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 Regulations of Connecticut State Agencies (Last Updated: June 14,2023)
 Title17a Social and Human Services and Resources
 SubTitle17a-392-1_17a-392-14. A Patient’s Right to Certain Information Prior to Treatment by a Physician, Establishing the Connecticut Medicare Assignment Program and a Task Force to Develop a Medicare Supplementary Catastrophic Health Coverage Plan

  Sec.17a-392-3. Eligibility: Residence  

Latest version.

  • (a) Residence criteria. An applicant must have resided within Connecticut for a period of at least 183 consecutive days immediately preceding the date the applicant's application to participate in the program is received by the Department. The applicant must have or intend to have a fixed place of abode in Connecticut with the present intention of maintaining a permanent home in Connecticut for the indefinite future. Included in this section are persons residing in long-term care institutions located within Connecticut.

    (b) Documentation of Residence. The burden of establishing proof of residence within Connecticut is on the applicant. Copies of the following documents, citing the applicant's name and address, may be submitted as such proof:

    (1) Social Security Administration Form 1099.

    (2) A copy of the applicant's current Social Security entitlement letter (SSA 2458).

    (3) Landlord's records and rent receipts; mortgage receipts.

    (4) Documentation of Property Tax Relief eligibility.

    (5) A completed and signed federal income tax return.

    (c) Other documentation. If an individual does not have any of the documents listed in subsection (b), the individual may submit other documentation showing the applicant's name and address for consideration by the Department, including a driver's license or evidence of financial transactions, such as bank statements or credit card statements.

    (d) Institutional residents. An applicant who resides in a chronic and convalescent nursing home, rest home with nursing supervision or other institution, may submit a sworn statement or certification of residence signed by a nursing home or institution official as proof of residency.

    (e) Change in residence. If a program participant leaves Connecticut with the intent to establish domicile elsewhere, he or she becomes ineligible to participate in the program effective as of the date of exit from Connecticut and, in that event, his or her Connecticut Medicare Assignment Card shall be immediately returned to the department.

(Effective December 17, 1992)