| Medicaid (also known as Title 19 or Title XIX) is a federal
and state funded medical assistance program offered by the Connecticut Department of
Social Services (DSS) for certain low-income families and individuals. For those
eligible, Medicaid covers most medical care services. Medicaid is a very complex
program. The material presented here describes the program in very general terms.
It is always best to consult a legal services or private attorney who has
experience in Medicaid law.
Who is eligible for Medicaid?
For the elderly, there are several ways to become
eligible for Medicaid coverage:
- If you receive State Supplement (AABD) benefits, you are
automatically eligible for Medicaid.
- If you receive SSI benefits, you are NOT automatically
eligible for Medicaid in Connecticut.
- If you receive Category Three benefits through the
Connecticut Home Care Program for Elders (CHCPE), you are automatically eligible for
Medicaid.
- If you have very limited income and assets, you may
automatically qualify for Medicaid. Income limits vary depending on where you live.
Higher income limits exist in lower Fairfield County.
- If your income is over the set Medicaid limits but your
assets are within these limits, you may also qualify for Medicaid through a process called
a "spend down" whereby DSS considers your high medical bills.
- If you need nursing home care or long-term home health
care, you may be eligible for Medicaid if your income won’t cover the costs of
medical care and if you have limited assets.
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What medical care does Medicaid cover?
Medicaid covers most health care services including
hospital and nursing home care, home care, lab tests, X-rays, medical equipment like
wheelchairs, eyeglasses, hearing aids, most prescription drugs, some dental care and
doctors' care. Medicaid also covers foreign language interpreter services.
Medicaid does not cover independent podiatrists, chiropractors, naturopaths, psychologists
or therapists (physical therapists, audiologists or speech therapists).
However, such services are covered by these providers if the services are received in a
clinic setting.
Medicaid pays the medical provider directly at a rate
determined by the state which is generally less than the private pay rate. Some
doctors and dentists will not accept Medicaid patients for this reason. Medicaid
recipients in nursing homes must pay their income towards the cost of their care, except
for a personal needs allowance, unless they have a spouse in the community who needs
additional income to meet his or her needs.
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If I apply for Medicaid, will the state take my house?
In most cases, no. The state will not take your
house if you remain living in it.
If you receive nursing home care, but you are expected to
return home within six months, the state will not put a lien on your home. Even if
you reside in a nursing home for more than six months, the state may not place a lien on
your home if any of the following people live in your home:
1) your spouse
2) your minor child;
3) your disabled child;
4) your sister or brother who has an equity (ownership)
interest in the home, and who has resided in the home at least one year prior to your
institutionalization.
If you do return home from the nursing home, any lien the
state placed on your home must be dissolved, or removed from the title of your property.
In some cases, Medicaid may place a "lien"
against your home. A lien is a claim to secure a debt. Before a lien may be
placed, you must be given a written notice by the state. If you do not believe that
the state should place a lien, you have a right to request an appeal called a Fair
Hearing. When the home is sold, the lien has to be paid off. Medicaid can only
place a lien on your home if (1) you are in a nursing home and will never be able to
return home and (2) none of the relatives listed above live in the house.
Even if a lien is placed on your home, it does not have to be sold until you and your
spouse are dead.
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For more information on Medicaid:
Contact the nearest Area Agency on Aging
(1-800-994-9422).
Contact the Department of Social Services for a Medicaid brochure and Medicaid application.
Obtain more specific PAMPHLETS about Medicaid by clicking
on the link to the left.
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