My mother has the Aid and Attendance spousal benefit from my father being in WWII. She lives in Minnesota and they have an Elderly Waiver. Any advice?

As a first item, you need to look at moms $ as income and assets & understand how they are different. $ in every mo - eg SSA $, VA A&A - is income; if she is on a waiver, the AL should be requiring her to do a copay to them of almost all that income. $ left in her bank account at the end of the month & after the copay is her “assets”. And her program allows her to have assets at $3,000 max.

If the AL hasn’t yet been requiring a copay, that happens as for some states it is only after the application is fully processed can the facility legally ask for it. Your kinda on the honor system till then. Most states do not do this, they require the copay to the facility all the while the application is being processed.

So how much $ would mom have after her copay is all current? That’s her assets. What is this figure?

but back to the A&A, Here’s what I think will be the issues:
- VA views any payments to vets or spouses as independent of any other programs. SSA or waivers of no interest to them.
- Medicaid however is concerned abt all income & assets. Look at her application as to what the required time cream is for reporting $ change. I bet it within 60 days of $ going into bank account. You have time, don’t fret. It actually happens often as elder gets an unexpected inheritance that takes them over the limit.
- if the A&A $ is going to be continuous, (so it’s the lump sum $ plus VA $ every month afterwards to her till forever) then she will likely be over the income limit for a Medicaid waiver. She would be ineligible for the waiver & will need to go off Medicaid waiver. Hopefully the VA $ PLUS her SS$ or other retirement mo income will go to pay her bill at the AL.

Will she have enough $ between the 2 (the VA A&A and her SS$) to fully pay for AL?
If not, and it’s close, ask the AL if they are ok on accepting it anyways. So she stays on A&A but goes off of the Medicaid waiver. The billing office at the AL should be able to determine what payment pipleline works best for them. You would need to let her caseworker know in writing & expect this to take weeks to process.
or
Even between the 2, she’s really way under being able to pay for AL and the AL won’t work with her/you, then she probably needs to cancel the A&A and remain on the Medicaid waiver.

Yeah all that work to get her on VA and it’s not enough to pay for AL and it’s too much income to keep. I think she can get the A&A suspended. That’s what you want to do cause for when they get to needing a higher level of care like in a SNF, the costs are way way higher than A&A could ever pay, so A&A stops, they go onto LTC Medicaid but will get a $90 a mo stipend from VA. I think, but not sure, the $90 stipend is only if in a NH/SNF, not in AL.

Lump sum $ she got, well, that is NOT going to go back to VA. It’s going to need to be spent down on legit bigger ticket items for her and done within a single month if at all possible. This so that she starts her month ok $ wise for the waiver at under 3 K and end it at under 3K.
So….
If there is an actual check to her, do NOT deposit it just yet. You want to hold off on depositing it, till you have a plan, ok.
To me, how much this VA lump sum $ is what drives her options.
So how much are you looking at? $5,600 or $10,200?
Does she have a preneed funeral & burial done?
Does she possibly have any dental work she really needs done but hasn’t been able to afford it?
Just mull all this over, but don’t do anything just yet.

Why? In part 2.

Part 2.
Your mom has a lot of health issues. So she was recently hospitalized and has been discharged to a SNF that has a rehab program?
Mom right now is not actually in the AL but in rehab?
is this it???

If so, she is right now on MediCARE for payment for her rehab. The usual for hip break is 28 days. The first 20/21 are 100% MediCARE and then afterwards at 50% MediCARE up to 100 days. Now she has to be progressing in her rehab and the therapists measure and report this almost daily. Try to ask them how she is progressing. If she simply isn’t, then it’s time to have a clear talk with the SW & nursing as to her moving from a Medicare rehab patient to becoming a LTC custodial resident. She will probably need to do a new Medicaid application for Long Term Custodial Care. It is different than the waiver application. But lots of the same data.

The VA lump sum $ will be viewed as an asset that needs to be spent down. So again you have to have a plan as to what to do and within the month if at all possible. Sometimes it’s flat easier just to private pay to get to the sweet spot on assets for Medicaid. Once again her SSA or other mo income is a copay to the NH. She will get -again- a personal needs allowance from her SSA income that is hers to spend. Tends to be $50-60 for most states. MN could have this higher. Should she stay in the NH, she can also get the VAs personal needs stipend of $90 a mo. For LTC Medicaid, the asset limit could still be 3K but it may be lower at 2k as in theory all their room&board is taken care of entirely once in LTC facility. ALs still have the aspect that they are more active & more possibilities to go & do & spend in the community.

Personally if it was my mom and the rehab/SNF is saying she is a good fit to stay there and become a custodial care resident, I’d do it. Forget about the AL & A&A $ and have her go onto LTC Medicaid at the SNF. I’d be quite concerned that if she went back to the AL, there’s going to be another event and your doing all this again & going to be months of paperwork drama in sorting out VA vs waiver.
Good luck and try to stay organized & positive.

From what I read, this sounds like a Medicaid program. If so, Mom cannot receive both. If she ends up in LTC she definitely can't have both. Medicaid is usually higher so A&A drops off.

You need to call the dept the waver comes out of.

If it were me, I would contact the office that handles the Waiver... I would think they would be the one to evaluate her new financial situation and how her benefits may be affected by the increased A&A. If the back dated amount puts her over the limit allowed in her checking account, it may require a simple payment (up to the back dated amount received), toward the amount already Waived. Then I would think they should only look her new total income going forward. It is possible her new income amount may enable her to pay a larger amount toward her care and less being Waived. Like others have said, it appears she is in a period where Medicare and supplements will be paying for most of her care due to her surgery so this gives you time to try and sort out her new financial situation. Definitely do not touch any of the back dated amount added to her checking account until you have received the correct information and are complying with the rules. Try to be very discerning with information you are given by anyone outside the Waiver office.

An attorney who specializes in elder care may be able to advise.

There is a maximum payment of $3261 per month and I stlll can’t find anywhere that says says $3000 is the maximum in the account. Call Patriot Angels. They are experts in this.

An elder care lawyer will be able to advise you on how to handle this. They know the laws and how to work them to your advantage. The elder lawyers are expensive, but your best route.

First thing, don’t panic! If it’s happening to your mom, it’s happening to other folks.

A&A is a federal (VA) program, as you know. Don’t worry about contacting them.

Waiver programs are state programs that “waive” the income threshold of individuals with certain health conditions or in certain categories to make them eligible for Medicaid. Therefore you need to contact your waiver case worker. I don’t know specifically about the programs on Minnesota, but in most places she would need to spend down that excess income she received from A&A toward her care. But as a previous poster mentioned, don’t touch the money until you reach the case worker. S/he will direct you.

An elder attorney can help. You need to SPEND DOWN and the attorney fee will help that happen as well

SPanning: Per Google - "If the person receiving Aid and Attendance Pension is also receiving home care, assisted living care or nursing home care then Medicaid may become part of the planning equation for receiving care. An understanding of Medicaid is needed." Disclaimer: Not my authoring.
You should go to Medicaid.gov for further explanation.