How to Pay for Home Care in Connecticut

Medicare almost certainly will not pay for this

This is the most common misunderstanding on the subject, and it comes from a real thing that sounds identical. Medicare pays for home health. Home care and home health are different services, billed differently and ordered differently.

Home health is short term. A doctor orders it, usually after a hospital stay, a fall or a new diagnosis, and a home health agency sends skilled staff and therapists for a stretch of weeks while your parent works toward a specific goal. An aide may help with bathing during that window, but only a few hours a week, and only while the skilled part is still running. When the goal is met, it ends.

Non-medical home care is the other thing, the part with no end date. Someone to cook lunch, to be there for the shower, to keep the kitchen straight, to drive to the pharmacy on Park Street, to sit with your mother at four in the afternoon when the house gets quiet and she gets anxious. Medicare calls that custodial care and does not cover it.

• Medicare does not pay for homemaker help, companionship, supervision, or a caregiver on their own with no skilled service alongside.
• It does not pay for live-in or around the clock care.
• A Medicare Advantage plan may add a limited in-home support benefit, and these vary by plan and by year. Read the plan's Evidence of Coverage, or call the number on the card and ask specifically about in-home personal care and homemaker hours.
• Home health and private home care can run at the same time, and often should. Many families use both, then keep the home care going after the home health episode closes.

Private pay, which is where most families start

Most families pay privately at the beginning, whether or not another source comes through later. Benefit applications take weeks and sometimes months, and the shower your father cannot manage safely is a problem this Saturday. Starting privately and applying in parallel is the normal path, not a failure of planning.

The money usually comes from a mix rather than one pot: Social Security and pension income, savings, a spouse's income, adult children splitting the month between them. Some families look at a long-term care rider on an existing life insurance policy or at home equity. Those are real options and they are also decisions to make with your own financial advisor, not in a rush at the kitchen table.

Four things move the number: how many hours a week, how hands-on the care is, whether you need overnight or live-in support, and the four-hour minimum on every visit. We put the detail on our page about what shapes the cost, and we give you a clear quote on the first call.

• If the budget is tight, buy the hardest hours instead of spreading coverage thin. Morning routine and bedtime are usually where the risk and the arguments live.
• If an unpaid family member is doing most of the work, a few scheduled respite hours protect the arrangement you already have.
• Before you sign with any agency, ask for the hourly figure in writing, the minimum visit length, and what happens to the bill on holidays or when a shift is cancelled.

Long-term care insurance: read three lines of the policy first

If your parent has a long-term care policy, it may well cover care at home and not just a facility, but the older the policy the more carefully you need to read it. Find the policy booklet, not just the annual statement. Three things decide almost everything.

First, the elimination period, which is a waiting period before benefits begin, often 30, 60 or 90 days. Some policies count calendar days from the day care starts, others count only days that care was actually delivered, which takes far longer to satisfy if you are using two visits a week. Second, the daily or monthly maximum and the total pool of benefit. Third, the definition of an eligible provider, because some policies pay only for care from a state-registered or licensed agency and will not reimburse an independent caregiver hired privately.

Most policies also have a benefit trigger. Typically a licensed health care practitioner has to certify that the person needs substantial help with at least two of the six activities of daily living (bathing, dressing, toileting, transferring, continence and eating), or has a significant cognitive impairment, and that the need is expected to last at least 90 days.

One Connecticut note worth knowing. Policies bought through the Connecticut Partnership for Long-Term Care carry dollar-for-dollar asset protection, so for every dollar the policy pays out, a dollar of assets is disregarded if the person later applies for Medicaid. If the policy is a Partnership policy it will say so on the face of it.

• Have ready: the policy number and booklet, the insurer's claim forms, the doctor's certification, a written care plan, and invoices showing dates, hours and the services provided.
• Ask the insurer whether they pay the agency directly (an assignment of benefits) or reimburse the family after you have paid. That changes your cash flow for months.
• Open the claim before care starts if you can, and keep every invoice. Missing or late paperwork is a common reason a claim stalls.

VA benefits: two different doors, and people confuse them

Veterans and surviving spouses in Connecticut have two separate routes, and they are administered by different parts of the VA.

The first is Aid and Attendance, an increased monthly pension amount for wartime veterans and surviving spouses who need help with daily activities or supervision because of memory loss. It is income and asset tested, with a net worth limit that VA adjusts every year and a look-back period on assets given away. Ongoing unreimbursed care expenses can be counted against income, which is often what brings a family inside the limit. Important detail: VA pays this money to the veteran or surviving spouse, not to the agency. You still pay us, and the pension helps you do it.

The second is VA Homemaker and Home Health Aide care, which runs through VA health care rather than through pension. A veteran enrolled in VA health care who meets the criteria can be assessed by a VA social worker and have in-home help authorized through an approved agency in the community. It is worth a phone call to the veteran's VA team even if the answer takes a while.

Do not pay anyone to file a VA claim. Accredited veterans service officers, your town's veterans service officer and the Connecticut Department of Veterans Affairs help with this at no charge, and they do it constantly.

• Have ready: the DD-214 discharge papers, marriage certificate and (for a surviving spouse) the death certificate, current income and asset statements, and out-of-pocket care costs.
• VA has an examination form, 21-2680, that the veteran's doctor completes describing the help they need. Ask the doctor's office for it early, because it is usually the slowest piece.
• VA generally pays from the date it receives the claim, so filing early matters. You can submit an intent to file first to hold that date while you gather the rest.

Medicaid in Connecticut: how the home care programs work

Connecticut runs the Connecticut Home Care Program for Elders through the Department of Social Services. It is designed for people 65 and over who would otherwise need the level of care a facility provides, and it can cover homemaker services, personal care help with bathing and dressing, adult day programs, delivered meals and non-emergency transportation, so someone can stay in their own home instead.

There are two sides to it. One is funded by Medicaid and has strict income and asset limits that change every year. The other is a state-funded part, for people whose income or assets are above the Medicaid limits but who still cannot carry the cost alone, and it comes with a share of the cost paid by the family. Adults under 65 with a disability apply through different Connecticut programs rather than this one.

Getting on it is a process, not a form. There is a financial application, an in-home assessment of what your parent can and cannot do, and then a care plan built around approved hours. Expect it to take time. Two things catch families out: the five-year look-back on money or property transferred out of a parent's name, and the fact that not every agency participates in every program. Ask any agency you speak to which programs it can bill before you commit to anything.

If your parent is married, do not assume the household is disqualified because of joint assets. There are spousal protection rules designed to keep the at-home spouse from being left with nothing, and they are worth asking about specifically.

• Start the application by calling DSS at 1-800-445-5394 and choosing the home care option.
• Have ready: proof of income and Social Security award letters, bank and investment statements, life insurance policies, deeds, and any records of gifts or property transfers in the last five years.
• Because approval takes time, plan how you will cover care in the meantime. Families often begin with a small privately paid schedule and expand once a program is approved.

One folder, and free help in Connecticut

Whichever route you take, the same documents keep getting asked for. Put them in one physical folder now, before anyone is on hold with you. Proof of income, recent bank statements, insurance policies including any long-term care policy, the Medicare and any Advantage plan card, discharge paperwork from any recent hospital stay, a current list of medications, and for a veteran the DD-214.

Then write one page in plain words describing an ordinary day for your parent, and what goes wrong in it. When does she need help getting up. Who handles the shower. What happened the last time she was alone overnight. Assessors, insurers and VA all ask a version of this question, and families who have thought it through get further, faster, than families who answer with 'she manages, mostly'.

You do not have to work through this alone or pay for advice. Dial 2-1-1 anywhere in Connecticut for free help finding programs. Your regional Area Agency on Aging has counselors who explain Medicare and Medicaid options at no cost. For anything VA related, start with an accredited veterans service officer.