California State Medicaid Plan Amendment re Optional Benefits Cuts
VA Benefits and Medicaid Eligibilitymedia.straffordpub.com/products/va-benefits-and-medicaid... ·...
Transcript of VA Benefits and Medicaid Eligibilitymedia.straffordpub.com/products/va-benefits-and-medicaid... ·...
VA Benefits and Medicaid EligibilityMeeting Complex Requirements for Benefits Qualification and Application
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THURSDAY, FEBRUARY 16, 2012
Presenting a live 90-minute webinar with interactive Q&A
Yale S. Hauptman, Atty, Hauptman & Hauptman, Livingston, N.J.
Laurie A. Hauptman, Atty, Hauptman & Hauptman, Livingston, N.J.
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V.A. Aid & Attendance Benefits
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Korean War Dec 7, 1941 — Dec 31, 1946 June 27, 1950 — Jan 31, 1955
Aug 5, 1964 — May 7, 1975Feb 28, 1961 if served in Vietnam
World War II
Vietnam War
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To Qualify for Pension:the Wartime Veteran must have served in the U.S. Armed Forces and….
Served at least 90 days active dutyServed at least one day during wartimeWas honorably discharged
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To Qualify for Pension: (Continued)Is over 65 years old,
blind or disabledHas substantial recurring,
unreimbursed Medical Expenses Has Limited Household income
and assets to pay medicalexpensesHas Expectancy of living and
paying future medical expenses 8
Basic Criteria for NeedRegular Aid & Attendance:Inability to dress/undressInability to keep oneself presentableInability to feed oneself Inability to attend to the wants of
natureAn incapacity that requires
assistance 9
Definition of “Housebound” that triggers qualification:
Substantially confined to home or premiseDue to disability or
disabilities Reasonably certain to
last for life10
Proof of Medical ExpensesNeeded
A Physician must provide a diagnosis supporting the scope
of care and corresponding expenses being provided 11
The Net Worth Limitation
Exempt Assets:Your house
Your car
Your household and personal goods
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About $80,000 for a couple
About $40,000 for a single person
Countable Asset Limitation
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The Critical Calculation:Gross Household Income
Recurring Unreimbursed Medical Expenses(UME)
Income for Veteran Administration Purposes(IVAP)
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Maximum Available Pension Resource (MAPR) MAPRis the maximum available
pension per category of need
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Special Monthly Pension Rates Paid to Veterans Age 65 or Older, Permanently and Totally Disabled, or a Surviving SpousePermanently and totally disabled veteran in need of
regular aid and attendance
With one dependent
Surviving spouse
MAPR * MMC
$20,436 $1,703
$24,228 $2,019
$13,128 $1,094 16
Case Study 1: Married Couple, Vet needs A&A
Couple’s Gross Income:
UME (home care, prescriptions, co-pays): $57,600
$45,000
$(12,600)
Couple’s Gross Income:
UME (home care, prescriptions, co-pays): $57,600
$45,000
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(IVAP):$(12,600)
Rounded to $0
Couple will receive $2,019 monthly Benefit, tax free!
When IVAP is less than MAPRa benefit may be awarded
MAPR: $ 24,228
Case Study 1: (continued)
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Case Study 2: Widow of Veteran
UME (home care, prescriptions, co-pays):
$18,000
$3,000
Gross Income:
UME (home care, prescriptions, co-pays): $15,000
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(IVAP): $3,000
When UME fails to meet or exceed Gross Income,
a partial benefit is available.When IVAP is greater than MAPR
NO benefit is awarded
MAPR: $ 13,128Case Study 2: (continued)
Partial Benefit!: $10,128
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Any VA penalty for gifting assets?
VA currently has No Penalty Period of ineligibility for gifting
“excess” assets to other family members
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Should one give assets away to qualify?The answer depends on:Family dynamicsLife expectancyLikelihood of increased future medical
expensesTax consequencesFinancial benefit vs. financial lossThe “Medicaid Trap” caused by gifts within
5 years to nursing home need22
If one needs Medicaid within
5 years of any gift, he or she will be penalized
by a period of Medicaid benefit ineligibility!
“Beware the Medicaid Trap!”
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How Does Medicaid Work?
Exempt Assets Countable Assets
For A Single Person
House
Car
Funeral
Life Insurance
Household Goods
Almost Everything Else
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A Single Person Example
$100,000
$2,000 25
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$500,000
Married Couple (Example)
$2,000
(John)
$109,560(Sally)
$109,560
John & Sally Smith
$219,080
Look Back Period 5 Years
Penalty Starts When:In Nursing Home (or need
nursing home level of care)
“Otherwise Eligible”
$2,00027
All Trusts Are Not Created EqualRevocable Living TrustCredit Shelter TrustIrrevocable Life Insurance TrustSpend Thrift Trust
Income Only Type TrustVeterans Eligibility Trust
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Trust to Qualify for MedicaidIrrevocablePrincipal cannot be distributed Income typically can be distributedThis is a problem for qualification for VA benefits under the “relinquishment” ruleVA will count the trust assets under VA asset rules
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Veterans Eligibility TrustCan be grantor trust or notIncome payable to lifetime beneficiaries and not to grantorAssets in trust not countablefor VA purposes 30
Veterans Eligibility Trust(Continued)
Home can be placed in trust and qualify for Section 121 exclusionLimited testamentary powerof appointment to allow forstep up in basis upon death
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How is VA benefit treated by MedicaidAid and Attendance is NOT treated as income for Medicaid eligibility purposesOther VA benefits are treated as incomeCheck your state’s Medicaid regulations 32
How is VA benefit treated by Medicaid (continued)
However VA benefit is available to be used towards care when on MedicaidOnce VA knows you are receiving Medicaid they will reduce pension to $90 per month
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V.A. Aid & Attendance Tips
Fax VA ApplicationsDementia issues are a red flagWaive 60 day due process
periodInvolve local Congressman 34
V.A. Aid & Attendance Tips(Continued)
Healthy veteran with sick spouse can collectExpediting a claim if claimant is
on hospiceVeterans that received honors
may get preferential treatment35
Be Nice To Me –I Pick Your Nursing Home!
How to Provide For Your Parent’s Care Without Going to
the Poorhouse or Nuthouse
www.BeNiceToMeBook.com
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Yale S. HauptmanLaurie A. Hauptman
HAUPTMAN & HAUPTMAN, P.C.570 West Mt. Pleasant Avenue, Suite 101Livingston, NJ 07039(973) [email protected]
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