Connecticut home care programs

Home health: the medical benefit

In Connecticut, skilled home health is Home Health Services (Connecticut Medical Assistance Program). It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Connecticut Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits. Family members are not paid under this benefit.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating and household tasks is "home care" or personal care. In Connecticut it is paid through the programs below rather than a separate agency personal care benefit.

Consumer-directed care: the person hires their own aide

Connecticut's consumer-directed option is Community First Choice (CFC), DDS Self-Directed Supports, and Personal Care Assistance Waiver. The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Community First Choice (CFC) and DDS Self-Directed Supports allow a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Connecticut offers structured family caregiving through Adult Family Living (AFL). A family member who lives with the person provides day-to-day care and is paid a daily stipend rather than hourly wages.

An agency that holds the Medicaid contract enrolls the household, coaches the caregiver, checks in on a set schedule and keeps the care notes. Unlike consumer-directed care, the caregiver does not become anyone's employee by the hour, and the agency, not the family, is the Medicaid provider.

Other ways Connecticut pays for care at home

Waiver in-home services: Acquired Brain Injury Waivers (ABI) and Connecticut Home Care Program for Elders (CHCPE). These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

State-funded: Connecticut Home Care Program for Elders — state-funded portion. Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Home Health Services (Connecticut Medical Assistance Program)).
• Wants to choose the aide, including a relative where allowed: Community First Choice (CFC), DDS Self-Directed Supports, and Personal Care Assistance Waiver.
• Lives with a family member who provides care most of the day: Adult Family Living (AFL).
• Meets nursing-home level of care and needs more than personal care: Acquired Brain Injury Waivers (ABI) and Connecticut Home Care Program for Elders (CHCPE).