Using Aid and Attendance to Pay for a Nursing Home
The Easiest and Most Difficult Application
For a potential beneficiary in a nursing home, the application for Pension is very straightforward. The claimant simply has to check the box on VA 21-526 or VA 21-534 that he or she is a patient in a nursing home and provide evidence for that. An award, including an aid and attendance allowance from VA, is almost always forthcoming without any additional requirements relating to a rating. Nursing home costs are also automatically annualized.
Unfortunately, in most cases, Pension does not work well for paying the costs of a nursing home. This is because the amount of Pension income is rarely enough to cover the difference between the cost of the nursing home and the beneficiary's income. On the other hand, Medicaid will cover this difference in cost and in most cases Medicaid is a better alternative to Pension.
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. Finally, if assets have to be gifted in order to qualify for Pension, this could make the potential Pension beneficiary ineligible for Medicaid.
There are, however, circumstances where Pension fits very well for a beneficiary in a nursing home. One case would be where the nursing home patient has to go through a spend down in order to be eligible for Medicaid. Pension would also be beneficial where the nursing home patient is strictly private-pay or is private-pay awaiting an available Medicaid bed. And in some cases, Pension and Medicaid together might be a better alternative where there is a spouse at home. But each of these instances is specific to the individual circumstances.
As easy and simple as the Pension application for a nursing home patient is, claimants should always seek the advice of a consultant who understands both Medicaid and the VA benefit. There are strategies that can be pursued to make Pension for nursing home patients work out in certain cases. But most people can't solve it on their own and it requires an expert to make the combination of Medicaid and Pension successful.
Annualization of Nursing Home Costs
If the veteran or veteran's surviving spouse is a patient in a nursing home, VA should automatically allow 12 months worth of nursing home costs to be applied as medical expenses. The patient will also automatically receive an aid and attendance allowance. The expenses applied are out-of-pocket costs after reimbursement.
For an explanation of the special annualized treatment of unreimbursed long term care costs and insurance premiums please go to the article entitled "Understanding the special case of long term care medical costs."
An annualized medical expense deduction can be allowed for unreimbursed nursing home fees even if the nursing home is not be licensed by the state to provide skilled or intermediate level care. The definition of a "nursing home" for purposes of the medical expense deduction is not the same as the definition of nursing home set out in 38 CFR 3.1(z). A nursing home for purposes of the medical expense deduction is any facility which provides extended term, inpatient medical care.
A responsible official of the nursing home must sign a statement that the disabled claimant is a patient (as opposed to a resident) of the nursing home. We have included in our book a copy of a VA form that is used for this purpose. It is called " VA Form 21-0779 -- Request for Nursing Home Information in Connection with Claim for Aid and Attendance." A copy of the contract with the facility should also be included when submitting this form. Statements and evidence of payment must also be included. Canceled checks are not acceptable.
Read More When should a Veteran or their Family use a Consultant?
What is a Veterans Benefits Consultant & when should a family use a veterans benefits consultant.
Who is eligible for the Veterans Aid & Attendance pension benefit?
Using aid & attendance to pay any person for care at home, for professional home care, for assisted living, or to pay for a nursing home.
The application process for aid and attendance Pension.
The National Care Planning Council, we promote and support planning for long term care.
An individual acting as a consultant must be careful not to violate any federal statutes and VA regulations pertaining to representation of veteran claimants. At the NCPC, we recognize our responsibility to assist you regarding these matters & have ensured that this package offers extensive guidance on what we believe constitutes a compliant veterans benefits consulting practice. Integrity & honesty are at the heart of our business. We expect those who purchase this package to maintain high ethical standards in all areas of their consulting practices. Furthermore, we would like to express our gratitude and support for those who display stewardship, compassion, care, & integrity while working with seniors & thier families.
