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my step father has dementia and needs assistance. he has a relative who lives with him full time but caring for him is a challenge. He has an aide 2x a week for 4 hours from the VA hospital. can he still apply for Medicaid and receive additional aide services through them as well?

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Yes. My mother gets VA and Medicaid
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Medicaid is based on income and assets, so the help he gets from the VA shouldn't affect his eligibility. You can go to the Medicaid website and find out if he qualifies.
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you can also call the VA and tell them he needs more help and they should increase it
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Yes, my mother receives an $1,149 per month Aid and Attendance benefit as well as Medicaid. Her income has only been her very low monthly SS check so she was eligible for Medicaid without any spend down period. She is in an AL that accepts Medicaid but does take a cost share amount of $1,020 per month from the A&A amount. At such time as this amount drops to $190 (this is anticipated by the VA rep with whom I met because mom lives in AL now and not independently), that $190 is for her personal needs and cannot be accessed by the AL so they would go back to just the Medicaid payment. Hope this helps.
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Yes, definitely. My dad gets help from the VA and also has a Medicaid long term plan. One seems not to have bearing on the other; as others have said here, Medicaid is mostly based on your father's income and assets.
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Yes. You can apply for Aid and Attendance through VA AND Medicaid. Your local Department of Aging can also help. Good Luck!
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I'm uncertain how other states work but go on Medicaid.gov look for HCBS Waiver program, his health may qualify without income test, VA may require a point of contact from Step-dad to speak for him unless he has Medical POA, in such case the VA PCP may act on a message or require office visit to substantiate funding add'l hours. Good luck.
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Yes, your step father can be reimbursed for home care he pays for out of pocket.

The VA looks at monthly income. If unreimbursed medical expenses are equal to your household income, you are entitled to the maximum Aid & Attendance benefit. If considered a medical expense, the family member could be paid for the value of some of the hours they devote to your step father.

The VA also looks at the value of "liquid assets" like cash, stocks, IRA, 401k, other tax-deferred income, bonds, mutual funds, art, coins, stamps, and collectibles. The Aid and Attendance pension regulations consider whether some or all of the claimant’s estate should be used for the claimant’s care. The VA considers:
whether the property can be readily converted into cash at no substantial sacrifice and life expectancy.

Get help with the application preparation from your town's veteran agent or a service provider that specializes in aid and attendance. Talking with an elder law attorney near your home would also be beneficial.
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Remember there needs to be differentiation with skilled care which could be Certified Nurses Aide to cover showering, transfers, vitals etc. where homemaking is not skilled and many agencies are nonmedical as service providers. So depends on what the hospital is providing and what you need in addition to that.
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Ask the VA to increase his care time.
I have a client who receives twice a day care for two hours each.
If there is someone else who can do the caregiving often the responsibility will fall on them. If that person is unable to continue the caregiving schedule, VA should Step up care.
There is a Housebound Program which is easier to get than the Aide and Attendance. That may be what he already has. Just negotiate the house up.
Good Luck
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