My mother, currently under New York's home-care Medicaid , just received a large payment from the Veterans Admin (as a surviving spouse) after over two years of arbitration. When I initially applied, she was in assisted living, and the payment was to offset the costs of the facility. The VA did not approve immediately and I had to assist in paying from my personal savings as my mom's savings were insufficient.

During the interim as I fought the VA to get my mom her due payments, we switched services and applied and qualified for Medicaid homecare services where she could return to her rented apartment with 24-hour care. This obligated us to adhere to the spend-down income and asset structure.

After multiple VA interactions we finally won the case but, I now have a set of uncashed checks from the VA including one large check covering two+ years of monthly VA pension payments and a set of regular monthly checks. I have neither acknowledged receipt nor cashed these checks for fear of disrupting my current Medicaid homecare and the inevitable Medicaid nursing home application.

My questions:

1) Am I able to deposit this larger check and have my mom repay me to help offset payments that I paid to cover my mom's assisted living care two years ago? I have kept all receipts and have evidence of my personal payments.

2) How do I go about recalculating spend-down to accommodate this new VA income? Medicaid told me to just advise the local office and let them figure it but, I am afraid that Medicaid will tell me I am over the limit and cancel my mom's Medicaid.

3) Looking to the future, how will my actions affect mom's eligibility for nursing home care with the 5-year lookback? These are legitimate debts to my wife and me.

I have already informed the VA that mom now receives Medicaid. They may reduce the monthly payment to the minimum but, I still would need to deal with a large un-cashed check.

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Thank you for this information; I appreciate your advice. I have already asked the VA to look at their analysis again and confirm, or reassess. I expect this will take them a couple months and would expect they won't pay more than that 90 USD monthly minimum. I will tabulate my expenses over the past 3 years. My priority is to maintain this 24 hour care . (Yes, Igloo572, I was amazed that we got the 24hr care but, apparently it can be done. Actually, she has 12 hour care but, the aide sleeps in her home during the night. It is not pure 24 hour care). Medicaid Home Care is different than Medicaid nursing home care (in New York, at least). The maximum monthly is about 800 USD but your assets can go as high as 14K. It seems that VA payments are not counted as income. I am not sure whether this pertains to the more strict nursing home medicaid. We looked at New Hampshiire as my sister is there but, my mom wanted to return to her home and this home care program was attractive.

Garden Artist, the checks have a statement printed on the front that they are good for a year. This gives me a bit of time to do my due diligence.
Helpful Answer (0)

As a added thought on the bonus funds, I would hold off on spending down. Try to clearly find out in writing if VA will clawback monthly payments for all months mom has been on medicaid.

For NH LTC Medicaid, VAs A&A stops once they are on NH LTC Medicaid. It drops down to $ 90 a mo. But I don't know if this is also done for those still considered to be living in the "community" and getting A&A.

I'd bet a case of Prosecco that VA A&A will stop & they will attempt a clawback as mom is getting 24hr care paid by Medicaid. (how you were able to even get 24 community based care is probably a whole novel in & of itself...). Coukd be months for the match up to happen.

If you want to be very OCD on this, you may want some sort of memo of understanding between you & mom (if shes competent) as to your fronting express for her to be reinbursed. It is after the fact - which isn't ideal - but could be good to have just in case.
Let us know what happens too. Thanks!
Helpful Answer (1)

To lessen issues I'd suggest mom & you open a new checking account at the same bank where she already does her banking & place all the VA checks into this new account. You get the VA oayments to switch direct deposits to now go into this account as well. You name it VA and have this written on the checks. Account is In moms name but you as a signature (as your her DPOA) & POD to you. As we are about to start June, try to get this done ASAP so you can get reinbursement payments all through the new acct by end of June.

This way no commingling with the other banking already in Medicaid system.

You fronted expenses for mom like for couple of years correct?
You have a paper trail of cancelled checks or receipts correct?
So you write checks to yourself to reinburse for everything you paid for that would have been paid IF VA had not had a glitch. All must be an exact match, so receipt for AL rent for $ 3,572.50 has a check written to you for $ 3,572.50 with the date of payment on the memo line. Yiu take all diwn to a Fed EX office and make 2 set xerox of all checks to have on hand readily for Medicaid inquiry.... Get on your bookkeeping so that all goes through the bank so you end the month with all reinbursements paid. Do each receipt as its own check, even if it's a small receipt, so that this is very OCD detailed.

There will be funds left. This just stays in VA account till you get a notice from medicaid.

You don't recalculate. Medicaid has to do this. You should send a letter to Medicaid. In it (keep it short & 1page) include moms Medicaid # and state that VA is now paying mom $ xxxx per month under its Aid & Attendance program . Just put in whatever VA is paying mom each month & you could attach a copy of May payment. . Don't go into the backstory....years of dealing with VA dramarama. Just the new monthly income increase. I'd fax this from fed Ex office as well as you get a printed transmission report to show it was sent and received by medicaid. You can also mail it - I personally when dealing with medicaid always sent everything certified mail with the return registered receipt from USPS - it runs abou $ 8.00 for the duo and you have documentation that whomever got it and it's is acceotable for court/litigation legal proof too. Medicaid will verify the income increase and send mom a new copay or SOC (share of cost) for Medicaid. Medicaid may not go back to recover all months. If so Mom will end up with bonus $. You just need to spend down to have mom stay under 2k in assets.

If your worried that mom will be over income limit for Medicaid, you can just add up her SS monthly, her VA monthly and any other monthly income and as long as its under whatever amount her state has set for monthly income limit, she's good.

I had to deal with an sticky issue somewhat similar with my mom & her NH Medicaid. My late dad (died in 1980's) was a fed & mom got a civil service annuity & federal high option BcBS through him. Her actual income was around $ 1800+ a mo. But annuity took about $ out for BCBS. BCBS was her secondary health insurance to her Medicare primary & she had basically zero co pay for 30 years after dad died. When mom finally went into a NH and onto Medicaid, BCBS was suspended as BCBS will not pay if Medicaid is able to pay. Now Medicaid took almost 6 mos to be done but retro'd coverage to day 1 of application. BCBS retro'd& clawed back coverage back to day 1 months later SO mom got a 1time payment for the BCBS overpayment and this happened months later. I contacted Medicaid and as the amount paid amortized for the period of time was still under the Medicaid income limit, there wasn't change to moms Medicaid status and I was told just to spend down to get mom under the 2K asset limit. It essentially was bonus $ and it actually came in handy as some of the outside vendors at the NH (like OT & PT's) paid by BCBS got clawback & could not rebill as they didn't participate in Medicaid so there were some funds to pay them. The NH was sent letters from me & bcbs as to the suspension. WHy any vendor at a NH would not participate in Medicaid at a facility where majority of residents are on Medicare & medicaid is beyond me......
Helpful Answer (3)

Addressing only the issue of the uncashed checks, most checks generally have an expiration/invalid date of 6 months from the date of issuance. Check these uncashed checks to see if they're still valid, which I suspect they're not, except for the ones issued in the last 6 months.

But for the VA's purpose, it issued the checks and would have considered them payments, regardless of whether they were cashed or not.

I would address this issue first as the total amounts under consideration may be considerably less if the checks have already expired.
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