Most of America’s long-term care system is paid for by Medicaid — not Medicare. Medicare covers short rehab stays after a hospital admission and then stops. The bill for ongoing nursing-home care, in-home support past rehab, or assisted living (which Medicare never covers) has to be paid by the family or by Medicaid. In Connecticut, where the cost of care is among the highest in the US, Medicaid planning has unusually high stakes.1

Three eligibility tests

1. Medical/functional eligibility

Connecticut conducts a clinical eligibility assessment to determine whether the applicant meets the nursing-facility level of care. The assessment is conducted by an Access Agency contracted with DSS for HCBS waiver enrollment, or by a hospital discharge planner / pre-admission screener for nursing facility admissions.2

2. Income

Connecticut Medicaid uses a medically-needy spend-down approach for HUSKY C applicants whose income exceeds the categorical limit. Excess income is spent on care costs to meet the eligibility threshold. The specifics vary by program and household;.

3. Assets

The applicant’s countable assets must be at or below Connecticut’s asset limit (~$1,600 for a single applicant — slightly lower than the federal SSI baseline). Federal categorical exemptions apply:

The five-year look-back

Connecticut applies the standard federal 60-month look-back to all Medicaid LTC applications. Any uncompensated transfer of assets in the 60 months before application creates a penalty period during which the applicant is otherwise eligible but Medicaid will not pay.

Connecticut’s penalty divisor reflects the state’s average monthly nursing-facility cost — one of the highest in the country — meaning a given dollar transfer produces a shorter penalty in Connecticut than in lower-cost states. Conversely, the absolute dollar cost of mistakes is higher because Connecticut nursing-home rates are higher.3

The Connecticut Home Care Program for Elders (CHCPE)

Connecticut’s principal HCBS pathway for older adults is the Connecticut Home Care Program for Elders (CHCPE), codified at Conn. Gen. Stat. §17b-342. CHCPE is administered by DSS with regional Access Agencies handling intake, eligibility determination, and ongoing care management. The program provides home-based services as an alternative to nursing-home placement, including personal care, homemaker services, adult day services, and home modifications.4

CHCPE has two tracks — one for Medicaid-eligible recipients and another sliding-fee program for older adults whose income or assets exceed Medicaid limits but who still need significant care. The sliding-fee track is distinctive among US states and provides a meaningful bridge for families who need care support but aren’t Medicaid-eligible.

Paying a family caregiver

Within CHCPE and related Connecticut Medicaid programs, consumer-directed service options and the Adult Family Living program can allow the recipient to receive care from a family member in some circumstances. Spouses generally cannot be paid. Eligibility, rates, and program availability vary; coordinate with the Access Agency case manager.

The community-spouse situation

Federal spousal-impoverishment protections apply. The community spouse retains:

Connecticut’s elder-law bar has substantial expertise in community-spouse planning, particularly in Fairfield County. Most one-spouse-needs-care situations can be planned to a non-catastrophic outcome with 12–24 months of lead time.

Estate recovery in Connecticut

Connecticut applies estate recovery in line with federal requirements. Connecticut has historically pursued recovery against probate assets; the scope (whether Connecticut pursues expanded estate recovery against non-probate assets such as joint tenancies and revocable trusts) has been the subject of policy evolution.5

Coordination with revocable-trust planning, beneficiary designations, and the Connecticut probate process is one of the more nuanced areas of Connecticut elder-law practice.

When to start planning

The honest answer: yesterday. Connecticut’s high cost-of-care, the state-level gift tax, and the interaction with estate-tax planning make early engagement particularly valuable. Plan five years ahead if you can; plan as soon as decline is visible if you can’t.

What to do this month

For Connecticut-specific legal and probate context, see Legal & Financial in Connecticut.