OVERVIEW OF MEDICAID (Title XIX)

Defining Medicaid (Title XIX)

Medicaid (or Title 19) is a program of medical assistance provided through Connecticut's Department of Social Services (DSS). This program pays medical bills for certain categories of people whose income and assets are too low to cover their medical bills. Medicaid has different rules for different types of people -persons aged 65 and older, disabled persons, children under 21, certain families and persons in nursing homes. The rules for establishing eligibility for Medicaid for a person living at home than for those residing permanently in a nursing home.   For more deails, go to the following link: http://www.ct.gov/dss/lib/dss/pdfs/medicaid.pdf

Medicaid is a needs-based program which was created by Congress to help pay for medical care for those aged and disabled persons as well as indigent children and their caregiver relatives who meet strict eligibility criteria. It is jointly financed by the federal and state governments. Unlike Medicare, Medicaid applicants must satisfy both the financial and non-financial eligibility requirements.

Non-Financial Requirements

• A U.S. citizen or an eligible non-citizen
• A resident of Connecticut

Financial Eligibility - Asset Limits

• Single Person $1,600
  
• Married Couple $2,400

Financial Eligibility - Income Limits
In most of the State of Connecticut, an individual's income may be no more than $659.00 per month (including the standard unearned income disregard of $183 per month). The exact amount depends upon where in the state the applicant resides. In addition to the $183 disregard mentioned above, the Medicare Part B premium might also be able to be deducted.

"Spend Down" Eligibility
Persons who meet all of the other Medicaid eligibility rules, but whose income is too high are permitted to "spend down" their income to establish Medicaid eligibility for 6 month periods of time. The "spend down" is similar in concept to a deductible amount in health insurance. After the person's "spend down" has been accomplished and proven, Medicaid will cover the individual's Medicaid-covered medical care for the rest of the 6 month period.

Community Eligibility - Assets
In CT, the resources (or accumulated wealth) that one may maintain without affecting eligibility for Medicaid (Title 19) benefits while living at home are:

• A home
  
• Personal assets (cash, bank accounts, stocks, bonds) up to a total value of no more than $1,600 for an individual and $2,400 for married couples
  
• An allowance toward funeral and burial expenses (including a burial fund, life insurance, etc.) the total value of which may not exceed $1,200 or a $5,400 irrevocable contract with a funeral home.
  
• The value of one burial plot per individual applicant

The health care services funded by Medicaid are extensive.

Nursing Home Coverage Under Medicaid

Medicaid will pay for nursing home costs under certain circumstances. Medicaid is often considered as a payment source when it appears that a nursing facility placement may be long-term.

For married couples, the financial eligibility rules differ in some important and favorable ways. "Spousal impoverishment prevention" address the issue of assets and income of the spouse remaining in the community. These "spousal impoverishment" rules are lengthy, complex and are individualized depending on the situation.

Medicaid Application Process

Applications for Medicaid may be obtained from most nursing facilities or from the CT Department of Social Services (DSS) regional offices. Most facilities have social services staff who can assist with the application. In addition, each town in Connecticut has a Municipal Agent for the Elderly (MA). This person can assist with Medicaid information and application as well. DSS offices and Municipal Agents are listed in the blue pages of the phone book. Look under State of Connecticut for DSS and individual town's senior services for the MA.

You can download an application on-line by clicking on the following link: http://www.ct.gov/dss/lib/dss/PDFs/w-1f.pdf

Or you can contact the DSS office nearest to you:

• CT Dept of Social Services
  925 Housatonic Avenue
  Bridgeport CT 06604
  203-551-2700 

          1642 Bedford Street
          Stamford CT 06905
          203-251-9323 

          The DSS office in Bridgeport will receive clients & cases for residents of  Norwalk, Westport

              and Weston, and has a toll-free number (877) 551-2700 for these residents.

 

              The DSS office in Stamford will receive clients & cases for residents of New Canaan & Wilton,

               and has a toll-free number (866) 663-9300 for these residents.

• Visit www.ctelderlaw.org or contact Connecticut Legal Services (CLS) at 1-800-
  or 203-336-3851 in Bridgeport. CLS has a number of good publications regarding
  Medicaid and other issues of importance to senior adults.
• Contact your attorney for individualized Medicaid issues or the local Bar Association if do not have an attorney. Visit www.ctbar.org for information regarding attorneys.
• Contact the CHOICES program at your local Area Agency on Aging   1-800-994-9422.  The CHOICES program is the designated State Health Insurance Program for CT.  It is funded by the federal Center for Medicare and Medicaid Services (CMS).  Information services are free of charge.