What is a Personal Needs Allowance (PNA)?
  Answer: -The amount of your gross income that is allowable for you to keep each month, and not counted towards your cost of care.  This amount is established legislatively.  The current amount, effective 7/1/2021, is $75.00.  For the PCA waiver recipients, the amount is set at 200% of the Federal Poverty Level (FPL).
  -A PNA can be used for items such as clothing and other personal items for your individual benefit.
  
• What Is Considered a Residential Care Home?
  Answer: -An umbrella term for licensed boarding facilities, New Horizons, and adult family living homes approved by the Department.
• What is Long Term Services and Supports?
  Answer:

  Formerly known as Long-Term Care, this umbrella term has been updated to include coverage of the entirety of the programs and services offered.

  Follow this link to see a detailed definition.

  -Clients are allowed coverage of Long Term Care Services through several programs and over a continuum of settings. This includes care in a skilled nursing facility, Residential Care Home, through Home and Community Based services, and also through Money Follows the Person. 

  Follow this link for details regarding Money Follows the Person.

• What is needed to determine the Community Spousal Allowance (CSA)?
  Answer: -Verification of any and all income the community spouse is receiving.
  Follow this link for a full guide to verification's. 
• What is Patient Liability (PLA)?
  Answer: -Patient Liability (PLA) is a recipient’s portion of income that is put towards the cost of their care, paid to the nursing home, residential care home, or contracted fiduciary for those on waivers.  Patient Liability (PLA) is calculated by subtracting the Personal Needs Allowance and other approved deductions from the gross unearned income.  
• What is the process for reporting a change or discrepancy?
  Answer: -All requests for changes should be put in writing along with the verification of the change, and mailed to the DSS ConneCT Scanning Center at PO BOX 1320; Manchester, CT 06045.  These should include a FastLink Coversheet generated with your unique barcode from www.connect.ct.gov
• What number do you call for non-emergency medical transportation?
  Answer: Please call Veyo  at  1-855-478-7350. 
• What should I send with the Application/Redetermination?
  Answer:

  -The completed and signed form
  -Verification of Gross Income
  -Verification of Assets
  -Verification of any deductions, i.e. medical premiums
  -If you have a spouse, verification of their income/asset/shelter costs
  -Pages 1 & 2 of the W-1LTC details this for Skilled Nursing Facilities and Waivers.
  -See application and redetermination forms for more details.
  - Please complete a W-1E form requesting cash assistance for Rated Housing Applications 
  -If you are a Rated Housing Provider, also send a W-265.

  Follow this link for a full guide to verification's

• Who do I contact if I have a concern regarding the care provided in a Skilled Nursing Facility?
  Answer: -If you are a resident or a representative of a resident of a nursing home and you do not feel your rights are being treated with appropriate care, please contact the Long Term Care Ombudsman at 860-424-5200 or 866-388-1888. You can also follow this link for the Long Term Care Ombudsman Program webpage.
• Who is my caseworker?
  Answer: -For applications requesting help with nursing home coverage or home and community based services, the contact information for the eligibility worker processing the application can be found on previous correspondence received from the Department.  If you cannot locate the correspondence, please contact the appropriate Application Center  
  -For all other applications/redeterminations/interim changes, submit all information with your client ID # on all pages to the DSS Scanning Center; PO Box 1320; Manchester, CT 06045.
  -Once you are active on assistance, you no longer have an assigned caseworker.