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Rule of thumb is, if the individual has applied for and accepting state assistance the state considers ALL INCOME, they then pay the balance to the NH with the exception of the amount she is allowed to keep in what they call a patient trust fund, in GA. that amount is $50. Also in GA. she would be allowed to have up to 2,000 in that fund.
I did apply for the VA and the NH gets it, gets his Civil Service Retirement and all of her Social Security. Reason I applied for it, my Dad was a 3 war vet, dedicated is life to service for this country and he would have wanted my Mom to get the funds to help take care of her no matter who was getting them. hope this helps you in some way. Keep up the good caregiving!!!
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Some things to remember:
1. The Medicare benefit for Skilled Nursing Facility (SNF) is "up to 100 days per benefit period", as long as the patient meets criteria for medical necessity and making reasonable progress. It is not a guaranteed 100 days.
2. As Kevin said, the purpose of Medicaid (or MediCal, the California version of Medicaid) if for the SNF or personal care provider, etc. to be paid for unreimbursed expenses. They are not "taking the patient's money", per se. They are attempting to get reimbursed for their expenses. Depending on the level of services provided, with room, food, general care, nurses, doctors, medications and things like therapy and durable medical equipment, the cost of skilled nursing in a facility can be as much as $1,000 a day. So if they are being paid anything less than $15-20,000 a month, they are likely losing money. If you look at the numbers, few of these facilities make any money - they are barely keeping their heads above water. It is best if you apply for whatever aid she qualifies for and get the facility as much as you can, so the care will be better for her and everyone else.

I know I feel naked without a few dollars in my pocket. In my experience with my in-laws and my mother, a few dollars here or there made them feel better, but overall basic needs are taken care of while in the SNF and cash is not useful except for the hairdresser or barber. I prefer to leave a check for those services so I know for certain what is being paid.
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As for the Aid and Attendance benefit, you can qualify if in EITHER Assisted/Personal Care or Skilled Nursing, and even in home care. It will pay as long as you have qualifying expenses called Unreimbursed Medical Expenses (UME's). Medicaid/Medical is applied for when you are broke and have spend your money down...to certain limits. A qualified Medicaid advisor or attorney can help with this process. You may be able to protect a certain portion of assets to apply for Medicaid or the VA if a qualified advisor is used.
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The VA will pay $90 per month if on Medical/Medicaid. They won't pay the full benefit. If approved for the benefit before applying for aid, the benefit will drop to $90/mo. This is a Federal benefit and doesn't change from state to state. The person in the SNF can keep the $90 (plus $45/mo allowance) from what I've been told....at least in PA.
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You need to contact your local VA office. My Mom is in rehab and we are waiting for the Medicaid to be approved so we can look at Assisted Living Facilities. VA told me the benefit is Aid and Attendance for surviving spouse. The Aid and Attendance benefit is "only" for assisted living facilities, not long term care. I will not be able to apply for that benefit until she is physically admitted and living in the Assisted Living Facility. My understanding how it all works, is that Medicaid will convert the Skilled Nursing Facility Medicaid to meet the Assisted Living Medicaid. The Medicaid portion of the Assisted Living Costs is only for the medical needs portion. VA, Aid and Attendance will also pay a portion, up to 1100.00 and the rest will be out of pocket.
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In PA she would be applying for MEDICAID (State Welfare program). I have not heard of MediCal? At any rate, if eligibility for a welfare program is met, the State will pay only the difference between the monthly cost of care and the patient's income. Therefore, the VA benefit would increase her income, thereby increasing her share of the monthly payment. The State will not TAKE her VA, but it will reduce what the State pays. Now, even though you would refuse to apply for benefits that you are aware your mom is eligible for, the State may require that you do so, thus reducing their payment. I hope this is helpful and I hope I have understood your question well enough. Good luck with your mom and her situation!
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My mother in law was on Medicaid in order to get into an assisted living facility. Since she was only left with $25 a month we were also encouraged to apply for the VA benefit and told the home could not touch the money and they didn't for a period of time. Then we got hit with "we made a mistake and we do have to count that money." So she was back in the situation she was before she applied. It was a really long application process and the money basically ended up going to someone else. This was in Colorado. We ended up taking her out of the assisted care facility and bringing her here to live with us.
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