MEDICAID (Husky C & Husky D) Application Instructions

Print and Mail an Application

Fill in a HUSKY application form which can be downloaded from the DSS website or visit the nearest regional DSS office to apply during normal office hours. County/tribal officers or social service agency representative may assist you if you have a disability or have trouble filling out the form. To find the agency that handles HUSKY applications in your county, click here. Applications are usually processed within 45 to 60 days.

Telephone Application / Appointment

Call HUSKY Info line at 1-877-CT-HUSKY and set an appointment. You may also find your local agency's number from the DSS website and call them directly for an appointment.

You'll find out if you qualify for Medicaid within 45 to 60 days after submitting your application. If for any reason your application is denied, you will receive a notification explaining why. You may appeal through a fair hearing. If your assets, income or living situation changes, a social worker must be notified immediately. The DSS office likely to verify the information you submit through your employers or landlords or computer matches with banks, department of labor, motor vehicle department, social security administration and the internal revenue service. If you receive Medicaid when you are 55 years old or older, after your death, the state usually pursues reimbursement from your estate for the assistance you received.

Appeal Process

If coverage is denied you may write to the DSS Office of Administrative Hearings and Appeals in Hartford to request a Fair Hearing within 60 days of the notice of denial. Contact a local Legal Services office through the Statewide Legal Services program for assistance in preparing for the Fair Hearing.

Eligibility Requirements

In order to qualify for benefits covered in this program, you must be:

• A beneficiary of Temporary Family Assistance (TFA).
• A beneficiary of State Supplement for the Aged, Blind or Disabled (State Supplement).
• A parent or a caretaker relative with income at or below 185% Federal Poverty Level.
• A child under 19 years old.
• A Teenager aged 19 and 20 with very low income
• Pregnant with an income under 250% Federal Poverty Level
• Employed and disabled earning more than the traditional income limits
• Severely disabled individual and can be cared for at home and are eligible for Medicaid if the legally liable relative's income is not counted when determining eligibility
• A refugee - Refugees receives benefits equivalent to Medicaid for 8 months
• A Single adult with income at or below $614 per month living in Southwestern Connecticut or $505 per month living outside southwestern Connecticut.

Income guidelines for Husky C:

Household Type	Monthly	Yearly	Twice-Monthly	Bi-Weekly	Weekly
Single Person	$700*	$8,400*	$350*	$323.08*	$161.54*
Married Couple	$946*	$11,352*	$473*	$436.92*	$218.46*
Medicaid for Employees with Disabilities	$6,250*	$75,000*	$3,125*	$2,884.62*	$1,442.31*
Institutionalized Individuals	$2,829*	$33,948*	$1,415*	$1,304.15*	$652.08*

Income guidelines for Husky D:

Household Members	Annual Income	Monthly	Twice-Monthly	Bi-Weekly	Weekly
1	$20,120	$1,676.67	$838.33	$772.31	$386.15
2	$27,214	$2,267.83	$1,133.92	$1,044.00	$522.00
3	$34,307	$2,858.92	$1,429.46	$1,315.69	$657.85
4	$41,400	$3,450.00	$1,725.00	$1,587.38	$793.69
5	$48,493	$4,041.08	$2,020.54	$1,859.08	$929.54
6	$55,586	$4,632.17	$2,316.08	$2,130.77	$1,065.38

Pregnant women and individuals with urgent medical conditions are not required to prove their immigration status.

Visit the DSS website to find out the region you live in.