Does paying $400 a week count toward "spending down" for Medicaid qualifications for an Alzheimer's patient with a VA pension?

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My mom receives SS and Va pension overqualifying her for Medicaid. We spend $1,400 a month for caregiver service while i am at work. Dad died in Vietnam War.

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If dad died in Vietnam you must first distinguish as to whether mom is receiving "Compensation" or "Pension" You stated pension (I am also assuming dad was not career military) so I'm going to go with that.
The answer will depend to some extent on what state mom resides in and what Medicaid services you are applying for (Home and Community Based Services -"HCBS" or Institutional).
Basically, you need to know this:
There are three levels of pension; basic (the lowest), housebound, and aid and attendance. In most states only the "basic" benefit is counted as income for Medicaid eligibility purposes because the balance is presumably going to "cost of care".
Except for allowance for personal care expenses, or in the case of HCBS an amount stipulated by the state, all income will be going to cost of care in any event.
The problem, therefore, will be with respect to the net VA pension income that will be countable for Medicaid eligibility purposes. If, after determining this amount, mom is still over your state's income cap ($2,022 per month in most states) the problem is easily cured by a provision in Federal Law in OBRA '93.
The provision provides for the establishment of what is known as a "Qualified Irrevocable Income Trust" (QIT) otherwise referred to as a "Miller Trust" or simply "Income Trust". The trust allows income over the income cap to be diverted away from the applicant for qualification purposes. The excess income is placed in the trust each month and in the same month is distributed towards the applicant's cost of care.
Some states provide QIT's through their Medicaid offices (e.g., Texas). Others, like my state of Florida, do not and attorneys will charge up to $1,800 to provide this document...which should, in my opinion, be a crime.
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When I applied for VA benefits for my Mom I asked about this issue. I was told that, if Mom ever needed Medicaid, that they could remove the VA benefit in order for her to qualify. I'm not certain about a VA "pension," however.
You really need to talk to an elder care financial advisor or attorney that specializes in Medicaid. There are so many rules and the last people to call for information are those at the VA.
PS: I would call your local ALF and ask who they use to help their residents file VA paperwork. Then call that company and ask for a referral for a Medicaid advisor...they usually have someone on staff.
good luck
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Thank you very much. I am currently trying to get someone from Social Services to tell me if the money I am spending on caregiver service is infact "spending down". If it is the case, then she should qualify for assistance. I am also seeking a consultation with a va certified elder attorney. Our biggest problem is that none of us have the "big bucks" to afford the attorney.
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Mr. Robbins, Thank you so much for taking the time to respond and give insite to my situation. My dad was career military and died at the age of 36 just months before his tour was to be completed. He joined at the age of 14! My mother does receive his pension of $1,194 as well as $286 for Aid and Attendance which I applied for because of being homebound and receives social security. totaling $2,156. Department of Social Services did tell me the aid and attendance was not counted as income but she was still over qualified. To some this amount may seem to be a lot of money until you add day care at the rate of $350 a week.
Since I have last signed on to this site I have (with the help of very good friends) written the director of DSS and I have been informed that they are willing to take another look at the information. I will have to re apply to determine if Mom qualifies. Letters have also been sent to state representatives and congressman for notice and assistance.
As a single educator, I will have to return to work in a month and Mom is too advanced to be alone and needs assistance but not sure if the time is right to place her in a skilled facility.
I have never heard of the OIT/Income Trust but very much appreciate you bringing this to my attention.
People like you are a very valuable asset to those of us who are just beginning to find our way around the system. Thanks once again.
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