We were instructed to file for both Medicaid and VA when my 92 year old father-in-law fell and broke his hip. We had to put his dementia wife in Memory Care as we had no idea how long he would need recover and go home, if ever. Up to this point he had been taking care of her. After the hospital, he went into rehab. From there he went into assisted living. He fell in Jan. and was approved for Medicaid in April. As was his wife. He was in assisted living for one month and then returned home. That lasted a month and now he is in a nursing home permanently. Today I received a notice from the VA saying he is entitled to a $600 benefit. What do I do first? Notify Medicaid, VA or the nursing home? Who is entitled to that money? Do I just send it back?
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I'm assuming its a VA Aid & Attendance benefit. If the VA $ is going to be or has been direct deposited (bet it is) then just leave whatever $ from VA in his bank account. If it was me I would NOT call VA just yet, it will only make things more confusing. There likely will be other VA payments coming in. They will do a clawback eventually…… SSA and federal retirements do clawbacks, (for my mom SS was within a month but feds took 3 months) so I'd imagine that VA can too. Just let $$ sit in FIL bank account. Do NOT spend it or pay it towards his NH stay.
What I'd suggest is to make more a top priority to deal with is what FIL & MIL need to do & pay to have their MC & NH payments Medicaid compliant. With MC & NH costing an average of 7K month, that's 14K a month that must be paid one way or another. The VA $ can just sit there….. till it must be repaid. Medicaid is more important to get done correctly.
Did anyone explain how income gets reviewed for Medicaid? If not, here's my take on this: for individuals on NH Medicaid, it's pretty straightforward in that all monthly income (SS, retirements, pensions) paid to NH as their SOC (share of cost in Medicaid speak). But for couples, well it's oodles more complicated and for you all it sounds even MORE COMPLEX as she went in MC & onto Medicaid (correct?) but he was - I'd bet - viewed by Medicaid as a "Community Spouse" & then also applied for a VA benefit. CS can have it so that monthly income that MIL would normally pay for her SOC can be diverted to CS as a CSRA or MMNA. (Community Spouse Resource Allowance or Monthly Maintenance Needs Assessment) Think of it as sort of alimony for the nonNH spouse. Now as long as FIL was either at home, or in rehab or even in AL, he was viewed as a CS and could have CSRA. Plus while FIL was at home, in rehab & maybe even in AL, it was the same for the $ 600 VA. But now both FIL & MIL have to pay almost all their monthly income to the MC & NH as their Medicaid SOC as they are both in long term care. Long story short is that your states Medicaid program will need to do an updated review to determine their correct income & finances to come up with what their new SOC is. It is not a figure done by the MC or the NH but based on a figure in a letter from your state's Medicaid program.
You can kinda figure out roughly what the SOC will be by looking at their awards letters - the info submitted with their initial application that comes from SSA and any other retirements that state to the penny what they will be paid each month for 2017. For SSA they are a trifold that is mailed in Nov/Dec of 2016. Their Medicare monthly payment and their PNA's get deducted from SOC due.
To make this more confusing realize VA $ 600 Aid & Attendance will not be income to be paid as part of the SOC to the NH as it will cease & get clawed back for any months paid in error. Medicaid might have to add it in the income formula but then it should be subtracted to come up with the correct SOC. It is a situation ideal for snafu's with Medicaid and the billing department at the MC & NH and the VA. I'd suggest you find out ASAP who the Medicaid caseworker is for each facility (it's likely a caseworker assigned to all facilities within certain zip codes) and speak with them directly and follow up all conversation with a letter or fax that recaps your understanding of what's what. Yeah it's work but if there's a clusterF, it's thousands and thousands of $$$$ involved. After you speak with the caseworker, then I'd send a letter to VA (there may be a form that Medicaid gives you to send to VA).
And for even more confusion, there will still be a VA benefit paid. BUT instead of $ 600 Aid & Attendance, VA instead pays $ 90 a month as a VA personal needs benefit & this $ 90 is NOT included in the SOC. Medicaid also has a personal needs allowance that is too is NOT included in the SOC. Now just what the Medicaid PNA is varies by state. Like for my mom in TX, her PNA was $ 60 a month and if she had had VA benefits would have had $150 ($60 + $90) a month as her personal spending money but all her other income would be paid to the NH as the required SOC. Your MIL should have gotten her PNA placed somewhere for every month she has been in MC and on Medicaid. If it's been going into an account for her at the MC, please find out how much it is.
Just how long it takes for the VA to catch up and claw back, I'd bet will take 4 months. AND to add to the complications, probably the time FIL was in rehab & at home will be considered a valid VA payment (he was not in a long term care situation). So if 2 months, that's $1200 that will be his $ but will be viewed as an asset by Medicaid. AND keep in mind that 3K is the asset limit for couples Medicaid. You don't want to have them go over 3K and jeopardize Medicaid.
Really try to spend their PNA each month till VA correction / Medicaid SOC gets resolved. Even if it means they have a stockpile of toiletries, hearing aid batteries, shoes and clothes sitting in a room at your house. Have them sign up for barber & beauty shop each month. Try not to get too overwhelmed in all this, it will work out eventually. Good luck!