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. For a beneficiary with a spouse at home, the combination of Pension and Medicaid may not work due to Medicaid rules.

Consider these important points:

  1. VA pension, based on UME’s and A&A, pays a monthly rate based on accountable income, minus UME’s, with additional monies for dependents.
  2. The “$90 Nursing Home Rule” states: if a veteran, without a spouse or children, (or a widow without dependents) is approved for Arizona Medicaid (ALTCS) and is a resident of a Skilled Nursing Facility (with a Share of Cost assigned or not), NO MATTER what their private pay rate of pension was, they WILL be reduced to $90 per month of VA pension. VA and ALTCS regulations identify this $90 as “totally A&A” and can’t be assessed for Share of Cost, or countable toward monthly income. Usually, the $90 is additional personal funds for the client.Though rare, ALTCS clients who are either Service-Connected (SC), or widows who receive Death & Indemnity Compensation (DIC, meaning the Veteran died SC) are not affected by the $90 Nursing Home Rule because they are NOT pension programs.Also, even though ALL of the criteria for reduction to $90 are met, veterans and widows who reside in a STATE HOME (usually 1 or 2 per state) are totally EXEMPT from the $90 reduction. Our State Home is run by AZDVS, and is on the same grounds as the VAMC at 7th St. and Indian School Road. They are exempt from the reduction, and also subject to ALTCS assessment for Share of Cost and monthly income limit.
  3. A great part of this regulation is that a VA overpayment can’t ever be created; all overpayments are waived. For example, if a widow at $1113/month pension is approved for ALTCS effective 3/1/13, and the VA finally adjusts it 8/1/13, the $7,200 overpayment is waived.

For more questions on ALTCS eligibility and the VA Pension program, contact JacksonWhite today.

Call us at (480) 464-1111 or fill out the form below.