DROPPING MEDICAID TO RECEIVE A @ A

[TOMBAY]

The husband of my sister-in-law died recently.  He was a Korean War Vet.  She remains in a nursing home, supported by Medicaid.  She would like to move to an assisted living facility but to do so she would need the VA Aid and Assistance pension. Does anyone have experience or suggestions about getting off Medicaid and switching to A and A?

[jpez]

SHe doesn't need to 'drop' medicaid.
1. By moving out of the nursing home, Medicaid quits paying the nursing home. Medicaid only pays the nursing home because the nursing home sends them a bill easch month. If she moves out then they won't send Medicaid a bill. But she is still eligible if she goes back.  If you literally 'quit' Medicaid, then you would have to reapply all over again.
2. What is her monthly income? She may be eligible for other Medicaid programs. What state is she in?
3. To be eligible for the Pension rating A&A, (Max of$1056 monthly) then she needs to spend all of her income on CARE.  That is usually not a problem when living at assisted living facilities.
4. also, depending on her income, she may be eligible  for help thru Medicare.

[VSR]

SHe doesn't need to 'drop' medicaid.
1. By moving out of the nursing home, Medicaid quits paying the nursing home. Medicaid only pays the nursing home because the nursing home sends them a bill easch month. If she moves out then they won't send Medicaid a bill. But she is still eligible if she goes back.  If you literally 'quit' Medicaid, then you would have to reapply all over again.
2. What is her monthly income? She may be eligible for other Medicaid programs. What state is she in?
3. To be eligible for the Pension rating A&A, (Max of$1056 monthly) then she needs to spend all of her income on CARE.  That is usually not a problem when living at assisted living facilities.
4. also, depending on her income, she may be eligible  for help thru Medicare.

She can also qualify for pension and Medicaid at the same time.  If she did this, she would qualify at the $90 protected rate which Medicaid cannot use to pay for her care.  This would increase her monthly spendable income to $135 from the standard $45 Medicaid usually allows patients under their care.   Message me with questions. 

[PMC-Chris]

Additionally, some assisted living facilities are Medicaid-approved, and if it's and assisted living facility VA won't reduce her payments to $90.00.

@Max - I'm not sure, but I don't know if they continue to receive the $45.00 from Medicaid if they are receiving the VA $90.00.

[jpez]

Yes, they do continue to keep the 30-75 personal needs allowance(depending on the state) of their income AND the 90 from VA.  The reason as stated is that Medicaid does not look at the A&A award as income.
But for clarification You CAN BE ON MEDICAID AND RECIEVE THE FULL VA BENIFIT IF YOU ARE NOT IN A NURSING HOME.
So iif the individual is on any Medicaid program: in-home, independent, assited, RCFE, or Nursing home, the Award is not counted.
(with the understanding that it is the VA that reduces the award to $90 in the nursing home if the person is using Medicaid)

Consistantly, low-income housing conciders the VA Pension as counted income

[VSR]

Yes, they do continue to keep the 35-45 (depending on the state) of their income AND the 90 from VA.  The reason as stated is that Medicaid does not look at the A&A award as income.
So iif the individual is on any Medicaid program: in-home, independent, assited, RCFE, or Nursing home, the Award is not counted.
(with the understanding that it is the VA that reduces the award to $90 in the nursing home if the person is using Medicaid)

Consistantly, low-income housing conciders the VA Pension as counted income

Medicaid considers VA awards as income unless they are on the $90 rate.  For example, if a surviving spouse was in receipt of DIC with aid and attendance, Medicaid would consider this as income and DIC awards can not be reduced to $90.  Only the $90 protected rate pension is not considered income by Medicaid.

[jpez]

from the MEDICAID MANUAL

MEDICAID                                     TREATMENT OF INCOME           02/09 SECTION 2405-2
BASIC  CONSIDERATIONS
(cont.)
Income Not Included in Determining  Financial Eligibility
The following are not considered income, and are disregarded when
determining Medicaid eligibility:
• bills paid by a third party (vendor payment) for an item
other than food, shelter or clothing
• conversion of a resource, such as selling a car to get
cash.
NOTE: The cash received from conversion of a resource is
not counted as income in the month of conversion. Any
cash remaining on the first day of the month following the
month of the conversion is a resource.
• credit life or credit disability insurance payments
• earned income tax credits (EITC)
• income tax refunds
• non-cash items which will be excluded or partially excluded
as a resource after the month of receipt, such as a vehicle
excluded because it is used for medical treatment.
EXCEPTION: Food and shelter are always
assigned a value as ISM and included in the
eligibility budget as unearned income for ABD
Medicaid A/Rs in LA-A, B or C.
• medical or social services provided as cash or in-kind
• proceeds of a loan
• rebates and refunds
• replacement of income which is lost, stolen or destroyed
after receipt (e.g., replacement government checks)
• return of erroneous payments
• value of personal services (e.g., mowing the lawn)
• Veteran’s Aid and Attendance
• Veteran’s Household Allowance
• Veteran’s Unusual Medical Expense (UME)
reimbursement
• weatherization assistance (storm doors, windows,
insulation, etc.)

[jpez]

from the MEDICAID MANUAL

MEDICAID                                     TREATMENT OF INCOME           02/09 SECTION 2405-2
BASIC  CONSIDERATIONS
(cont.)
Income Not Included in Determining  Financial Eligibility
The following are not considered income, and are disregarded when
determining Medicaid eligibility:
• bills paid by a third party (vendor payment) for an item
other than food, shelter or clothing
• conversion of a resource, such as selling a car to get
cash.
NOTE: The cash received from conversion of a resource is
not counted as income in the month of conversion. Any
cash remaining on the first day of the month following the
month of the conversion is a resource.
• credit life or credit disability insurance payments
• earned income tax credits (EITC)
• income tax refunds
• non-cash items which will be excluded or partially excluded
as a resource after the month of receipt, such as a vehicle
excluded because it is used for medical treatment.
EXCEPTION: Food and shelter are always
assigned a value as ISM and included in the
eligibility budget as unearned income for ABD
Medicaid A/Rs in LA-A, B or C.
• medical or social services provided as cash or in-kind
• proceeds of a loan
• rebates and refunds
• replacement of income which is lost, stolen or destroyed
after receipt (e.g., replacement government checks)
• return of erroneous payments
• value of personal services (e.g., mowing the lawn)
• Veteran’s Aid and Attendance
• Veteran’s Household Allowance
• Veteran’s Unusual Medical Expense (UME)
reimbursement
• weatherization assistance (storm doors, windows,
insulation, etc.)

What is intersting is the reference to A&A and not HOMEBOUND. Which further begs the question if the manual cares if it is Comp or Pension? Regardless, it is not counted. Which is one of the reasons this forum exists. To help the consumer better understand the system.

[vbcoder]

TOMBAY;

You need to check with the state she live's in because NC does count A&A and Housebound as countable income.

[VSR]

Yes, VA income is also considered income in Minnesota for Medicaid

[jpez]

I have a great deal of actual hands on experience (10 yrs) with 'Government Benefit Programs'. I have written 4 different 8 hour Continuing Education Classes for Attorneys and financial advisors and I would be willing to bet that they are 'counting' it incorrectly. I could tell you stories about locations who have done something a certain way for 5, 6 7 yrs and when asked to provide the source or code......nothing is there to back up the way the action was being taken. The had been (inbreeding) doing it wrong the entire time.  Think of how many seniors where denied a benefit because of "that's how we have always done it here"

What you have to understand is that for a state to 'get' Mediciad dollars, there have to follow Medicaid rules....unless the have an approved state plan ( CA w/ Medi-Cal & Mass w/ MassHealth are just two examples).  There are given latitude on some financial #s like the spousal impovershment dollars.  But the concept of 'counting or not counting' VA Pension is based on a fundamental principle dealing w/ disability awards. It would be like saying IRA income is not taxable in one state but taxable in another.

WHy is this important?
Because the day the general public understands that Medicaid isn't just about nursing homes and VA isn't just about Assisted Living Facilities AND that programs can be effeciently and effectively blended together to properly serve the seniors in CARE  with the most possible aid is the day that America finally provides the CARE that is deserved at the correct location.

[VSR]

I guess either way, considering that this is a VA forum, VA is required to drop beneficiaries in Medicaid approved nursing homes down to $90 regardless of what kind of coverage Medicaid provides them.

[jpez]

I guess either way, considering that this is a VA forum, VA is required to drop beneficiaries in Medicaid approved nursing homes down to $90 regardless of what kind of coverage Medicaid provides them.

Max, I am trying to be understanding of your lack of understanding.
MEDICAID is not about nursing homes!!!!!!!!!!!!!
Fine, Va pay 90 in nursing homes, thats over and done.
VA pay full benefits when some one is on medicaid in the community. And being on Medicaid in the community does not mean giving up Medicare.  Medicare is their primary health ins.
Only 3% of all seniors are in nursing homes. there is an 86% occupancy rate in NH today. it was 89% 10 years ago. There are less seniors in nh today 1.3 million than 10 yrs ago. 1.6 million.

Despite how much 'help' you might be giving on VA you have no idea about the real world of CARE. And that matters despite you not caring "what kind of coverage" Medicaid provides.
20% of all seniors are at home in some level of 'unpaid' care from a loved one.
80% of all seniors have less that $1600 a month of hard income. DO you not realize that they probably spend $500 a month on premiums, co-pays and rxs?

[jpez]

TOMBAY;

You need to check with the state she live's in because NC does count A&A and Housebound as countable income.

If that is actually happening, then they are incorrect. As per the Manual, the awards are NOT counted as income
Here is the page from the North Carolina Medicaid Manual:
http://info.dhhs.state.nc.us/olm/manuals/dma/abd/man/

B. Non-Countable Unearned Income
Do not count the following unearned income:

1. Supplemental Security Income (SSI) is non-countable unearned income, except for recipients budgeted as long term care. Refer to VIII.
2. Relocation payments.
3. Benefits from Food and Nutritional Services.
4. Food grown by a member of the household. If home grown produce is sold, count as earned income.
5. Child Nutrition Act and National School Lunch Act benefits.
6. Assistance from other agencies and organizations. This includes assistance provided in cash or in kind under any governmental, civic, or charitable organization whose purpose is for rehabilitation, special training, educational opportunities, or social services. This includes:
a. Vocational Rehabilitation (VR) incentive payments for training, education, and allowance for dependents.
b. VR cash received for payment of personal care assistance services.
c. VA Aid and Attendance and Unreimbursed Medical Expenses (UME).
d. VA aid to the homebound.
e. VA Reduced Improved Pension up to $90 received under P.L. 102-568.
f. Work First payments.
g. Chore services under Title XX.
Count items c. and g. for homebound PLA a/r as earned income when paid directly to a chore provider/attendant who is a Medicaid a/r.

REVISED 11/01/07-CHANGE NO. 22-07

http://info.dhhs.state.nc.us/olm/manuals/dma/abd/man/MA2250-05.htm#P529_26714

[vbcoder]

VIII. COUNTABLE UNEARNED INCOME

D. Veteran's Benefits
At application and review, explore potential benefits for each budget unit member. Even if the a/r denies that anyone receives the benefit, explore the possibility. An a/r or financially responsible person may not be receiving a payment due to recoupment of an overpayment. In this case budget the entitlement amount.

VA benefits increase at different times based on the increase in cost-of-living.

1. Potential eligibles include:
a. Disabled individuals with disabilities incurred or aggravated by military service and the spouse or dependents of such individuals.
b. Permanently and totally disabled veterans including veterans age 65 or older who have sufficient wartime service. The surviving spouse may be eligible for pension also.
c. Surviving spouse and dependent children of veterans who die in service or who died of a service connected disability.
d. Parents of a veteran who died in service or of a service connected disability when the veteran has no other surviving dependents.
2. Verification
a. Send verification letter (figure 7) to VA Regional Office Claims Division, 251 N. Main Street, Winston-Salem, North Carolina 27155. Requests must include:
(1) Beneficiary's full name, and
(2) VA claim number or any two of the following:
REVISED 11/01/07-CHANGE NO. 22-07

(VIII.D.2.a.(2))

(a) Veteran's military service number. The veteran's military service number may be verified by the local VA service office, or
(b) Veteran's Social Security number, or
(c) Veteran's date of birth.
b. Award letter. However, a general increase may have occurred since the date of the award letter.
c. Current check
3. Budgeting
a. Count the monthly VA benefit entitlement for the budget unit member unless:
(1) The a/r is a student who is receiving VA benefits to pay for tuition, fees, or other necessary educational expenses;
(2) The VA payment is Aid and Attendance and/or Unreimbursed Medical Expenses; this does not apply to veterans who reside in a North Carolina State Veterans Nursing Home. Refer to MA-2270, Long Term Care Need and Budgeting; or
(3) The VA payment is the Reduced Improved Pension up to $90 received under P.L. 102-568.
b. Aid and Attendance (A&A)
(1) Aid and Attendance benefits are only issued to veterans or the spouse of veterans. The Adult Helpless Child allowance is not the same as Aid and Attendance and is countable unearned income.
(2) Need for aid and attendance is considered to exist when the veteran is so nearly helpless that he cannot care for himself without the services of another person. VA recipients who receive aid and attendance are entitled to higher VA income limitations or additional VA benefits, depending on the type of pension received. Aid and attendance can be received by:

http://info.dhhs.state.nc.us/olm/manuals/dma/abd/man/MA2250-07.htm#P1376_75136