Connecticut Association of Area Agencies on
Aging Representing:
Agency on Aging of South Central CT
North Central Area Agency on Aging
Western CT Area Agency on Aging
Senior Resources - Agency on Aging Eastern CT
Southwestern CT Agency on Aging
Legislative Agenda for the 2014 Session
The Connecticut Association of Area Agencies on Aging (C4A) looks forward to working
with members of the Connecticut General Assembly to provide effective and costefficient services to Connecticut residents. C4A is an association comprised of five
Area Agencies on Aging (AAA) that provide a seamless range of services to
Connecticut’s older residents and individuals of all ages who are eligible for Medicaid
and/or Medicare. C4A administers programs and funds under the Older Americans Act,
Medicaid waiver, State respite care programs and Money Follows the Person (MFP).
AAAs play a major role in helping consumers successfully navigate the complex
medical and social service arenas including the coordination of health insurance
information; streamlined access to assistance programs; comprehensive assistance to
help consumers understand complicated program eligibility and application processes;
and long term care supports to meet emergent consumer needs. Area agencies on
aging represent the boots on the ground helping to transition hundreds of Connecticut’s
residents from institutional settings back to their communities. In this changing
healthcare landscape, AAAs stand ready to support the bridge between medical and
social services to provide an integrated approach to meeting consumer needs. As the
2014 session approaches, C4A looks forward to discussing issues that affect seniors
and other vulnerable populations.
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AT A GLANCE
In the 2014 Legislative Session, C4A asks Legislators
to consider the following:
1. Include funding for navigators and assisters in
all SIM and Dual Eligible projects so that clients
can receive much needed support to help
navigate complex health and social service
systems.
2. Support the capacity and sustainability of a
strong, Long Term Care provider network
through fair and equitable reimbursement of
services.
3. Support a Presumptive Eligibility process for
clients applying for a Medicaid waiver, such as
the CT Home Care Program, to prevent
unnecessary and premature institutional
placement and streamline access to Long Term
Care Services.
4. Remove the waiting list to the Connecticut Home
Care Program for the Disabled so that all of
Connecticut’s residents have access to services
that allow them to forego premature institutional
placement and improve the quality of life.
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Help Consumers Navigate the Complex Long Term Care Supports
System
Full support to provide Information, Referrals and Access to Connecticut’s older adults,
caregivers and persons with disabilities. Connecticut’s citizens need assistance
navigating the myriad of home and community-based services. The concept of a single
point of entry is essential to help individuals navigate complex eligibility and application
processes. Websites do not meet the needs of many low-literacy individuals or
individuals without computer proficiency. Information is often presented in legal or
medical jargon. The State Innovation Model recognizes the importance of coordinated
efforts of community organizations, healthcare providers, employers, consumers and
public health entities. C4A stands ready to strengthen community-based health and
social services and linkages to primary healthcare by working to develop uniform,
effective processes leading to certification as a community-based practice support
entity. By offering a consumer-based model of advocacy, literacy and navigation
supports, consumers will make the best long term care decisions and ultimately save
State funds.
Trainers of community partners of local resources,
Support for Fair and Equitable Reimbursement of Community-Based
Services
C4A appreciates the demands imposed on the State’s budget as a result of the slow
growing economy. A connection must be made between the stabilization of critical
programs that constitute the safety net for our most vulnerable citizens and Medicaid
rate reimbursement for providers. As members of the General Assembly consider
programs and budgetary decisions to address the needs of our most vulnerable
citizens, we urge you to be mindful that many providers have gone seven years without
a cost of living adjustment while facing significant increases in rent, utilities and
insurance expenditures. In 2014, we ask that the Connecticut Legislature supports the
full cost of doing business through a much-needed analysis and corresponding increase
to the reimbursement rate of Medicaid providers. The State’s Money Follows the
Person initiative and Medicaid waiver diversion programs put stress on an already
burdened long term care system. Reimbursement rates have been frozen since 2007
resulting in some agencies refusal to accept Medicaid clients. This trend will limit the
care plan options for older adults and jeopardize the quality of care for Connecticut’s
most vulnerable citizens. To insure an adequate community-based network of long
term services and supports the State needs to adequately reimburse providers. Shortterm gains reaped from inadequate reimbursement will soon give way to long term loss
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as clients experience higher hospital recidivism rates, increased emergency department
use and declining health outcomes.
Presumptive Eligibility
To support the Governor Malloy’s policy initiative to move from institutional care to
community-based care, the Connecticut Association of Area Agencies on Aging
(C4A) recommends that “Presumptive Eligibility” be used by Connecticut Access
Agencies (AA) when assessing potential clients for the Medicaid Elder Waiver program.
Background
The term “Presumptive Eligibility” means that an elderly applicant is temporarily
accepted for Medicaid and can receive services through the Waiver program following
an initial screening by the appropriate AA. If the applicant meets the basic functional
and financial eligibility criteria, the applicant can immediately begin receiving in-home
services, case management and other benefits through Medicaid Waiver. AAs
would determine presumptive eligibility through statements from the applicant and a
functional assessment.
The applicant must still be approved by the Department of Social Services, but the
application process would not delay the applicant receiving services. This change
would increase the number of diversions and the federal dollars coming into
Connecticut. The formal Medicaid application process can begin immediately following
the Presumptive Eligibility action, but waiting on Medicaid approval would not delay the
diversion process. It is the responsibility of the AA to monitor the application process
and set a deadline for the submission of all associated documentation. Failure to
submit the required application documents would result in immediate termination of
services and the applicant would be held responsible for the expenditures to date. If the
applicant is not approved at this point, past expenditures may be paid through State
funds or, in the case of false statements, from the applicant.
Connecticut has established Presumptive Eligibility for pregnant women in low-income
families. The policy grants immediate, temporary health coverage through Medicaid to
women meeting the basic eligibility guidelines. The goal was to quickly start prenatal
care and reduce infant mortality by funding services during the waiting period for final
approval.
Advantages
In this situation, applicants are frail elderly adults who face the risk of nursing home
placement because they are not able to provide self-care. If institutionalized, they are at
risk of losing their homes in the community and face increased impairment with longer
recovery times.
Presumptive eligibility has been used for a number of years in other states, such as
Ohio, Pennsylvania, Washington, and Iowa.
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The advantages are:
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More Federal money is pulled into the state through Medicaid.
The case is expedited with the client receiving services more quickly.
There is less risk of premature nursing home placement due to faster provision of
in-home services.
Applications are done more thoroughly with low error rates (less than 2% in other
states).
Fewer State Alzheimer’s Respite funds and Older Americans Act funds would be
used to support the clients pending eligibility resulting in a greater number of
non-waiver qualifying clients served.
Issues
There is the possibility that an applicant could be determined to be eligible by the initial
assessment and later found to ineligible by the state because of client
misrepresentation or other errors in the initial assessment. Funds expended during the
time between the initial assessment and the state’s approval process would need to be
paid through Medicaid Waiver Administration funds. While this is a concern, historically
there is a very low error rate (fewer than 2%) for the initial screening and there would
not be a large amount of Administrative funds required.
Current Action Needed
C4A believes that Presumptive Eligibility should become accepted procedure within the
Medicaid Elder Waiver application process immediately. This process has been
supported for pregnant low-income women and has been used successfully in several
states in the past five years. C4A asks the legislators to consider this important
legislation in keeping with the critical needs of constituents and Connecticut’s desire to
rebalance Medicaid expenditures.
For further information on programs and services offered through the Connecticut
Association of Area Agencies on Aging:
Contact:
Telephone:
Email:
Web site:
Marie Allen, Executive Director
203-333-9288
mallen@swcaa.org
www.ctagenciesonaging.org
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