Sec.17a-301-3. Eligibility

(a) To be eligible for the Program an individual must meet all the following criteria:

(1) Be 60 years of age or older;

(2) Be a resident of Connecticut;

(3) Be inappropriately institutionalized or at risk of inappropriate institutionalization as defined by these regulations based upon the individual's functional, psychological and social status;

(4) Have an income at or below 300 percent of the current maximum Supplemental Security Income benefit for an individual living independently or in the case of a married couple, 300 percent of the current maximum Supplemental Security Income benefit for a married couple living independently. Married applicants will be subject to the income provisions for single individuals if each spouse maintains a separate residence and neither spouse has access to, or receives support from, the other's income.

(b) Persons whose income levels are between 150 percent of the federal poverty level and the maximum income limit for the program or whose liquid assets are greater than the minimum community spouse protected amount as defined in the Connecticut Department of Income Maintenance Uniform Policy Manual must contribute towards the cost of their care on the basis of a fee scale specified by the Department. The Department may establish policies providing for exceptions to this requirement, limited to situations where combined co-payments and necessary living expenses exceed available income, circumstances make it impossible to collect copayments or the cost of collecting co-payments is greater than the sum of the required client payments.

(c) The Department may from time to time establish priorities which insure that persons with the greatest social and economic need receive timely assistance.

(d) Any individual applying for services on or after July 1, 1989, who may be eligible for medical assistance benefits pursuant to Section 17-134a of the Connecticut General Statutes and in need of medical services that could be covered by Medicaid shall, as a condition of participation in the program, apply for such benefits, cooperate with all application requirements, and accept such benefits if determined eligible.

(1) The Department may grant exceptions to this requirement, limited to situations in which a severe hardship exists and refusal to provide services will leave the individual unable to obtain services which are necessary to maintain physical and mental health. In order to be considered for such an exception, the applicant or the case manager must apply directly to the Commissioner on Aging stating the specific hardship conditions which exist. Examples of such hardship situations include: the applicant is mentally incompetent and is unable to take the steps necessary to complete the Medicaid application and no other responsible party has yet been designated, or legal proceedings prevent the individual's access to information necessary to complete an application.

(2) All exceptions will be valid for a period not to exceed two months. An extension may only be granted by the Department following a specific request for an extension which explains the reasons for the continued hardship. In general, all requests for exceptions and extensions must include a plan for subsequent application for Medicaid benefits. The decision to grant exceptions and extensions shall be at the sole discretion of the Department.

(Effective June 2, 1992)