No Luck with Medicaid? VA to the Rescue

Karl had been in an assisted living facility for several years and doing well there.  His family felt fortunate.  Although Karl didn’t have much in the way of assets he did have income from Social Security and a pension, totaling $5000.  He also had a long term care insurance policy that was paying $2500 a month.  His daughter, Mindy, called me, however, because now Dad needed nursing home care.  She figured she needed to apply for Medicaid.  That’s when I explained to her that Karl couldn’t get Medicaid, even if he has not even a dollar to his name.

 Mindy corrected me.  “Dad only has $500 in the bank.  His income doesn’t count towards the $2000 asset limit”, she said.  That’s true but the assets aren’t Karl’s problem.  He has too much income.  You see, if his income exceeds the Medicaid reimbursement rate, that rate which Medicaid pays the nursing home for its’ Medicaid residents, then he won’t qualify.  (Actually, Medicaid requires the resident to give his income to the nursing facility and then it will pay the difference up to the reimbursement rate.)   And the long term care insurance, which will pay out for another 3 years, counts towards income.

 “But, the nursing home we looked at said their private pay rate is $10,000 per month”, Mindy told me.  “He only has $7500.  What are we going to do?”  I asked her if Karl was a veteran.  He was, of World War II.  If you are a regular reader of this blog you know that there is a wonderful program available to wartime veterans and their surviving spouses which can provide additional income in the form of a pension.

 I told Mindy that Karl could obtain a pension of $1700 per month.  That would bring his income up to $9200 per month, close to the $10,000 she was quoted.  We could either negotiate with that facility or find another one that would accept her dad’s income on a private pay basis.  That would get her through 3 years, until the insurance policy is tapped out.  And what then?  Karl’s income would most likely be below the Medicaid reimbursement rate at that point and we could then qualify him for Medicaid.

 I could hear the relief in Mindy’s voice.  “This is all so complicated.  I am so lucky I found you.  I could never have figured this all out myself. ”  I understood completely.  It’s so difficult to navigate through the long term care system without a knowledgeable guide.  To see if VA benefits can help you check out our 30 second VA Quiz at http://elderlawtodaypodcast.com/areas-of-practice-2/veterans-benefits/