None of the VA participating nursing homes will accept my husband with Frontal Temporal Dementia. How do I get him into a non-participating nursing home with VA responsible for financing cost?

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He moves from being VA funded to becoming eligible for LTC Medicaid.

Ltc Medicaid will pay his room& board costs. Then between Medicare and Medicaid, his medical costs should be covered. He would become a “dual”.

For LTC Medicaid he will need to do an application for it along with a set list of documents to show he’s “at need” financially. My experience is that the NH that has available Medicaid beds gives you a list of what’s needed documentation wise and you gather these up and then go back at the NH where the application gets filled out; they look at the documents and he goes in as a Medicaid Pending admission.

If he already is is on VA Aid & Attendance, that will be suspended for him by the VA. The NH should put the A&A $ down but it gets excluded from available resources by the Medicaid caseworker. Once on Medicaid, He will instead go to a $90 monthly VA personal needs allowance.

If he is on A&A this is important....... Medicaid will retro payments back to the date of the Medicaid application. Applications can take 2, 3.... 5 or 6 months. All those months VA will likely still be paying his A&A, you cannot, again cannot spent it, as VA WILL WANT TO CLAWBACK THE $. VA seems to move glacially, so it could be months of VA $ in his bank account. Leave it there as eventually VA will want it reimbursed back.

If for some reason they - the VA - don’t and you get a letter stating that no recoup, no recovery, no reimbursement required,then you like immediately go and buy a fully paid preneed funeral and burial for him or find another big ticket item (wheelchair, dental work) to spend on within the month of the letter to get him under the 2K maximum of nonexempt financial assets. If he wants to be buried at the VA cemetery, I’d really suggest you speak with a FH that will be taking his body and doing the funeral service as to what charges are outside of what the VA pays for. Getting buried at VA cemetery in my experience is way way way backlogged. It could be weeks before in ground burial could happen. A lot of this seems to be dependent on what National cemetery he’s going into. So there may be 2 events: a viewing at the FH, then in ground later at one of the National cemeteries. My WW2 FIL is buried at Santa Fe National, but MIL died like 4 yrs ago and it took like 5 mos for his plot to be opened for her cremains. Santa Fe is unusually long as I think this one is technically full so no new service member burials; it’s really old old national cemetery, like Spanish American war dead buried there. Had it been a body, it would had had to been held at FH till an in ground could be scheduled with VA. My mom’s FH told me that Ft. Sam cemetery (newer & huge) was taking like 3 - 4 weeks to get in ground done as VA flat understaffed.

Under LTC medicaid rules, he must pay his monthly income to facility, but that monthly income would be like his SS monthly or his other retirement income. But you as his spouse may ask for a waiver of his income to go to you to enable you to live in your community (CSRA or MMNA). VA Aide & Attendance is not a retirement income resource.

Really it may be simpler to move him to LTC Medicaid. I will say, that as you will be a “community spouse” for Medicaid, you want to get with an NAELA atty in advance of application to possibly move $ to maximize the CSRA (community spouse resource allowance) that hubs needs to pay to you instead of all going to the NH. But you need to do this ahead of the application as Medicaid affixes assets/income as of the date (the “snapshot” day) of the application. Medicaid does not require CS to themselves become impoverished, only hubs needs to. But just how to do this is not simple. Plus you’re overwhelmed in day to day caregiving.
For a CS, really to me you need an atty to come up with best options for your unique situation. Good luck.
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I am sorry to be the bearer of bad news but the VA will not finance 100% of the cost of a nursing home. They will cover up to half of the cost.
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Karsten Jan 2019
My dad did get 100% at a VA contract home as he was also on hospice. Had he not been on hospice, he would not have qualified However, Debis dad is 100% disabled and that often allows you to get in free. I don't understand why they are not accepting him.
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Unless a nursing home has a contract with the VA, the VA will not assume nursing home costs. Even if you qualify for Aid and Attendance, that alone will not take care of it?

Does your husband have funds? If not cant he qualify for Medicaid? If he does have funds, you may have to pay out of pocket until he is out of funds (not including allowances).

But why wont the VA contract homes not accepting him?
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