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There’s huge emphasis on the $$ aspect on Medicaid but they have to show need for skilled nursing care for NH Medicaid as well. If part of health history, ICD codes/diagnosis, even RXs are left off the medical part of the application, it may not pass Medicaid eligibility review. Medical is facility responsibility.
Your Mom between her SS, her teacher pension & the A&A.... when added up, is taking her above whatever her state has set as the monthly income limit for LTC Medicaid. Like for my late mom the mo income max was $2,064; my mom got $900 SS and 1k from dads retirement so under $2064 but if she had a teachers retirement of $500, she would have been at $ 2400 so $336 over the income limit & so ineligible for Medicaid. So she would have needed to do a Miller Trust to deal with the $336 overage so qualify for Medicaid.
I’d bet your mom’s situation is somewhat along these lines. BUT her overage is coming from the $1,100 VA A&A. As it’s VA it’s totally fixable but not via a Miller. Instead Mom can file to get the A&A “suspended”. Suspended rather than relinquished. Once that happens, VA switches to paying her just a $90 a mo personal needs stipend. The $1100 a mo stops, so no more counting as income. The VA personal needs $90 will be extra $ for her to each mo AND will be in addition to a personal needs allowance that her states Medicaid program allows her to keep. For my mom the PNA was $60 a mo, so if dad had been a vet (instead he was a federal civil servant), mom would have had both $60 & $90 a mo as fun $$ each month.
My understanding is that A&A as a source of $ works fab for living at home or IL or AL or while in spend-down mode as between thier savings, retirement $, SS, & VAs A&A there’s enough $ to cover costs of care. But once they move into a NH with its cost from 5k - 15k a mo, there likely isn’t enough $$$ to cover NH costs. But if they go onto Medicaid, it will cover thier NH room&board costs totally. So they suspended VA A&A (as double dipping now not allowed) and apply instead for Medicaid. Comprende?
The sticky in this is that the Medicaid caseworker isn’t factoring in what happens once A&A is suspended. Ditto for billing at the NH. I’d try to get with the SW at the NH to see if they know of a at-no-charge VA benefits counselor. Get them to help your mom bridge the application / suspension. There’s gonna be a total butt-rash lag time between the months VA still paying A&A and Medicaid eligibility. VA should eventually claw back the $$$ paid, so don’t spend it or pay the NH the $1100. NH should just be getting paid mom’s required copay or SOC (share of cost) that is based on what her SS & pensions pay to her, & this figure based on her annual “awards letters” which she received in November that states to the penny what she’s getting paid for 2018. Like for my mom, she basically had a monthly copay of $1840 a mo to the NH ($1k + $900 - $60 personal needs allowance) which I paid by check to the NH from her checking account and built each mo by her PNA. Personally I’d caution against letting the facility become the direct deposit payee for moms incomes sources as there is going to be accounting issues till all smoothed out plus it allows you to use her VA$90 and state monthly PNA $ more as you determine.
There’s quite a few posts on this site over in the VA Q&As on dealing with this.
Make yourself a fresh pot of coffee or favorite adult beverage and jot down notes to ask the SW at the NH. 😉.
Actually, the finance officer or Social Worker at the home should know about A&A and if it can be used for LTC.
See if her nursing home has a social worker who can help you with the process. My brother in law is handling this as he lives in the same town as her. If we need to hire an attorney we will use some of her remaining funds to do so.
It's sad that this process is such "a secret" and people aren't aware of the trust. I read about it on this site months ago and immediately called BIL and told him to talk to the social worker about it so that we could be ready when her funds run out.
https://www.va.gov/GERIATRICS/Guide/LongTermCare/Paying_for_Long_Term_Care.asp
I had another link on home care but it's no longer valid and I need to check it out to figure out what happened, but hopefully the link above will still be good when you try it.