By Rita Files
As much as the
VA Non-Service Connected Pension Benefit (more commonly referred to as “Aid & Attendance”) is useful in offsetting the high cost of eldercare, it can significantly affect someone's ability to qualify for Medicaid in assisted living after their assets are exhausted. As welcoming as the additional income might be, it is NOT always in the best interest of the person applying, especially if they might need Medicaid before they need a higher level of care. Keep in mind, once the additional income is awarded the Veteran or surviving spouse cannot stop the benefit in order to qualify for Medicaid.
Recently an
Aging with Grace Eldercare Specialist received a call from a frantic daughter whose mom was living in a Florida memory care assisted living owned by one of the larger assisted living providers in the country. Sixteen months ago, the assisted living provider paid an organization to assist the family with obtaining the VA surviving spouse aid and attendance benefit. This increased the woman’s monthly income to $2600.00/month and provided the additional funds, along with her 50K in savings, to move in into this lovely community.
Now with less than 10K in savings, she will be unable to continue to pay the $3850.00 each month. Even if this provider did participate in the Medicaid waiver program for assisted living, this resident would not qualify since the additional $1057.00 from the VA puts her over the state’s Medicaid threshold of $2022.00. Although long term nursing home care is not needed at this time, her income may leave her with no other alternative. In this particular situation, the benefit representative “hired” by the assisted living provider never addressed or recognized the possible need for Medicaid after her assets were depleted.
With independent and assisted living providers introducing the VA benefit to potential residents for additional monthly income, we are seeing more and more people in the same situation. Not only is it a violation of the federal guidelines for an "interested" third party (such as a provider) to pay a fee on behalf of a Veteran family for this type of service, the providers can and have found themselves in liable situations.
Federal Regulation 38 CFR 14.636: Payment of fee by disinterested third party. (i) An agent or attorney may receive a fee or salary from an organization, governmental entity, or other disinterested third party for representation of a claimant or appellant even though the conditions set forth in paragraph (c) of this section have not been met. An organization, governmental entity, or other third party is considered disinterested only if the entity or individual does not stand to benefit financially from the successful outcome of the claim. In no such case may the attorney or agent charge a fee which is contingent, in whole or in part, on whether the matter is resolved in a manner favorable to the claimant or appellant.
It is critical that our veterans and their families work with individuals who are knowledgeable about both the VA benefit and Medicaid with an understanding of the potential impact the additional income can have. Offering a free pre-qualification analysis, allows a consultant to determine a client’s potential eligibility and helps identify possible conflicts before applying for the benefit. Any fees paid by the Veteran family, are strictly for pre-filing consultation to assist them with assembling a well developed and supported claim. By anticipating all of the documentation requirements that are necessary and submitting them with the original application, the time from submission to a decision is shortened.
Certified veteran benefits consultants are private practitioners and are not connected with the Department of Veterans Affairs. They comply with federal statutes and regulations governing the preparation, presentation and prosecution of any claim for veterans’ benefits with the
U.S. Department of Veterans Affairs.
