OVERVIEW OF MEDICAID (Title XIX) 

What is Medicaid?

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 government and administered through the CT Deptartment of Social Services.  Unlike Medicare, Medicaid applicants must satisfy both the financial and non-financial eligibility requirements.

The rules for establishing eligibility for Medicaid vary for a person living at home vs. a person residing in a nursing home.  For more details visit the following links: Medicaid brochure or Medicaid in CT booklet

If you are on Medicaid and need to locate a provider click here: Directory of Providers

Non-Financial Requirements

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

Financial Eligibility - Asset Limits (asset limits exclude a person's home that they live in)

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

Financial Eligibility - Income Limits

In Fairfield County, an individual's income may be no more than $851.00 per month (including the standard unearned income disregard of $183 per month). The exact amount depends upon where in the state the applicant resides.

"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 for Low Income Adults

The state of Connecticut has a new program for low-income adults under the age of 65.  This new coverage is replacing the State Administered General Assistance Program (SAGA).  It is open to CT residents aged 18-64, who do NOT receive federal SSI or Medicare and who are not pregnant.  Strict income limits apply and are set at 56% of the Federal Poverty Level.

For more infomation on this program click here.

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 who  can assist with Medicaid information and application assistance.

You can download an application on-line by clicking here.


Or you can contact the DSS office nearest to you: 

  • CT Department of Social Services
    925 Housatonic Avenue
    Bridgeport CT 06604
    203-551-2700
     
  • CT Department of Social Services
    1642 Bedford Street
    Stamford CT 06905
    203-251-9323
     
  • The DSS office in Bridgeport will receive  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 cases for residents of New Canaan & Wilton, and has a toll-free number (866) 663-9300 for these residents.
     
  • Visit CT Elder Law or contact Connecticut Legal Services (CLS) at (203) 336-3851  or  (800) 809-4434 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 Connecticut Bar Association if you do not have an attorney.
     
  • Contact the CHOICES program at your local Area Agency on Aging (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.
     

     

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