Connecticut proposes a new assisted-living Level 5 for elders with higher care needs

The Connecticut Department of Social Services (DSS) has announced its intent to ask the Centers for Medicare & Medicaid Services (CMS) to amend two of the state’s Medicaid home and community based services waivers: the Home and Community Based Services Waiver for Elders — the waiver behind the Connecticut Home Care Program for Elders (CHCPE) — and the Personal Care Assistance (PCA) waiver. The notice of intent was issued under section 17b-8 of the Connecticut General Statutes.

The headline change affects the CHCPE elder waiver only: DSS proposes to add a Level 5 to assisted living, expressly “to support members with higher acuity needs to age in place.”

Both waivers would also see two shared changes. For Adult Family Living, DSS would modify the service definition and provider standards, with edits that clarify and further define the department’s expectations around training, oversight, and the responsibilities of the provider agency and the caregiver. And the Training and Counseling Services for Unpaid Caregivers Supporting Participants (COPE) would gain a second delivery model in both waivers, allowing an independent occupational therapist to engage without a registered nurse; DSS notes this model is approved and validated by the certifying body for COPE services.

Who it affects

The assisted-living Level 5 would apply to elders served under the CHCPE waiver who receive assisted living services — people whose care needs have grown beyond what the current levels cover. The Adult Family Living and COPE changes reach participants in both the CHCPE and PCA waivers, and the family caregivers who support them.

Why it matters

Assisted living under the elder waiver is paid in levels tied to how much care a member needs. When a resident’s needs outgrow the highest available level, the practical alternative has often been a move to a nursing facility. A Level 5 aimed at higher-acuity members is designed to let assisted living communities keep caring for those residents — supporting members “with higher acuity needs to age in place,” in DSS’s own words — rather than requiring a transfer as needs increase. For families, the caregiver-facing changes matter too: clearer training and oversight expectations for Adult Family Living providers, and a COPE model that lets an occupational therapist work with unpaid caregivers without a registered nurse involved, which DSS says is intended to support greater utilization of the service.

What happens next

This is a notice of intent, not a final change. DSS is collecting written public comments first; after the comment period it intends to submit the amendment application to CMS, which must approve waiver amendments before they can take effect.^[1] The notice does not state a proposed effective date.

Key Takeaways

• DSS intends to ask CMS to amend Connecticut’s CHCPE elder waiver and PCA waiver.
• For the CHCPE elder waiver, DSS proposes adding an assisted-living Level 5 for members with higher acuity needs, so they can age in place.
• Both waivers would get updated Adult Family Living service definitions and provider standards covering training, oversight, and provider and caregiver responsibilities.
• Both waivers’ COPE caregiver training and counseling service would add a second delivery model letting an independent occupational therapist engage without a registered nurse.
• Written comments are due by December 3, 2026.

How to comment

All written comments on the application must be submitted by December 3, 2026 to Christine Weston, Director of Community Options Unit, DSS Central Office, 55 Farmington Avenue, Hartford, CT 06105, or by email to Public.Comment.DSS@ct.gov. A copy of the complete text of the waiver applications is available at no cost on request from the same contact, on the DSS website (www.ct.gov/dss) under “Press Releases” and on the DSS Medicaid Waiver Applications page, and at any DSS field office or the Town of Vernon Social Services Department.