A & A and Medicaid

Discussion in 'General Discussion' started by jbryant916, Jul 10, 2010.

  1. jbryant916

    jbryant916 Newbie

    We are beginning the process to apply for A&A for my mother-in-law. Right now, she is paying to live in an assisted living facility from her own resources. By the family's calculations, she will literally be out of money in about 9 months, and we are also preparing an application for Medicaid. My question: If she should be approved for A&A, and then subsequently goes on Medicaid, will the A&A benefit continue to be paid directly to her? (A&A and her Social Security benefits combined would not cover her monthly expenses).

    Thanks much for any insight on this. If the A&A would have to be forfeited/surrendered because she was on Medicaid, we're wondering if we should even bother with the A&A application, given the time required to process the claim. Thanks again.
  2. vetadmin

    vetadmin Administrator Staff Member

    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.
  3. jbryant916

    jbryant916 Newbie

    Thanks much. That's kind of what we were thinking. OK, we can make a decision as to whether to apply with that information. Although, $90 bucks is $90 bucks....
  4. vetadmin

    vetadmin Administrator Staff Member

    Yes it is, and in this economy even more so.
  5. AngelaManz

    AngelaManz Jr. Member

    Aid and Attendance isn't paid in full if someone is in a nursing home. When that happens, only $90 per month is paid. But Medicaid doesn't typically pay for assisted living. In Virginia, there is a small auxillary grant that can help with assisted living costs, but it's hard to obtain and very small. So if your mother-in-law stays in assisted living, with some kind of Medicaid grant benefit coming in but not paying the full amount of her care, then she could potentially keep the full A&A amount (since assisted living is not a nursing home). However, if Medicaid is paying for all of her care, then she would not be able to keep the full benefit.
  6. Max

    Max Hero Member

    Its also worth noting that the $90 rate does not apply to vet's with dependents or vets in veterans homes, even if they are covered by Medicaid. I'm pretty sure it also doesn't apply if they have Hanson's disease (leprosy)
  7. AngelaManz

    AngelaManz Jr. Member

    I thought I had heard it all, but I did not know about the leprosy. Very interesting. Thanks Max
  8. jeannes

    jeannes Newbie

    I, I am new here and am not sure this is the best place to post...here or start a new thread. Mom is getting VA A & A, plus SSR and a small pension. We moved her into a nursing home about 3 months ago. We are starting the process of applying for medicaid. I can not find...and I have looked... if Texas counts the A&A as income. My dilemma is this...if they do count it, then I need to establish a Miller trust, as her 3 sources of income put her slightly over the $2022 monthly income limit for Texas Medicaid. But as I understand it...if she is accepted for Mediciad, then the A&A benefit drops to $90/month...which would put her below the income limit and I wouldn't need the Miller Trust. As she is not quite 'there' due to assets, wouldn't it be easier to just start petitioning the VA to drop her benefits to the $90? She has enough in assets to cover the reduction in monthly income for at least 3 months. Any thoughts? Thanks!
  9. KarenO

    KarenO Jr. Member

    My understanding is that A&A is not counted as income for purposes of Medicaid eligibility but after you go on Medicaid the A&A drops to $90 as you mentioned. My Mom lives in Florida but I am not sure if this is state specific.
  10. Fit2009

    Fit2009 Sr. Member

    Hi Jeannes, KarenO is correct - it is by State, but most follow the federal regulation to exclude A&A for eligibility purposes - those that don't are usually just doing it incorrectly, some have more liberal rules.
    This site has a few of the specfic states regulations - here is their Texas link:
  11. AnnieN

    AnnieN Newbie

    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
  12. vbcoder

    vbcoder Jr. Member

    AnnieN ;
    The way I understand it is that Medicaid in most state do not count A&A benefits as income but once it's in a bank
    account it's considered an asset.As you know, the bank account can not exceed $2000 at any time to qualify for Medicaid.

    If I'm wrong maybe someone will correct me.
  13. tkharr

    tkharr Newbie

    Does anyone know how the rules for Medicaid and A & A apply in North Carolina? If someone had Medicaid first, then received the death pension benefit but later received an increase to the point that it put the recipient's medicaid eligibility in jeopardy, then how can this be resolved?
  14. AngelaManz

    AngelaManz Jr. Member

    For Medicaid, income is considered as "income" in the month it is received, and only as an asset if it is held into the next month. A&A is not considered as income for Medicaid purposes. However, if the A&A income is held by the Medicaid recipient into the next month, such that his/her assets are now over $2,000, then that will cause ineligibility for Medicaid. The easiest way to handle that is to purchase something that the Medicaid person needs to keep them under $2,000 in countable assets.

    If the person has Medicaid first and is in a nursing home, then that person will only receive the $90 per month of A&A. This is in addition to the $40 personal needs allowance that Medicaid allows the person to keep. The same rules apply though - the person on Medicaid cannot have more than $2,000 in assets.

    The statement that the bank account cannot exceed $2,000 at any time is not correct. As stated above, money received during the month is income and not counted as an asset unless it is held into the next month. So for example, if Dad has $1900 in his account and goes on Medicaid, when he receives his income of let's say $2000, it will look like he is over the asset limit. But he is not because he will pay his patient pay, keep his personal needs allowance, and then at the end of the month he should have $1940 (assets he started with, plus personal needs allowance). At some point, the $40 per month will cause his assets to go over $2,000 and then he will need to spend a little bit to get back under.
  15. vbcoder

    vbcoder Jr. Member

    Best way to get the correct answer is to give the wrong answer...hehe..

    Thanks AngelaManz for correcting me...I should have stated that the monthly balance should not exceed $2000...
  16. Fit2009

    Fit2009 Sr. Member

    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.
  17. jpez

    jpez Full Member

    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.
  18. Fit2009

    Fit2009 Sr. Member

    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
    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 -
  19. jpez

    jpez Full Member

    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.
  20. jpez

    jpez Full Member

    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.

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