A & A and Medicaid

[Fit2009]

It really is state by State - in Massachusetts you can keep the A&A income not spent in the month indefinetely and it does not count against you for Medicaid purposes...ERBC has a North Carolina Medicaid and the VA page http://www.elderbenefitsconsulting.com/medicaidandthevapensi/northcarolina.html Which revelas that the A&A and Unreimbursed medical expense components will not be counted as income and that amounts received need to be spend by the end of the month after receipt.

[jpez]

A further question on this if I may jump in...in our State A&A is excluded from eligibility for medicaid purposes but I'm thinking about how this actually works.  When I apply for medicaid we will have spent down to 2K.  So does the 2K exclude all of the money that we have received from A&A since my loved one has been accepted?  If this is the case, my loved one will be eligible for medicaid sooner than otherwise. For example, she may be eligible at 10K if eight thousand of that is attributable to A&A.  The A&A money is not currently kept in a separate bank account from the rest of her money, if that makes a difference.  It will be after I have been declared fiduciary but I'm waiting for that process to finish so that I have instructions as to banking.  Cheers, Annie

Annie, the advise was incorrect. Income (for medicaid) is the money recieved in the month. The next month any money left in the account is now an asset.  it is not still concidered A&A. so if you have 8k in the chking acct you are over the asset limit.

[Fit2009]

Hi Jpez,
I don't think the answer is incorrect - in North carolina, you have until the end of the month after receipt to spend the funds before they are counted as an asset - here is the referenceAdult Medicaid Manual MA-2230 FINANCIAL RESOURCES REVISED 01/01/10 - CHANGE NO. 09-10
I. POLICY PRINCIPLES
A. Resource Policy Rules
6. The following are not considered resources in determining Medicaid eligibility or transfer of assets.
a. [...]...For one calendar month following its receipt, cash paid by a recognized medical or social services program is not a resource provided the cash is not income and not repayment for a bill already paid.
 
I believe the preceding regulations show that A&A would fall under this exclusion.  End of the month after receipt is a common concept in Medicaid, several other states do it this way, but perhaps I am missing something.
Let me know if you disagree -

[jpez]

Hi Jpez,
I don't think the answer is incorrect - in North carolina, you have until the end of the month after receipt to spend the  
6. The following are not considered resources in determining Medicaid eligibility or transfer of assets.
a. [...]...For one calendar month following its receipt, cash paid by a recognized medical or social services program is not a resource provided the cash is not income and not repayment for a bill already paid.
 
I believe the preceding regulations show that A&A would fall under this exclusion.  End of the month after receipt is a common concept in Medicaid, several other states do it this way, but perhaps I am missing something.
Let me know if you disagree -

Well, there's a sentence to chew on!!!  lol
The way 'income' works: income is not a countable asset in the month it is recieved.  we all agree here. with the example above. So income in october does not count against the $2k limit. vet has 1999.99 and recieves variuos income totaling $ 2457 and he is eligible for Medicaid in October.  He has bills for $2400 and spends it in October. On Oct 30 he has$ 1999.99 +57= $2056.99.  He is still eligible for October because he was below the allowable limit ($2k for a single) one day in the month. Which was the day he had 1999.99.
Remember the rule is any one day, not ‘the last day or the first day”.
Now nov 1 he has $2056.99 he is still eligible, as long as at some point he gets below the allowable limit (2k). So the $57 of income that is left over from October is now a countable asset.
On to your question:
For one calendar month following its receipt, cash paid by a recognized medical or social services program is not a resource provided the cash is not income and not repayment for a bill already paid

I assume we know if the VA pension is “a recognized medical or social services program”?
If it is then the question is: is pension NOT income?  I really don’t know.  HUD housing says ANYTHING is income. So does SSI.  Medicaid says VA PENSION (for disability) is not counted as income in the month received.
Now the kicker, a lot of ‘people’ say “va will help pay your assisted living” so that would make it a repayment……..
BUT VA pension is NOT a repayment.
 Think of it as supplement for being ‘low net income’. But it is NOT income.!!!!! (hopefully you are starting to laugh…….)
But even if it all were true, in the NEXT month you would still have to resolve the issue because now it is an asset.
 

[jpez]

Again, when in a Nursing Home on Medicaid, you only recieve the $90.

BUT where this whole issue can really help is when the VET is not in the Nursing home, but living in the community.

Example: in CA we have InHome Supportive Services. up to 280 hrs at about $9 hour paid to a caregiver. (the care giver doesn't have to qualify for medi-Cal)
THe single vet with alzhiemers has $850 of SS and 2k in countable assets. Owns his home.  He qualifies for Medi-cal, IHSS, QMB (medicare A &B) and Extra Help (medicare Part D). hes has ZERO share of cost and pays no $97 uot of his SS check. His Rxs are $2-6 and no donut hole or premium. He get a caregiver for 280 hours each month (720 total hours in a month).
His daughter lives with him and provides care and oversight for the rest of the time (IHSS is only 9 hrs aday).
She applys for VA Pension w/ Aid&Attendance rating and he gets it. Vet is paying her $850 a month. Vet recieves $1640.
THe VA Pension A&A is NOT counted as income in the month recieved. But is counted as asset if just left in the account in the next month.
Now the is $2490 of income each month. But Medi-Cal(and Medicaid) consider him at poverty level of $850.
This can be very powerful because the majority of seniors only have there SS each month.
I used an example that is at the national poverty level. if the income was slightly higher, there woul;d be a share of cost but all of the programs would still be in place.
Also, what if he was just 'homebound' and not A&A? He would still recieve $1204 from the VA.

[Fit2009]

So, I believe my advice was correct - in NC, the VA pension is not considered income in the month of receipt (very clear in the NC regs) and lump sum payments from non-income programs are not counted as a resource until the following month.  In many states, you apply for A&A and then someone erroneous tells you to cancel out because your parent has gone to a nursing home and is spending down - but if that lump sum payment is needed - for debts or say a funeral. comfy chair for the applicant's room or dental work etc, let it come in and have a plan to spend it within your states limits.  In states like NC, you can get your back pay and contiune with your $90 - just spend it in time.  This is a response to the NC question only, not the living in the community post that follows.

[Snuffy]

Medicaid laws vary from state to state; however, if you file for Medicaid the most that would be awarded in A&A benefits would be $90.00.  For Medicaid purposes, the $90.00 cannot go towards medical expenses, and needs to be spent on personal items.

Is there any documentation (electronic copy or link) explaining the reduction of A&A to $90 once the Vet or Veteran's dependent goes on Medicaid?

I have been asked to provide that documentation to the Medicaid rep as we wait for instructions from the VA to return all but $90 from the A&A benefit.  In the meantime that money that is not her's is causing her bank balance to exceed the max of $2,000.

Thanks,
Snuff

[vetadmin]

I am not aware of a link to suggest to you, but there may be something on the VA's website referencing it.  Although it may not be written in language easily understood.

You may be better off calling the VA and asking them for assistance in clarification on it.

If anyone on the forums has already encountered this issue, hopefully they will step up and share.

[nananorma]

FYI - information is on the EVR instruction form.

[vetadmin]

Thanks!

[Snuffy]

FYI - information is on the EVR instruction form.

Excellent!  (Sorry, I should not have posted this question twice.  A more complete answer is provided elsewhere.)
Thank you both!

Snuff