Applying for Medicaid after Move to Nursing Home

[nananorma]

After a 5 day hospital stay, my mother was moved to rehab at a nursing home.  Her assisted living facility decided she needed too much "assistance" and was constantly calling me to complain.  After moving to the rehab and doing so well there, we decided that her level of care required more than she was getting at the assisted living and she will remain at the nursing home.   We have applied for and are awaiting approval from Medicaid (in Texas) to pay for the nursing home, since she has no assets to pay for it and her A&A and social security each month were barely paying and breaking even.  Once approved, the Medicaid will pay the nursing home back to the date she applied and they'll keep about 95% of her social security.

My question is this:  Has anyone had to deal with the VA in trying to pay back the monthly pension?  I notified the VA in January of her move; however, she has now received $1056 in February and again today $1056 for March.  I moved the February amount into my checking account and will do the same for March.  Medicaid requires her to have less than $2000 in assets.  I just want to pay it back and assume she'll receive A&A of $90.  I got the form letter from the VA about two weeks after my January notification that states "we have received your application for benefits"..... and because we're so busy don't expect a decision any time soon.  The same letter I received when I initially applied in 2008.  I'm wondering if this means it will be 6-8 months before it is done?  I've tried to call many times and never talk to a person.  The last time, after holding for almost an hour, was told the computers were down and to call back in an hour.  It's so frustrating.

Just wondering if anyone out there has had a similar experience and can give me guidance.

[Fit2009]

Hello Nananorma,
In most instances, the VA reduces the award to $90 based on approval of Medicaid, not when you apply.  And the VA should not ask for the money back for the intervening months.
So, what to do?  Call a VSO in Texas and ask them if you are going to have to give this money to Medicaid - make sure its someone who knows what they are talking about.  Here is a link to a site that has a bit about the Texas regulations although not what you are looking for on the asset side, but a start.  http://www.elderbenefitsconsulting.com/medicaidandthevapensi/texas.html Unless you have a legitimate step for charging your mother, I don't think taking the money and putting it in your account is a great idea.
sad to say, but if you haven't paid for a funeral, this might be the time. 
Putting it in a completely separate account while you figure this out seems more prudent.  If Medicaid asks for it you could say "I am afraid the VA may ask for it back, I am researching and it if is yours I will give it to you, but I can't give it to you and the VA".

[KarenO]

I am in a somewhat similar situation.  My mother was approved for Medicaid - at the time of approval she had less than 2,000 in assets.  However, despite informing the VA that she is now in a nursing home and costs now covered by Medicaid she still continues to receive the $1,054 per month and her assets are now over $2,000.  I would imagine at some point the VA will ask for this money back.  Since she has already been approved for Medicaid I don't believe Medicaid will again check her assets however I just want to get this money back to the VA that we are really not entitled to. 

[nananorma]

Thanks, KarenO - I was afraid that money sitting in her account would disqualify her from the Medicaid approval.  The social worker at her nursing home said she should be approved - no problem.  I guess I thought Medicaid might check the account again, even though I revealed the future change in income from $1056 to $90 from her VA A&A and could explain the payback situation.  I included a printout of the VA document describing this reduction.  They are keeping her at the nursing home, pending Medicaid approval, and assure me they will get their money retroactive to her admission date.  I would just like for the checks to STOP coming - strange how thinks turn around after sweating them STARTING just a few years ago!!

And, yes, she has a prepaid funeral already - one that has no cash value and can only be used for funeral expenses.  My Dad did that long ago - before his death in 2004.

[Fit2009]

Hi All,
Medicaid will check the assets again and they will kick someone off who is over the $2K, if you have been approved for Medicaid, you should send the VA a check and ask them to reduce the award to $90 per month as you were approved on X date - not hte date you applied for Medicaid, the approval date.

[KarenO]

Thank you for the information!  I didn't realize Medicaid would check the accounts again after approval since her only income is  SS check of 1298 and her A&A which would be reduced to 90 or less when Medicaid kicked in. 

My mother was approved for Medicaid on December 1st but was in rehab for two months so Medicare was paying up until she was actually transferred into long term care (nursing home) when Medicaid started paying.  I was under the impression from previous posts that she was still entitled to A&A unless Medicaid was paying AND she was in a nursing home (not rehab).   Fro m this post, I guess I need to send back the money from date of approval even though Medicaid did not start paying for her are until February 1st.

[KarenO]

I found this in an earlier post: 

"Effect of Medicaid-Covered Nursing Home Care on Entitlement to Pension

A veteran without dependents who is receiving Medicaid-covered nursing home care will have his or her pension benefits reduced to $90 a month for any period after the third full calendar month following the month of admission for such care.

38 U.S.C.S. § 5503(a)(1). Pub. L. No. 107-103, § 504, extended this limitation from September 30, 2008, to September 30, 2111."

Does anyone know about this - does this mean your A&A continues for three months after admission to a nursing home? 

[nananorma]

I have notified the VA of my mother's move to the nursing home..............but am not just arbitrarily sending back the money until I'm told where and how much.  I'll move to a separate account and hold it until instructed what to do.

[magnumpi28]

Hi Karen,
   I have a question for you,  A&A reamburses you for unreambursed medical expenses, how will you have any medical expenses if in a nursing home and medicaid is paying everything?

Thanks!
 

[nananorma]

Just an update - received a call today from the VA with a few questions. (A very pleasant, polite, informed and helpful young man!)   Main question was what her medical expenses have been since moving from assisted living to nursing home.  They will take that into consideration of whether she's entitled to keep her last check even though she'd moved from the assisted living, but still pending Medicaid approval.  Since she had no Medicare gap insurance, her out of pocket medical for hospital expenses totaled about $1500, which is more than the VA check.  He was inputting information today to change her monthly award to $90, which should appear as a direct deposit on April 1.  He had talked to the nursing home today and gotten information from them.  Sooooooooooo, hopefully this will be an easy solution!! I think I understood that the February 1 check was for January (when she was in assisted living); March 1 check was for February (when she had hospital expenses); and April 1 check will be the reduced amount.  I will receive a letter which will detail if any is to be returned and where to return it to.

[vetadmin]

Thanks for sharing this info and insights.  It does indeed sound like you have managed to get this straight in pretty short order.  Glad you got someone who was so helpful.

[Snuffy]

Thanks, KarenO - I was afraid that money sitting in her account would disqualify her from the Medicaid approval.  The social worker at her nursing home said she should be approved - no problem.  I guess I thought Medicaid might check the account again, even though I revealed the future change in income from $1056 to $90 from her VA A&A and could explain the payback situation. 

I included a printout of the VA document describing this reduction.

Does the printout describing the reduction relate to a particular state or is it generic for all states? 
I have been asked to provide that exact documentation for my aunt that has VA A&A and has just been approved by Medicaid.

Many thanks,
Snuff

[nananorma]

It's on the instruction sheet (VA Form 21-0510, June 2004) for the Eligibility Verification Report (EVR) - Question #E "How does receiving Medicaid-covered  nursing home care affect my pension?"  Answer:  "Pension payments may be reduced to $90 per month if you have no dependents and are receiving nursing home care which is covered by Medicaid.  This reduction  only applies if you are receiving Improved Pension.  The reduction does not apply if you receive Parents' Dependency or Indemnity Compensaion (DIC), Old Law Pension, or Section 306 Pension.  You are receiving Old Law Pension, or Section 306 Pension if entitlement to pension was established before January 1, 1979." 

In the phone call I received from the VA after notifying them of my mother's change from assisted living to nursing home, he stated that it was correct that her pension would be reduced to $90 per month beginning April 1st.  I will still have to submit EVR annually for the $90/monthly pension.  I'm assuming this is a VA instruction which doesn't have anything to do with what state we live in.

[vetadmin]

Thanks for sharing this!!

[Snuffy]

It's on the instruction sheet (VA Form 21-0510, June 2004) for the Eligibility Verification Report (EVR) - Question #E "How does receiving Medicaid-covered  nursing home care affect my pension?"  Answer:  "Pension payments may be reduced to $90 per month if you have no dependents and are receiving nursing home care which is covered by Medicaid.  This reduction  only applies if you are receiving Improved Pension.  The reduction does not apply if you receive Parents' Dependency or Indemnity Compensaion (DIC), Old Law Pension, or Section 306 Pension.  You are receiving Old Law Pension, or Section 306 Pension if entitlement to pension was established before January 1, 1979."  

In the phone call I received from the VA after notifying them of my mother's change from assisted living to nursing home, he stated that it was correct that her pension would be reduced to $90 per month beginning April 1st.  I will still have to submit EVR annually for the $90/monthly pension.  I'm assuming this is a VA instruction which doesn't have anything to do with what state we live in.

Apologies for posting the same question in two threads.  (Many thanks to each of you for responding to both!)
My question was also posed on the "Contact us" link on the state VA web page, with helpful responses and guidance received from both the state and national offices.
We can now return the balance due the VA, rather than wait a month or two for the Medicaid paperwork to be processed.  
This will resolve the concern of the checking account balance exceed the $2K Medicaid threshold.
Thanks again for such a quick, thorough and helpful response.

Snuff