Mom, 93 with Alzheimer's, no assets, is on Medicaid in a Nursing home in CT. She just started receiving VA Aid & Attendance $90 at the end of last year. I was told by the VA at the beginning of the application process, that she could use that for herself. The nursing home says it needs to go to them. I contacted DSS and they said it needs to go to them.
The VA reduces the monthly Aid and Attendance (A&A) benefit to $90 per month for veterans or surviving spouses who are in a Medicaid-approved nursing home, and have their care covered by Medicaid. This $90 is a personal needs allowance, IN ADDITION TO the standard Medicaid personal allowance.
From the VA's online manual: Chapter 3. Pension Reductions for Medicaid-Covered Nursing Facility Care
1. General Information on Pension Reductions for Medicaid-Covered Nursing Facility Care
38 CFR 3.551(i) limits to $90 per month the amount of Improved Pension that can be paid to a veteran (or surviving spouse) with no dependents who
· is in a Medicaid-approved nursing facility, and
· is covered by a Medicaid plan for services furnished by the nursing facility.
No part of the $90 monthly Improved Pension may be used to reduce the amount of Medicaid paid to a nursing facility.
https://www.benefits.va.gov/warms/docs/admin21/m21_1/mr/part5/subptiii/ch03/ch03.doc
"That $90 VA benefit you receive is usually kept by you, not counted towards your nursing home's payment, and gets added to your Personal Needs Allowance (PNA) for things like toiletries or entertainment, though it can become an asset if saved, potentially impacting Medicaid eligibility if it adds up too much."
Also be aware, at time of passing, what is left in Moms PNA and if she still has any assets that were allowed left, go to her estate. People on this forum have been told by facilities that this money reverts back to Medicaid, they are wrong.
The rep from the VA told me she said it is her understanding the $90 goes to my mom. She said to call DSS and ask them to send me something in writing saying that it should be counted as income.
And thank you for alerting me to the PNA account and that any assets from that go to the estate when she passes.
It's difficult navigating all of this not knowing which offices/agencies are telling you the right things.
Thank you
https://www.va.gov/pension/aid-attendance-housebound/
"VA Aid and Attendance benefits and Housebound allowance
VA Aid and Attendance or Housebound benefits provide monthly payments added to the amount of a monthly VA pension for qualified Veterans and survivors. If you need help with daily activities, or you’re housebound, find out if you qualify."
VA A&A is an extension of a VA Approved Pension. Each state handles pensions differently for Medicaid income purposes. For CT, pensions are considered income for the income limits.
Are you sure Mom is only getting $90/month? It sounds like this is her needs allowance and the SNF is getting the bulk of her pension A&A combination direct as "the Representative Payee for the SS & her pension."
"It's difficult navigating all of this not knowing which offices/agencies are telling you the right things."
mclisa81, I recommend getting a good case management social worker (VSO) approved by the VA. They can be found here: https://www.va.gov/get-help-from-accredited-representative/ A good VSO can help determine what is accurate and from whom.
Now she does have to pay attention to not having her bank statements ever end the month over 2K. For most States the maximum for nonexempt assets is a mere $2,000.
A ? for you / your mom….. how is she dealing with her income (like her SSA) and the VA stipend? Is she continuing to have them $ direct deposited to her old bank account? Or has she signed off for the facility to become her Representative Payee?
Yes, I am aware of the $2,000 and keeping an eye on that.
The nursing home is the Representative Payee for the SS & her pension.
As her conservator, I set up a bank account for her which I am the fiduciary, per the VA's instructions, to have the $90 deposited into. That money will be used to fund an irrevocable funeral plan.
Thank you!
If so, I would suggest that you do 3 things, as I’d be concerned that this NH sounds like the type that views all moms $ as theirs…
- 1. the PNA is done so that you/ your name is listed as the “beneficiary of”, or “pay on death” or “transfer on death” name and as a signatory on the account to do withdrawals. So that when mom dies, whatever is left in this at the Nh account will be transferred over to you by the NH. So that it’s a check made out to you so it bypasses probate so won’t become an asset of her estate. Like they send you a check made out to you for the after death balance. And by being signatory, you can take $ from the PNA when needed.
If this NH tell you that it has to escheat to become an asset of her estate, it does not. It can be done as a POD.
- 2. you ask them how they send out statements on the PNA. It is supposed to be at a minimum every 90 days. Technically they should and it should be an interest bearing type of account. The interest will be teeeny tiny. What the interest is, well is not the point….. the point is that it establishes that you know that PNA are a financial entity and should be an interest bearing account and you as her POA should be getting regular statements
- 3a. the NH will have someone who comes in to be the beauty shoppe. Find out & it’s costs. Leave enough $ in the PNA to take care of beauty shoppe and a smallish amount more for the first couple of months…..
-3b. Go to the NH to do a small withdrawal from mom’s PNA during this time. Like $20. Do this so that you know how the system runs at this NH plus it makes the NH aware that you totally plan on utilizing moms PNA $ to buy her things she could use. That the PNA $ is not just sitting there.
fwiw the PNA is restricted spending. Technically it is not to be used for anything that the LTC Medicaid program is paying for. As it pays for room & board, it cannot be used for the elder to pays for stuff on their home (if they are continuing to keep their home); it cannot be used for anything gifting, so no church tithing or buying wedding or bday gifts. It really is best for clothing, shoes, reading materials. In addition to the beauty shoppe. Your mom is lucky to have $75 + $90. Some states do the PNA at a mere $35!
My experience is that very often NHs will press very hard to become the rep payee and then the PNA $ is totally used to pay for a service at the NH. Like cable, or in room phone, or a set monthly off premises field trip. And these costs use up the PNA $ almost totally. Or the NH let the PNA build up, don’t inform POA/family and then when it gets close to the 2K, they order a costly DME / durable medical equipment item, so taking the PNA down to just a few dollars. And sometimes family isn’t ever made aware that the PNA exists.
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The VA stipend isn’t income the month it’s paid. HOWEVER it becomes an asset the following month. Most States have nonexempt asset max of 2K. The $ in the at the NH PNA plus the $ in that new fiduciary acct the VA had you set up for the $90 plus any other bank accounts she has, all added together has to be under the overall asset max each and every month.
For more fun, there will be a LTC Medicaid renewal done. The letter will ask for the last 3-4 months of her financials. Like bank statements. It will also ask for some of the very same items submitted in the initial application (life insurance info, funeral policy info). Plus her new awards letters from SSA and other retirements. So keep all her paperwork handy and stay organized so that you can respond to the renewal asap.