Help with Medicare, Medicaid & VA benefits?

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills.
Post Reply
User avatar
Topic Author
sperry8
Posts: 3065
Joined: Sat Mar 29, 2008 9:25 pm
Location: Miami FL

Help with Medicare, Medicaid & VA benefits?

Post by sperry8 »

Hello all,

I'm wondering if any of you have experience with Medicare, Medicaid & the Veterans Administration. My father is 81 and has Dementia & Parkinson's. He currently uses a doctor at the VA hospital as his primary doctor and because he is below the federal poverty limit, doctors and drugs are free for him. I've also brought him to a specialist (to get a 2nd opinion) and we have used Medicare for this. It appears Medicare lowers the rate of his visits, but we are required to pay for a good portion of the doctors visit as well as for prescriptions recommended by this doctor (which were not recommended by the VA). I have paid pay those bills for him, since he can't afford it.

So my question is, would it be helpful to also apply for NYS Medicaid for him? Would this jeopardize his benefits with the VA Hospital in any way?

My rationale for applying for Medicaid at this time is twofold. One, although he has dementia, he still has his faculties some of the time. It seems easier to apply for everything he is entitled to in advance before the disease worsens. Second, eventually he is going to need serious home health care and ultimately care in a long term care nursing facility. I'm hoping he can go for a while in his own home, but his mind isn't getting better and this seems to be what will occur over time. It is my understanding that Medicare doesn't help much with long term nursing care and that Medicaid is very useful to fill in the gaps in coverage. Is this a good plan? Can we continue to use the VA Hospital if we proceed with it?

Thanks so much to everyone, it's a tough time and if anyone has similar experience they can share, it would be very helpful.
BH Contests: 23 #89 of 607 | 22 #512 of 674 | 21 #66 of 636 |20 #253/664 |19 #233/645 |18 #150/493 |17 #516/647 |16 #121/610 |15 #18/552 |14 #225/503 |13 #383/433 |12 #366/410 |11 #113/369 |10 #53/282
gerrym51
Posts: 1679
Joined: Sat Apr 27, 2013 1:44 pm

Re: Help with Medicare, Medicaid & VA benefits?

Post by gerrym51 »

do you have a VA nursing home in the area. my deceased brother in law who had alzheimers starting at 55 and died at 62 spent the last 2 years of his life in a place called the old soldiers home which i guess was VA. very inexpensive.
User avatar
Topic Author
sperry8
Posts: 3065
Joined: Sat Mar 29, 2008 9:25 pm
Location: Miami FL

Re: Help with Medicare, Medicaid & VA benefits?

Post by sperry8 »

Thank you. I didn't know they had those. That was very helpful. It started me on a search re the VA and ultimately lead me to this:

http://www.veteransaidbenefit.org/aid_a ... g_home.htm

Among other things, it said: "Eligibility for Medicaid causes difficulty for those beneficiaries who also want to receive Pension income in a nursing home. For a single person, VA refuses to pay the full Pension benefit if that person is eligible for Medicaid and will only pay $90 a month towards nursing home costs."

So it appears Medicaid may conflict with VA benefits, although I'm not sure if it conflicts with the VA nursing homes you described.
BH Contests: 23 #89 of 607 | 22 #512 of 674 | 21 #66 of 636 |20 #253/664 |19 #233/645 |18 #150/493 |17 #516/647 |16 #121/610 |15 #18/552 |14 #225/503 |13 #383/433 |12 #366/410 |11 #113/369 |10 #53/282
kayo
Posts: 60
Joined: Sat Aug 18, 2012 9:54 pm

Re: Help with Medicare, Medicaid & VA benefits?

Post by kayo »

Check to see if he qualifies for a VA pension.
VA’s pension program provides monthly benefit payments to certain wartime Veterans with financial need, and their survivors.

Go to http://benefits.va.gov/PENSIONANDFIDUCI ... aminfo.pdf for more info.

Good luck.
Bruin
Posts: 165
Joined: Tue Apr 05, 2011 6:43 pm

Re: Help with Medicare, Medicaid & VA benefits?

Post by Bruin »

You should apply for Medicaid/Medi-Cal benefits.

In California, when applying for Medi-Cal (Medicaid) they determine a Share of Cost, which is essentially a co-pay that must be met first before Medi-Cal will pay towards a persons care. The Share of Cost can be between $0 and almost up to the amount of an individuals income.

In case of care in a nursing home, if a person has a $2000 pension, and nursing home care is $5000, they will typically establish of Share of Cost of income less a $35 personal need allowance, so $1965. The individual then would have to pay $1965 of their pension towards their share of cost, and Medi-Cal would pay the remaining $3035. So the entire stay is paid for with the individual's funds plus Medi-Cal funds, and the individual gets to keep $35/month.

In case of care in a nursing home, if a person has a $2000 VA pension, and nursing home care is $5000, the VA will simply reduce the pension from $2000 to $90. The $90 pension is exempt from being counted as income and Medi-Cal will pay for the entire $5000 cost of the stay. So the entire stay is paid for with Medi-Cal funds, and the individual gets to keep $90/month.

So yes, the sentence is correct where it states "Eligibility for Medicaid causes difficulty for those who also want to receive Pension income in a nursing home" however it is not necessarily relevant given that in either case the care is entirely paid for.

Now I would definitely do your due diligence as NYS is likely different than CA, and there are of course rare circumstances where issues may be different.
User avatar
Topic Author
sperry8
Posts: 3065
Joined: Sat Mar 29, 2008 9:25 pm
Location: Miami FL

Re: Help with Medicare, Medicaid & VA benefits?

Post by sperry8 »

Thank you Kayo, that brochure was very helpful!

And Bruin, than you so much. Your few sentences put together what many disparate websites have tried to explain, but certainly not as succinctly as you.

I also found this website:

http://www.payingforseniorcare.com/long ... nsion.html

Which states this: "Receiving a VA pension may disqualify a veteran that receives Medicaid benefits. Seniors receiving Medicaid should consult with a Medicaid Social Worker or Attorney prior to making the decision to initiate a VA pension."

It seems you can't have both (or at least it's hard to qualify for both). And as Bruin states, it doesn't matter anyway. It seems Medicaid is the way to go in this instance. I will look up the NYS benefits and requirements for Medicaid and proceed from there.

Does anyone know if he can still use the VA Hospital for his primary care? Would receiving Medicaid benefits disqualify him from that? Or solely from receiving Pension and Pension A&A benefits?

Thanks, this is very helpful stuff!
BH Contests: 23 #89 of 607 | 22 #512 of 674 | 21 #66 of 636 |20 #253/664 |19 #233/645 |18 #150/493 |17 #516/647 |16 #121/610 |15 #18/552 |14 #225/503 |13 #383/433 |12 #366/410 |11 #113/369 |10 #53/282
bayview
Posts: 2332
Joined: Thu Aug 02, 2012 7:05 pm
Location: WNC

Re: Help with Medicare, Medicaid & VA benefits?

Post by bayview »

Being on Medicaid (or Medicare, or having commercial insurance) will not in any way affect your father's access to VA hospital healthcare. If for some reason his income rose, he might have co-pays, but that sounds unlikely. At every VA hospital where I've worked, we've had patients with Medicare, Medicaid, commercial insurance, combinations of these, and no insurance at all. We are mandated and privileged to take care of veterans (although we sure aren't funded enough to do so as much as needed.)

There are both VA nursing homes (frequently called CLC's; Community Living Centers; generally located on or next to the campus of a VA hospital), and there are state Veterans Homes. The state homes are run by the individual states, not by the VA, but the VA inspects them at least once a year for safety and quality. Your father might qualify for either. There are also Contract Nursing Homes, non-VA nursing homes with which the VA contracts to take care of veterans who can't be placed in a CLC. I think there might be some eligibility issues, such as service connected disabilities, but not always.

You might want to call the nearest VA hospital and ask to speak to a social worker about your father's eligibility for VA healthcare and the impact of Medicare, Medicaid, VA pensions, and any other source of financing. Medical social workers (at both VA and "regular" hospitals) are the gurus of healthcare eligibility and financing, and they know what's possible and how to make it happen.

Good luck to you and to your dad!
The continuous execution of a sound strategy gives you the benefit of the strategy. That's what it's all about. --Rick Ferri
toofache32
Posts: 2349
Joined: Sun Mar 04, 2012 5:30 pm

Re: Help with Medicare, Medicaid & VA benefits?

Post by toofache32 »

Unfortunate situation, bless you for taking care of him.

Note to self.....do not burden my children this way.
User avatar
jeffyscott
Posts: 13484
Joined: Tue Feb 27, 2007 8:12 am

Re: Help with Medicare, Medicaid & VA benefits?

Post by jeffyscott »

My mother also has Parkinson's with dementia. She is 87 and was diagnosed at about 70 or 72. She is now living in an assisted living facility. I would look into that, rather than a nursing home. If you pick the right type of place, he should never have to go to a nursing home. You can look into that now, so you are prepared when the time comes. My mom's place is just 1.5 miles from my home, I am glad that I picked such a convenient location, this makes it easy to make frequent short visits. She was on a waiting list for another place that was a bit nicer but is 10 miles away, I am now glad it worked out that she ended up at the closer location, where I can stop in for 15-30 minutes on my way home and walk over on weekends, rather than, say, visiting for several hours once a week or something.

My mother had very little in assets and income. In my state they have a medicaid program called "family care" which will help pay for assisted living when she runs out of assets, in order to keep her out of a more expensive nursing home. My mother moved back here from Alabama partly because of this, from what I ran across when doing my research apparently every state except Alabama and Kentucky will provide some help with assisted living costs under Medicaid.

As a veteran, I think he will be eligible for something called "Aid and Attendance" benefit if he does go into assisted living. The assisted living places will know all about this, they always asked if my mom had been married to a veteran (she was, but due to divorce and remarriage was not eligible).

To be eligible for Medicaid assets will have to be under $2000 (actually, for my mom I was told $2000 plus one months income, so $3300 in her case). In my state every county has an office called "Aging and Disability Resource Center" to help with things like this, you might check if there is anything similar in your area.

My mother just recently went on hospice care. She stays at her assisted living facility and the hospice providers brings in extra services. Hospice services can also be provided to people in their own home. Hospice really only seems to mean that they will not try to cure her terminal illness, but since Parkinson's has no cure it seems to have little downside. It also means the facility calls hospice first, not 911, then the hospice nurse decides what to do.
Post Reply