Connecticut Medicaid pays for in-home personal care and related services through 3 programs, including the Connecticut Home Care Program for Elders (CHCPE) and the Personal Care Attendant (PCA) Waiver. The Department of Social Services (Community Options Unit) runs CHCPE and the PCA waiver through access agency care managers on a fee-for-service basis; DDS operates the IFS, Comprehensive Supports, and Employment and Day Supports waivers. EVV is also mandatory for Acquired Brain Injury waiver clients. The DDS service list comes from a February 2015 fact sheet and may be out of date.
Yes. Community First Choice is an optional 1915(k) State Plan service that gives eligible people self-directed Personal Attendant Care (PCA) and other supports.
Which Connecticut waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Connecticut Home Care Program for Elders (CHCPE)
Population
Connecticut residents 65 or older who are at risk of nursing home placement and meet the program's financial criteria.
Services covered
homemaker
companion
personal care attendant
chore assistance
adult day health
home delivered meals
care management
adult family living
assistive technology
Billing format
EVV through DSS's Sandata system is mandatory for CT Home Care Program clients; DSS describes EVV as a telephonic and computer-based in-home scheduling, tracking and billing system.
Adults who need hands-on help with activities of daily living to remain at home instead of entering an institution; slots are limited and filled in referral order.
Services covered
personal care attendant
case management
support broker
Billing format
EVV through DSS's Sandata system is mandatory for PCA clients.
People with intellectual disability who need an ICF/IID level of care and live in their own or family home.
Services covered
personal support
adult companion
respite
individualized home supports
live-in companion
personal emergency response system
adult day health
supported employment
Billing format
Services are paid from an individual budget through DDS qualified enrolled providers, agency with choice, or self-direction with a fiscal intermediary.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
Simple pricing
From$199/month
Up to 10 caregivers on Starter, 50 on Growth.
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