Who Are You?
Tell us a little about yourself so we can take you to the right place and make this as quick as possible.
A Family Member or Someone Seeking Care
You are looking for care support for yourself or a loved one and want to understand if you qualify.
Check My Eligibility →A Healthcare Professional or Care Manager
You are a provider, social worker, nurse, discharge planner, or care manager referring a client.
Submit a Referral →See If You Qualify for Caregiver Support
Answer a few quick questions — no typing required until the end. Our team will follow up to explain your exact options.
Where does your loved one need care?
This helps us match you with the right program — we'll walk you through your specific options on the call.
Who are you seeking support for?
Spouses are not eligible to serve as a paid caregiver under Connecticut's program — but our team is happy to have a conversation and offer guidance.
Spouse eligibility depends on the specific program. Our team will clarify exactly what applies to your situation on the call.
Is the person who needs care 65 or older?
Connecticut's programs support individuals aged 65 and up.
Where does the person who needs care currently live?
This helps us understand the care situation.
Does the person who needs care currently have Medicaid?
Connecticut's program is funded through Medicaid (Husky C or QMB).
Not having coverage right now is okay. Our team can help you understand eligibility and next steps when we connect.
When are you looking to get started?
Choose two preferred contact times
We'll call during one of your selected windows.
0/2 selected
How should we reach you?
We'll call you during one of your selected time windows.
By submitting this form you agree to be contacted by Gifted Hands Homecare. We will never share your information with third parties.
You're All Set!
A member of our team will call you during one of your selected time windows to walk through your options and next steps.
Have a question in the meantime? Call us at (978) 218-8248 or (860) 264-6184.
Submit a Referral to Gifted Hands Homecare
Use this form to refer a patient or client to our programs. Our intake team reviews every submission and follows up within one business day.
What is your role?
This helps our intake team understand the context of the referral and follow up appropriately.
Where are you referring from?
We use this to direct your referral to the right intake coordinator and keep records accurate.
Which state and program is this referral for?
Select the state first, then choose the program. Not sure which program applies? Select the most likely one and we will confirm on our end.
StateTell us about the person you are referring.
Basic details only at this stage — we will collect anything else we need on the follow-up call.
What assistance does the client need?
Select all that apply. This helps our team prepare for the assessment and clinical review.
Personal Care (ADLs)You do not need to select anything to continue. If care needs are not yet assessed, leave this blank and our team will follow up.
Insurance and urgency
This helps us determine eligibility and prioritize the follow-up appropriately.
Does the client currently have Medicaid / MassHealth?How soon does care need to begin?
Anything else our team should know?
Add any clinical notes, context, or specific instructions for our intake coordinator. This is optional but helpful.
If you selected Phone or Both, please choose two windows when you are reachable for a call.
Morning0/2 time windows selected
By submitting this referral you confirm you have authorization to share this client's information with Gifted Hands Homecare for the purpose of determining program eligibility.
Referral Received
Thank you. Our intake coordinator will review this referral and reach out to you within one business day to discuss next steps.
ATTN: Intake Coordinator