Medicaid waiver for ALF vs. VA Pension benefit?

[Alvingal]

My 81 year old father just entered an assisted living facility and receives a medicaid waiver.  Before we knew he would be a recipient of this waiver I had done much of the research and groundwork to submit his form 21-526.  Can you tell me whether he can apply and perhaps use his VA pension benefit rather than the Medicaid waiver benefit?  The reason I want to help him pursue the VA pension benefit is because it is a better benefit for his circumstance and could possibly allow him to retain a little more of his monthly income for personal items and secure a private room at the facility.  I am trying to contact his Medicaid case manager to determine whether his applying for the VA pension would in any way adversely affect his Medicaid waiver eligibility.  Anyone else had this circumstance?

[vetadmin]

If he is approved for Medicaid, the most he could receive from the VA for the A&A pension would be $90.00, and this money cannot be spent on medical expenses.  It would have to be used for personal items.

You would need to determine long-term which would be better financially for him.  You should look on the Tips and Resources section of this forum for the "countable" income tab and use that to determine where he stands at the end of the month to help makie your decision.

[Fit2009]

That $90 is if he is in an approved Medicaid Nursing Facility, recently the VA is not counting the ALF as a Medicaid approved nursing facility so the full benefit stays - if he can get the benefit and remain in the program - that's the best, but it comes down to how your state treats the pension - i.e. countable, non-countable, partially countable as income in determining Income for Medicaid purposes.  If you are asking - can I be on mediciad in an AL and apply for A&A becasue that additional income will enable him to private pay at a better fitting location for him the answer should be yes.

[VSR]

VA stopped dropping claimants down to $90 for ALF Medicaid cases because Medicaid only covers the medical portion of the bill.

[gt57]

VA stopped dropping claimants down to $90 for ALF Medicaid cases because Medicaid only covers the medical portion of the bill.

Is there a document that described this change?  I have Medicaid and VA telling me two different stories and my mother is about to go on Medicaid on the Assisted Living Waiver program in Ohio.  Medicaid states the A&A stays and is counted for income, VA agent is telling me the A&A goes to $90 a month and is not counted as income.  I have a hearing scheduled with Medicaid and I would like to have some documents with me to back up any information.

[vetadmin]

The problem is that each state has their own Medicaid laws, and we don't know how the states will look at it.  Due to the states differences, we don't have anything to reference as a defenitive guideline.

Sorry, and good luck with the hearing.  If anyone else can jump in with something to add here, please do.

[gt57]

We got through the first hearing (somewhat of a debacle) and was promised a ruling in 30 days which has passed.  This hearing was specifically regarding the effective date of Medicaid.  We think my mother's Medicaid should have started June 2011 instead of August 2011.

We have filed a second hearing which is of more interest to this forum regarding the "budget".  The budget is caculated such that all income except $50 is given to the Assisted Living Facility (ALF) and the ALF bills Medicaid for any remainder balance.

To recap, we are in Ohio and my mother is in an ALF and is Medicaid eligible and VA Aid and Attendance Eligible.  Ohio has a program called Assisted Living Waiver (ALW) which pays for the ALF and leaves my mom $50 per month.  We believe she should also be permitted to have the Vetarans A&A reduced to $90 (currently at $1,056) per month and she should be able to keep this as well $90 without being counted by Medicaid as income. This wil give her a total monthly allowance of $140 per month for personal expenses such as prescription co-pay, dental, toiletries, haircuts, clothing, outings, etc.

The problem is Medicaid, administered by the Ohio Dept of Job and Family Services (ODJFS), considers all of A&A as income and when on the ALW program, they keep the entire A&A.  We are waiting for a hearing date from ODJFS to get a resolution on this issue.

[poseypatch]

This topic is very appropriate in my/my mother's situation.  She is not yet eligible for Medicaid but will probably be sometime in the (near?) future.  I would really like to know how this turns out as it will help me in the future!
Thanks!

[gt57]

We still have not received our hearing date from ODJFS.

[gt57]

UPDATE:

No word on a hearing date but I did file form 21-4138 to inform the VA of Medicaid acceptance in December 2011.  In January 2011, I informed Ohio Medicaid (ODJFS) of the increase of VA A&A.  This apparently triggered a reevaluation of Medicaid and now Mom is ineligible for the Medicaid Assisted Living Waiver (ALW) program at the end of February because her income (SS + Pension + VA A&A) exceeds the cost of care.

I can only guess that they changed their mind of how the count the VA A&A as she should have never been approved in August 2011 for Medicaid ALW using the same formula.  Conversations with ODJFS is not easy as they will not provide any answers to "if" scenerios.  I asked if the VA dropped to $90 / month, would she be eligible?  They cannot answer this question.

I am concerned from previous post that the VA will not drop her to $90 a month since she is in an ALF but I do have a 21-4138 form prepared by a VA field agent that does request the drop to $90 worded as follows:

"I ELECT TO RECEIVE IMPROVED PENSION IF IT IS TO MY FINANCIAL ADVANTAGE.  I UNDERSTAND ONCE I NEGOTIATE PAYMENT UNDER THIS PROGRAM MY ELECTION IS IRREVOCABLE,  IN ADDITION I ELECT THE VA MEDICAID NURSING HOME RATE OF $90 PER MONTH AS I AM A MEDICAID PATIENT AND IN UNDERSTAND IT WILL BE TO MY ADVANTAGE."

I have not sent this yet as I am waiting to hear the status of my December submission as well as I have mailed my EVR with box 4D checked yes.  Box 4D ask " DOES MEDICAID COVER ALL OR PART OF YOUR NURSING HOME"