Coordinating VA Benefits with the ALTCS Benefit

By August 31, 2010Uncategorized

August 2010, Volume 13, Number 3

Coordinating VA Benefits with the ALTCS Benefit
The Department of Veteran’s Affairs (VA) offers benefit programs to veterans who were discharged from active service under other than dishonorable conditions.  One such benefit is known as the Wartime Pension, which provides financial support to qualifying veterans who meet income and asset requirements.  Another is the Widow’s Pension, which provides financial support to surviving widows or widowers of deceased wartime veterans.  Veterans and widows who qualify for these benefits, and who are homebound or require daily assistance due to a medical condition, may also qualify for additional benefits, known as Housebound and Aid and Attendance benefits. 

These benefits can be extremely helpful to veterans and widows who need additional income to help cover health care costs.  Those who qualify for Aid and Attendance on top of their Pension can receive as much as $1,949 per month, which can be enough to cover all of their monthly medical expenses.  But what about veterans and widows whose health declines, such that they later require care in a skilled nursing facility?  The average cost of skilled nursing care in Arizona is $6,000 per month, which is much more than what VA benefits will cover.

Problems tend to arise when veterans apply for VA benefits without first considering other options that may become available to them if their circumstances change or their health declines.  And, these problems are exacerbated when annuity salespeople, who say they are also veteran’s benefit specialists, market annuities that will purportedly help veterans qualify for VA benefits.  More and more, these “specialists” are pitching their products in assisted living centers as the only way for veterans to become eligible for VA benefits.  Not only are there other ways for veterans to become eligible for benefits, but annuities can create problems if the veteran later graduates from assisted living to care in a skilled nursing facility.

A branch of Arizona’s Medicaid program, known as ALTCS, provides a benefit to cover the costs of long-term health care for qualifying seniors.  As with veteran’s benefits, ALTCS has income and resource tests that applicants must meet, only stricter.  Many people who apply for veteran’s benefits later find it necessary to apply for the ALTCS benefit, but find that the planning they did to qualify for veteran’s benefits has created negative consequences for their ALTCS approval.  This is particularly troubling where the planning took place under a professional’s advisement.  The following example illustrates one of the more common scenarios:   

Mr. Smith is a veteran living in an assisted living facility that costs $2,000 per month.  An annuity salesman claiming to be a veteran’s benefits planner visits the facility and tells Mr. Smith that he can qualify for a monthly VA benefit of $1,949, if he puts his resources into an annuity.  Mr. Smith discusses the situation with his wife, and they decide to annuitize their assets so that Mr. Smith can receive the benefit.  Six months later, Mr. Smith’s health declines and his physician recommends that he move to a skilled nursing facility, which costs $6,000.  The Smiths cannot afford this care so they apply for ALTCS, only to find that under ALTCS rules, the annuity income must go towards Mr. Jones’ share of cost.  In other words, Mr. and Mrs. Jones are now required to spend money on nursing home care they could have saved for Mrs. Jones were it not for the annuity.  To make matters worse, Mr. and Mrs. Jones learn that their annuity cannot be converted back to savings without serious penalties, and their annuitized income stream is ultimately much harder to protect for ALTCS purposes than savings would have been. 

The issue here is not that the salesman intentionally misguided Mr. Smith, but that he failed to consider the big picture.  ALTCS planning involves different strategies than planning for VA benefits, and every VA applicant should consider the ALTCS implications of their VA benefit planning.  Because VA rules differ from ALTCS rules, applicants should coordinate their planning to maximize their benefits.

While most veterans prepare to become eligible for VA benefits based on their current health and financial situation, nothing prevents their situation from changing rapidly.  Whether or not a VA applicant requires skilled nursing care at the time of application, the applicant should always recognize the possibility of requiring such care in the future.  By working with somebody who understands the interplay between the VA and ALTCS programs, applicants can prepare to secure the best possible benefits in the short- and long-run.


You Asked – We Delivered!
New Training to Focus on both Medicare and Medicaid Benefits
Medicare and Medicaid are complicated benefits. On-going changes to these programs make them even more difficult to understand.  Be up-to-date with the benefits and changes by attending a new training held by JacksonWhite Elder Law and SCAN Healthplan. The new training will focus on the coordination of these benefits, benefit eligibility issues, and the future of the programs.

Understanding Benefits: An In-Depth Look at Medicare and Medicaid
Presented by: Richard Peitzmeier from SCAN Healthplan and Kristin Burns from JacksonWhite Attorneys at Law

Thursday, September 2nd, 2010
1:30-3:30 p.m.
JacksonWhite Attorneys at Law
40 N. Center St. Suite 200
Mesa, AZ 85201

Seating for this training is limited. Please RSVP at arizonaseniorlaw.com, by emailing firm@jacksonwhitelaw.com or by calling (480) 464-1111.
ALTCS Trainings for Health Care Professionals
There is always new information and things to learn about ALTCS eligibility. Make sure your up-to-date by attending one of JacksonWhite’s free trainings for health care professionals.

Thursday, September 9, 2010
Garden Place Suites
100 N. Garden Ave.
Sierra Vista, AZ 85635
Time: 10 a.m. – 12 p.m.

Thursday, September 23, 2010
Plaza Del Rio
13215 N. 94th Dr.
Peoria, AZ 85381
Time: 9 – 11 a.m.

Thursday, October 28, 2010
Foundation for Senior Living
1201 E. Thomas Rd.
Phoenix, AZ 85014
Time: 1:30 – 3:30 p.m.

Tuesday, November 9, 2010
JacksonWhite Mesa Office
40 North Center Street Suite 200
Mesa, AZ 85201
Time: 9:30 – 11:30  a.m.

Seating is limited at all trainings. Please RSVP at arizonaseniorlaw.com, by emailing firm@jacksonwhitelaw.com or by calling (480) 464-1111.


AHCCCS Benefit Changes Effective October 1, 2010
In response to significant fiscal challenges facing the State and substantial growth in the Medicaid population, AHCCCS will be implementing several changes to the adult benefit package, effective October 1, 2010. The changes to the benefit package will impact all adults 21 years and older. This includes members in the Arizona Long Term Care System (ALTCS) and American Indians regardless of whether they receive services through managed care or fee for service. Children under the age of 21 will continue to receive the full benefit package available under the Early Periodic Screening Diagnosis and Treatment program.

Changes

  • Most dental care eliminated
  • Services provided by a podiatrist eliminated
  • Insulin pumps eliminated
  • Percussive vests eliminated
  • Bone-anchored hearing aids eliminated
  • Cochlear implants eliminated
  • Orthotics eliminated
  • Specified transplants eliminated ¹
  • Well exams eliminated 2
  • Non-emergency medical transportation for limited populations eliminated 3
  • Microprocessor-controlled: lower limbs and joints for the lower limbs eliminated
  • Outpatient physical therapy limit of 15 visits per contract year limitation

1 – Per HB 2010: Pancreas only, Pancreas after Kidney, Lung, Unrelated allogenic hematopoietic cell, Heart for non-ischemic Cardiomyopathy, Liver for Diagnosis of Hepatitis C Transplants.
2 – Visits to the doctor when there is no specific complaint and not being treated for any symptoms.

3 – Per HB 2010, limited to childless adults and spend down populations in Pima and Maricopa Counties; children and ALTCS members would not be impacted. Implementation is subject to prior approval by CMS.