Department of Social Services Programs for the Aged, Blind and Disabled

May 2009

DSS Organizational Structure Central Office Administrative & Support Functions e.g. Program Policy, Hearings

Western Region

Northern Region

Southern Region

DSS Organizational Structure

Western Region Bridgeport Office 925 Housatonic Avenue Bridgeport, CT 06606-5700 (203) 551-2700 Toll-free: (877) 551-2700

Stamford Office 1642 Bedford Street Stamford, CT 06905-4731 (203) 251-9300 Toll-free (866) 663-9300

Danbury Office 342 Main Street Danbury, CT 06810-5833 (203) 207-8900

Waterbury Office 249 Thomaston Ave. Waterbury, CT 06702-1397 (203) 597-4000

Torrington Office 62 Commercial Boulevard Suite 1 Torrington, CT 06790-9983 (860) 496-6900

Western Region „

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Bridgeport Regional Office Towns: Bridgeport, Easton, Fairfield, Monroe, Norwalk, Stratford, Trumbull, Weston, Westport Stamford Sub-Office Towns: Darien, Greenwich, New Canaan, Stamford, Wilton Danbury Sub-Office Towns: Bethel, Bridgewater, Brookfield, Danbury, New Fairfield, New Milford, Newtown, Redding, Ridgefield, Sherman Waterbury Sub-Office Towns: Beacon Falls, Cheshire, Middlebury, Naugatuck, Oxford, Prospect, Southbury, Waterbury, Watertown, Wolcott Torrington Sub-Office Towns: Barkhamsted, Bethlehem, Canaan, Colebrook, Cornwall, Goshen, Hartland, Harwinton, Kent, Litchfield, Morris, New Hartford, Norfolk, North Canaan, Roxbury, Salisbury, Sharon, Thomaston, Torrington, Warren, Washington, Winchester, Woodbury

DSS Organizational Structure

Northern Region Hartford Office 3580 Main Street Hartford, CT 06120-1187 (860) 723-1000

New Britain Office 30 Christian Lane New Britain, CT 06051-4121 (860) 612-3400

Manchester Office 699 East Middle Turnpike Manchester, CT 06040-3744 (860) 647-1441

Willimantic Office 676 Main Street Willimantic, CT 06226 (860) 465-3500

Northern Region „

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Hartford Regional Office Towns: Avon, Bloomfield, Canton, East Granby, Farmington, Granby, Hartford, Newington, Rocky Hill, Simsbury, Suffield, West Hartford, Wethersfield, Windsor, Windsor Locks New Britain Sub-Office Towns: Berlin, Bristol, Burlington, New Britain, Plainville, Plymouth, Southington Manchester Sub-Office Towns: Andover, Bolton, East Hartford, East Windsor, Ellington, Enfield, Glastonbury, Hebron, Manchester, Marlborough, Somers, South Windsor, Stafford, Tolland, Vernon Willimantic Sub-Office Towns: Ashford, Brooklyn, Canterbury, Chaplin, Columbia, Coventry, Eastford, Hampton, Killingly, Mansfield, Plainfield, Pomfret, Putnam, Scotland, Sterling, Thompson, Union, Willington, Windham and Woodstock.

DSS Organizational Structure

Southern Region New Haven Office 194 Bassett Street, New Haven, CT O6511 (203) 974-8000

Norwich Office 401 West Thames Street, Unit 102 Norwich, CT 06360 (860) 823-5000 TOLL FREE (800) 473-8909

Middletown Office 117 Main Street Ext. Middletown, CT 06457-3843 (860) 704-3100

Southern Region „

New Haven Regional Office Towns: Ansonia,

Bethany, Branford, Derby, East Haven, Hamden, Milford, New Haven, North Branford, North Haven, Orange, Seymour, Shelton, Wallingford, West Haven and Woodbridge „ Norwich Sub-Office Towns: Bozrah, Colchester, East Lyme, Franklin, Griswold, Groton, Lebanon, Ledyard, Lisbon, Montville, New London, North Stonington, Norwich, Preston, Salem, Sprague, Stonington, Voluntown,Waterford „ Middletown Sub-Office Towns: Chester, Clinton, Cromwell, Deep River, Durham, East Haddam, East Hampton, Essex, Guilford, Haddam, Killingworth, Lyme, Madison, Meriden, Middlefield, Middletown, Old Lyme, Old Saybrook, Portland, Westbrook

Caseload Organization Clients & Assistance Units „ „

DSS assigns each household member a unique “Client ID”. DSS assigns a unique “Assistance Unit Number” for each DSS program that the household participates in.

Caseload Organization Clients & Assistance Units Example – The Jones Family: ‰ The household consists of John & Mary Jones, their two children, Joseph (age 2) and Jane (age 5) and John’s mother Nana Jones. ‰ John works part time. ‰ Mary is unemployed. ‰ Nana receives Supplemental Security Income (SSI).

Caseload Organization Clients & Assistance Units The Jones Family applies for assistance. They are eligible for: ‰ ‰ ‰ ‰

HUSKY (Mary, John, Joseph & Jane); Medicaid for the Aged (Nana); Qualified Medicare Beneficiary (Nana); Supplemental Nutrition Assistance Program (SNAP; formerly the Food Stamp program) (Everyone).

Caseload Organization Clients & Assistance Units

Each household member is assigned a unique Client ID: ‰ John - 003020010 ‰ Mary - 003020012 ‰ Joseph - 003020015 ‰ Jane - 003020017 ‰ Nana - 003020018

Caseload Organization Clients & Assistance Units

Each program is assigned a unique Assistance Unit number: ‰ ‰ ‰ ‰

HUSKY - 050255010 Medicaid - 050562147 QMB - 053415985 SNAP - 059632145

Assistance Programs „ „ „ „

Medicaid (aka Title XIX) State Supplement State Administered General Assistance (SAGA) Supplemental Nutritional Assistance Program (SNAP; formerly the Food Stamp program)

A Note of Caution: „

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The eligibility rules for our programs can be very, very complicated. If at all in doubt, please apply. It’s better to apply and be denied, than to never have applied at all!

Eligibility Considerations – Categorical & Financial; „

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Only certain “categories” of individuals can qualify for most DSS cash and medical programs. . These are known as “categorical eligibility requirements”.

Eligibility Considerations – Categorical & Financial; „ „

Most DSS programs are “needsbased”. This means that income and assets must be below certain limits in order to qualify.

Medicaid Adult Medicaid (Medicaid for the Aged, Blind & Disabled aka “MAABD”)

Family Medicaid

Medicaid for the Aged, Blind & Disabled Categorical Requirements „ „

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Aged – 65 years and older Blind – Social Security criteria or CT Board of Education and Services for the Blind Disabled – Social Security criteria

Disability Determinations „ „ „

Social Security criteria is the basis. Disability determinations can be done by DSS. Social Security determinations are binding.

Family Medicaid aka “HUSKY” „ „ „

Children under 21 Their Parents Pregnant Women

Medicaid

Institutional (Long Term Care)

Community

Medicaid Financial Requirements MAABD Asset Requirements „ „

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$1,600 limit. Applicants do not qualify for Medicaid until the month in which their assets are at or below $1,600. Certain assets are not counted under certain conditions, e.g. irrevocable funeral contracts, motor vehicles, life insurance.

Medicaid Financial Requirements Transfer of Asset Penalties „

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Applies to long term care services, both in an LTCF and provided under a Medicaid waiver program. Applies when individual of spouse dispose of assets at less than fair marker value in order to qualify for assistance. Penalty starts when the individual would be otherwise eligible for Medicaid payment of long term care services. Length of penalty depends on amount transferred (amount / avg. cost of LTC = months of penalty).

Medicaid Financial Requirements MAABD Income Requirements „ „ „

Monthly Gross Income – Disregards = Applied Income Applied Income < Medically Needy Income Limit (MNIL) … Eligible. Applied Income > MNIL … Spenddown.

Medicaid Financial Requirements MAABD Income Requirements „ „

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Certain coverage groups do not use the MNIL as the income limit. Instead, these groups use a “special” income limit that’s equal to 300% of the SSI payment rate, currently $2,022 per month. This special income limit is used for LTCF residents and for Medicaid waiver programs.

Medicaid Financial Requirements

Spenddowns „ „ „

Spenddowns are similar to deductibles (every six months). Medical expense are subtracted from the person’s income until the income is at or below the MNIL. The person must be responsible for the expense OR the expense must be paid by a wholly statefunded program such as ConnPACE.

Medicaid Financial Requirements

Spenddowns in LTCFs „ „

The projected cost of care is used as a medical expense. For all intents and purposes, individuals in LTCFs are income-eligible for Medicaid if they cannot afford to pay at the private facility rate.

Medicaid Waiver Programs „ „ „

It’s easier to meet Medicaid income eligibility requirements in an LTCF than in the community. It’s less expensive to provide LTCF services in the community than in an LTCF. The idea behind Medicaid waiver programs is that it’s less expensive to apply Medicaid LTCF rules and services to individuals in the community who would otherwise require placement in an LTCF.

Medicaid Waiver Programs „ „ „ „ „ „

Connecticut Home Care Program for Elders Connecticut Home Care Program for the Disabled Developmental Disability Waivers Personal Care Attendant Acquired Brain Injury Katie Beckett (Model) Waiver

Medicaid for the Employed Disabled (MED) „ „ „ „

Individuals must be working, despite their disability. Income limit of $75,000 per year. Asset limit of $10,000. Premiums based on income.

Medicare Savings Programs „ „ „

Qualified Medicare Beneficiaries (QMB) Specified Low-Income Medicare Beneficiaries (SLMB) Additional Low-Income Medicare Beneficiaries (ALMB) Also known as Qualified Individuals (QI)

Medicare Savings Programs QMB „ „ „

Income limit = 100% of the Federal Poverty Limit (FPL) after disregards. Asset limit of $4,000 for individuals; $6,000 for couples (may be eliminated soon). Pays for Medicare premiums, copays and coinsurance on Medicare-covered services.

Medicare Savings Programs SLMB „ „ „

Income limit = 120% of the Federal Poverty Limit (FPL) after disregards. Asset limit of $4,000 for individuals; $6,000 for couples (may be eliminated soon). Pays Medicare Part B premiums.

Medicare Savings Programs ALMB „ „ „ „

Income limit = 135% of the Federal Poverty Limit (FPL) after disregards. No Asset Limit. Pays Medicare Part B premiums. Federal Block Grant; Subject to available funds.

State Supplement AKA

Aid to Aged, Blind and Disabled (AABD) „ „ „ „

Cash assistance to Aged, Blind and Disabled Individuals. State Supplement recipients also receive Medicaid. Asset limit = $1,600. Income based on living arrangements „ „

Community living arrangements Residential Care Homes

State Supplement Income Eligibility for Residential Care Home Residents „

Needs – Applied Income = State Supplement Payment „ „

Needs = Residential Care Home rate + $28.90 Personal Needs Allowance Applied income = Gross Monthly Income $185.70 Unearned Income Disregard

State Supplement Income Eligibility for Residential Care Home Residents Example – James T. Kirk resides in the Enterprise Boarding Home. He receives $674 per month from SSI. Enterprise’s rate is $2,900 per month. „ „ „

Needs = $2,900 + $28.90 = $2,928.90 Applied Income = $674 - $185.70 = $488.30 Payment = $2,929.80 - $488.30 = $2,440

State Administered General Assistance (SAGA) „ „ „

Cash assistance for unemployable and transitional individuals. SAGA cash can pay for Residential Care Homes. Medical assistance for individuals who are not eligible for Medicaid.

SAGA Cash Assistance „ „

$250 Asset Limit Income limit depends on payment standard „ „

$206 for those in the community with shelter obligations Cost of residential care home for residents of these facilities

SAGA Medical Assistance „ „

$1,000 Asset Limit Income similar to community Medicaid (income compared to MNIL)

Standards of Promptness for Processing Applications. „ „ „

90 Days for Disability based programs. 45 Days for All Other Program Types (except SNAP, which is 30 days) Applications often take longer to process, typically due to delays in third party verifications.

Need More Information?? „ „

Go to www.ct.gov/dss and click on “Programs”. Call DSS Adult Services „ „

Adult Support (MAABD, State Supplement, SAGA) (860) 424-5250 SNAP (860) 424-5383

Questions??? „

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For case-specific questions, clients should contact their DSS workers in the Regional Office. For general policy issues, individuals can contact the Adult Support Team in the DSS Central Office at (860)424-5250.