Aid and Attendance and Medicaid - New Administrative law decision

Discussion in 'General Discussion' started by magnumpi28, Jul 21, 2009.

  1. magnumpi28

    magnumpi28 Jr. Member

    A May 27, 2009 Administrative Law decision in Georgia addresses the impact of Veteran's Administration Improved Pension with Aid and Attendance benefits on Medicaid eligibility. M.W. v. Georgia Department of Human Resources, reprinted here, concerns a nursing home resident who was the surviving spouse of a veteran and who was receiving Improved Pension with Aid and Attendance from the VA. The VA benefit was comprised of an aid and attendance benefit and a widow's pension.

    M.W. applied for nursing home Medicaid but was denied due to excess income resulting from her VA benefits. If the VA benefits were not considered as countable income, M.W. would have been approved for Medicaid benefits. However, although Medicaid excluded the aid and attendance portion of the VA benefit from the applicant's countable income, it included the widow's pension as countable income.

    Medicaid's denial was reversed by the Administrative Law Judge. The ALJ reasoned that, with regard to M.W.'s VA benefits, her income exceeded the maximum annual pension rate, and she would have been ineligible for VA benefits, if the VA had not deducted Unusual Medical Expenses(UME) and Continuing Medical Expenses(CMA) from her income. Therefore, the ALJ concluded that M.W. received VA Improved Death Pension with Aid and Attendance to reimburse her for her out-of-pocket UME and CME.

    The ALJ noted that, according to Georgia's state Medicaid Manual, UME/CME reimbursements and A&A are never considered as income for determining Medicaid eligibility. Consequently, the ALJ concluded that the entire amount of M.W.'s VA benefits must be excluded as income, for purposes of Medicaid eligibility, because M.W. only received the VA Pension with Aid and Attendance to reimburse her for her out-of-pocket UME and CME.
  2. KarenO

    KarenO Jr. Member

    Do you know how Florida treats Aid and Attendance - is it counted as income for determining medicaid eligibility?
  3. magnumpi28

    magnumpi28 Jr. Member

    Hi Karen...This is what i found from the flordia medicaid manual...
    1840.0906.05 VA Aid and Attendance (MSSI, SFP)
    The policy does not apply to OSS.

    The VA provides additional compensation when the individual needs routine aid and attendance by another. This compensation may be paid to disabled veterans and to spouses, widows, widowers, and parents of veterans. Aid and attendance payments provided to an eligible individual and paid by the individual to his ineligible spouse, parent, or child living in the same household in return for taking care of him are excluded from income for deeming purposes. Aid and attendance payments made directly to the ineligible spouse, parent or child on behalf of the eligible individual are also excluded as income for deeming purposes.

    Note: If an ineligible spouse or parent receives payments for services provided to anyone other than his eligible spouse or child, the payments are included as earned income subject to deeming to the eligible individual.

    VA considers an individual in need of regular aid and attendance if the individual is categorized as one of the following:
    1. blind or nearly blind,
    2. a nursing home patient due to mental or physical incapacity,
    3. unable to keep clean and presentable without assistance,
    4. unable to dress or undress without assistance, or
    5. has frequent need of adjustment of any prosthetic or orthopedic device and the adjustment cannot be made without assistance
  4. KarenO

    KarenO Jr. Member

    Thankl you so much for taking the time to research this!!

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