Breaking Down Connecticut's W-1LTSS Title 19 Long Term Care Medicaid Application

Applying for long-term care coverage under Title 19 (Medicaid) in Connecticut can feel overwhelming. The W-1LTSS form is long and takes into account every single aspect of your personal and financial details. Knowing how each section works makes it far more manageable. In this post, we walk through each major section of the application packet, explain what’s required, and highlight common pitfalls to avoid.

1. Instructions Pages

Before you even start filling out the form, these instruction pages provide essential guidance. You have the option of completing the application online or through the mail. Take some time to review the required documents and be sure you have a copy of each document that applies to you. It is important to know where you will be sending the application as this is determined by the county where the applicant resides.

What type of care you are applying for (nursing facility, community home care, room/board).

2. Applicant & Household Information (Pages 1-3 of the application)

This section gathers personal details for the applicant, their spouse and dependents. This information goes to the department of social services, which must verify identity, domicile (residency), and past living arrangements to determine eligibility.

3. Authorized Representative / Responsible Person (Page 4)

Here the applicant can name a person (or persons) to act on their behalf with respect to the application — someone who can receive notices, report changes, or sign on behalf if permitted. The representative must understand their responsibilities (including being bound by confidentiality and accuracy commitments). If you expect someone else (a trusted child, attorney, etc.) to help manage the process, fill this in clearly. This section does not appoint a conservator or remove your rights it simply allows an agent to assist with the application.

4. Income and Asset Section (Cash, Bank, Investments, Property) (Pages 6-12)

One of the most extensive sections: you must disclose nearly all income and assets owned by the applicant and spouse. Be honest because at this point in the long term care planning process, you should have already established financial tools and planning. DSS has access to internal account records on their end and may end up coming back with a request for statements for old/closed bank accounts. Some major categories include:

• Cash, checking/savings accounts, stocks, bonds, mutual funds.

• Trusts, annuities, retirement accounts (IRA, 401k, Keogh) and promissory notes.

• Real property: homes, rental property, life-use interests; vehicles; burial plots and contracts.

• Transfers, gifts or sales in the last 5 years (and for cash applications, 2 years) must be disclosed.

Title 19 eligibility depends on both income and assets, and the state conducts a look-back for transfers that could indicate improper gifting to qualify. Avoid common pitfalls like missing or underreporting assets can lead to delays or denial. Gather up statements, trust documents, property deeds well ahead of time.

5. Sales, Transfers and Gifts Disclosure (Page 11-12)

This portion asks whether the applicant or spouse has sold, transferred, gifted, or otherwise disposed of assets in the specified look-back period. Questions include:

• To whom was the asset transferred?

• What was the date, amount/value, and type of transfer?

• Additional questions for facility or home-care applicants about whether the transferee lived with the applicant, and if the applicant performed activities of daily living during that time.

These disclosures trigger the look-back rules. Improper transfers may result in a penalty period of ineligibility.

Tip: Consult an elder-law attorney if large transfers occurred you may need to explain the motivation for the gift.

6. Signature and Certification Section (At end of application)

At the end you must sign and date the form, certifying that all information is true, correct and complete under penalty of law. Submitting false information can lead to penalties and legal consequences. Always review for accuracy.

7. Supporting Documents & Mailing Instructions (From instructions)

While not a form section per se, you’ll find essential tables in the instruction pages that list required proofs:

• Copies of income documentation, account statements, trust documents.

• Real estate transaction records, life-use deeds, vehicle titles.

• Information about where to mail the completed application depending on whether the care sought is home-based or institutional.

We recommend using a folder to keep all proofs with your application, and submit copies (not originals).

Additional Best Practices

• Apply sooner rather than later. Don’t wait until your assets are spent — the look-back starts today.

• Be transparent with transfers. If you’ve given gifts or done asset transfers, be ready with documentation and the reason why.

• Maintain organized records. Especially account statements covering the past 5 years if you have substantial assets.

• Consider professional help. Because small mistakes can derail eligibility, talking with an elder-law attorney or Medicaid planning specialist may save headaches.

At Whitehead & Munson, we assist families with every stage of Title 19 planning, including:

• Reviewing your financial history and advising on eligibility strategy.

• Preparing and reviewing your W-1LTSS application and attachments.

• Helping you understand the look-back rules, asset transfers and how they affect eligibility.

• Coordinating with you and your family so you don’t risk losing care or legacy.

Get help with your medicaid application today!