What happens when a veteran or surviving spouse receiving Aid and Attendance goes into a nursing home?  A reduction in benefits may occur but only after the veteran or surviving spouse becomes eligible for Medicaid while in the nursing home.  When this happens, an unmarried veteran or surviving spouse’s Aid and Attendance pension benefit will be reduced to $90.  See 38 CFR §3.551(i).

However, if the veteran is married or has a dependent child living at home the reduction is not automatic.  If the spouse or dependent child has unreimbursed medical expenses then the veteran may continue to receive all or a part of the Aid and Attendance payment, even after entering a nursing home and qualifying for Medicaid.  Why is this the case?  The VA counts household income and deducts recurring household out-of-pocket medical expenses when determining eligibility for Aid and Attendance pension.  Even though the veteran is in a nursing home, the spouse’s income and out-of-pocket recurring medical expenses are counted when determining eligibility.

The lesson to be learned here:  Do not allow the VA to automatically reduce a married veteran’s Aid and Attendance award to $90 if the spouse at home has recurring out-of-pocket medical expenses.   Instead, submit evidence of the spouse’s recurring medical expenses once the veteran is approved for Medicaid, and the VA will recalculate the veteran’s eligibility for Aid and Attendance and could approve an amount over $90 per month.

ElderCounsel hosts educational events to train attorneys on Veterans Benefits.  To find the next class or to order the recording and materials from a prior class, please visit our Education Calendar and  Marketplace on our website.

Valerie L. Peterson

Valerie is the Executive Director of ElderCounsel, LLC , an organization that provides document drafting software, education and support to elder law and special needs attorneys across the United States.  Valerie is a frequent lecturer on elder law and Veterans Benefits.

In Medicaid planning we must often take the good with the bad.  So, let’s start with the…not so good:

The Supreme Court of Mississippi in Alford v. Division of Medicaid affirmed the lower court’s ruling that a state court has no jurisdiction to increase the Community Spouse Resource Allowance (CSRA) or Minimum Monthly Maintenance Needs Allowance (MMMNA) prior to a petitioner filing for Medicaid.  The Court interpreted 42 USC § 1396r-5 as requiring a Medicaid application to be filed, denied, and a fair hearing conducted before a Medicaid applicant can seek help in state court.

Previously, and in other states, a future Medicaid applicant or his/her spouse could file a petition in state court asking for an allowance above what would otherwise be allowed as the CSRA or MMMNA.  The Medicaid agency would then be bound by that court’s order.  Unfortunately this is no longer an option in Mississippi, at least for the time being.
Unfortunately, the good news earlier reported was in error.   The Superior Court of New Jersey Appellate Division in E.S. v. Division of Medicaid Assistance and Health Services upheld a penalty imposed under a personal service contract (called a “life care contract” in the case) between the petitioner and her daughter, in which petitioner made a lump sum advance payment to her daughter for the future provision of personal care services.  The mother was penalized for the transfer.

Personal service contracts are often used to provide a payment, either in a lump sum or hourly, to a family member who is providing care to an elderly loved one.  If properly documented, the money paid to the family member/caregiver is not penalized as an uncompensated transfer for Medicaid purposes.  Unfortunately, many states have forbidden the use of “lump sum” caregiver contracts when the family member is providing care, or if the recipient of the care is already in a nursing home.

Valerie L. Peterson

Valerie is the Executive Director of ElderCounsel, LLC , an organization that provides document drafting software, education and support to elder law and special needs attorneys across the United States.

We all know (or should know) the positive effect a handwritten or verbal “thank you” has on the recipient.  In this day of email, texting and Facebook, the positive effects of a handwritten thank you on the recipient are even greater.  Yet, many are still not taking the time to pick up the phone and say thank you, or, better yet, write a personal thank you note.

What many may not realize is the positive effect saying (or writing) “thank you” has on the sender.  It not only establishes a bond with the recipient, it creates an “attitude of gratitude” within the person giving thanks, says Karen Huck, Chair, Fine Arts and Communication, Central Oregon Community College in a recent issue of U Magazine.  This “attitude of gratitude” is good for our mental health, adds Huck.

This “attitude of gratitude” is something worth trying.   To help you get started, check out this link:  http://www.pure-inspirational-thoughts.com/thank-you-quotations.html.

One final thought:

“Gratitude is the best attitude. There is not a more pleasing exercise of the mind than gratitude. It is accompanied with such an inward satisfaction that the duty is sufficiently rewarded by the performance.”

Joseph Adisson

Thank you for reading this post!  Have a great day!

Valerie L. Peterson, Esq.

Valerie is the Executive Director of  ElderCounsel, LLC, an organization providing document drafting software, education and support to elder law and special needs attorneys across the United States.