Texas Medicaid and the VA Aid & Attendance Program
If you qualify for Aid and Attendance, you should consider how the Aid and Attendance funds are viewed in by Medicaid in the State of Texas. The website for the State of Texas Medicaid reference guide is http://www.dads.state.tx.us/handbooks/mepd/E/E-4000.htm. First, it is important to understand what you have been award. A veteran or surviving spouse may not be qualified for any pension under the VA rules until they meet the medical and financial criteria for Aid and Attendance. However, once they meet the criteria, the award they are granted is comprised of Basic Pension (Maximum Annual Pension Rate (MAPR)) and Aid and Attendance. This is important because Basic Pension is taxable and counts against you for Texas Mediciad - while the Aid and Attendance portion does not. Follow this link to the A&A Table on this website or check the figures on www.VA.gov.
Texas Medicaid and the VAís Aid and Attendance Pension: The Texas Medicaid Regulations are silent on the impact A&A benefits have on countable resources and therefore appear to be included in the total resource (asset) limitation, however, aid and attendance or housebound benefits are considered exempt income that does not affect eligibility or co-payment.
Texas Health and Human Services Commission Medicaid Eligibility for the Elderly and People with Disabilities Handbook Revision: 10-1 Effective: March 1, 2010
E-4311.1 1979 VA Pension Plan Revision 10-1; Effective March 1, 2010
.....Refer persons who have changed to the 1979 pension plan or who initially obtain entitlement to a VA pension after Jan. 1, 1979, to apply for aid and attendance or other potentially available benefits. However, do not monitor for the personís compliance to apply for other benefits when it is to increase the VA payment for medical expenses since aid and attendance or housebound benefits are considered exempt income that does not affect eligibility or co-payment.
E-4315 VA Aid and Attendance and Housebound Payments Revision 10-1; Effective March 1, 2010
VA pays an allowance to veterans and dependants who are in regular need of the aid and attendance of another person or who are housebound. This allowance is combined with the personís pension or compensation payment.This special VA allowance can be paid to:
disabled veteransí spouses;
If a person is in an institutional setting (for example, a nursing facility) because of mental or physical incapacity, the VA presumes eligibility for aid and attendance. Based on policy regarding medical expenses paid by a third party, do not consider in the eligibility and co-payment budgets the following VA payments:
Reimbursement for unusual medical expenses
Reference:Section E-1720, Social Services That Are Not Income.If it appears that the person may be entitled to an aid and attendance allowance and is not receiving one, refer the person to the VA. While living in the community a person receives a housebound allowance, but that allowance is adjusted to the aid and attendance allowance if the person moves to an institutional setting. Do not monitor for the personís compliance to apply for other benefits when it is to increase the VA payment for medical expenses since aid and attendance or housebound benefits are considered exempt income that does not affect eligibility or co-payment.Neither the beneficiary's award letter nor the VA check indicates whether aid and attendance is included in a person's total VA payment. To verify the type and amount of benefits received, contact the VA using Form H1240, Request for Information from Bureau of Veterans Affairs and Client's Authorization.Do not include aid and attendance allowance, housebound allowance and VA reimbursement for unusual medical expenses as a part of the total VA benefit in Section II of Form H1000-A/B. See Appendix XVI, Documentation and Verification Guide.
ERBC comment: Although a federal regulation, Texas is one of the few states to make it clear that veterans with dependents (spouse or child) whose payment is paid directly to the dependent do not interfer with their institutional medicaid benefit:
E-4310 Augmented and Apportioned VA
Revision 09-4; Effective December 1, 2009
....Apportioned VA payment. A VA compensation payment made directly to the dependent of a living veteran is an apportioned payment. Apportionment is direct payment of the dependent's portion of VA benefits to a dependent spouse or child. The VA decides whether and how much to pay by apportionment on a case-by-case basis. Apportionment reduces the amount of the augmented benefit payable to the veteran or veteran's surviving spouse.
A portion of a VA benefit paid by apportionment to a dependent spouse or child is VA income to the dependent spouse or child. It is not a support payment from the designated beneficiary.
E-4311.2 $90 VA Pension and Institutional Setting
Revision 10-1; Effective March 1, 2010
If a veteran without a spouse or child or a surviving spouse without a child is covered by Medicaid for services furnished by a nursing facility, the maximum pension that can be paid to or for the veteran or surviving spouse for any month after the month of admission to such nursing facility is $90. This reduced pension is an aid and attendance allowance in all cases, and not income.
VA law (38 U.S.C. 5503) provides that the amount of the VA pension for an institutionalized Medicaid recipient having neither a spouse nor child (or in the case of a surviving spouse, having no child) cannot exceed $90 per month.
The $90 VA pension may not be used in determining what the person in an institutional living arrangement must pay toward the cost of care. The limited VA pension, up to the amount of $90, is not counted as income in the eligibility or co-payment budget.
There is no association between the reduced pension and the personal needs allowance (PNA). If a veteran has income from other sources, the income from other sources may be considered countable. HHSC is to perform the co-payment calculations to determine the amount of the veteranís liability toward the cost of care.
Do not refer a person who is receiving the $90 VA pension in an institutional setting to apply for other benefits when it is to increase the VA payment for medical expenses since aid and attendance or housebound benefits are considered exempt income that does not affect eligibility or co-payment. If the personís only income is the $90 VA pension, refer the person to the Social Security Administration for SSI.
Because of automation limitations, the VA $90 capped pension is included in the PNA calculation.
For a non-SSI Medicaid recipient in an institutional living arrangement who does not have a VA pension capped at $90 per month, the total PNA will be up to the current maximum of $60.
For a non-SSI Medicaid recipient in an institutional living arrangement who has a VA pension capped at $90 per month, the total PNA may be up to $150 ($90 VA plus up to $60 PNA).
State supplementation is not allowed for a Medicaid recipient who is not an SSI recipient.
The VA $90 capped pension and PNA calculation does not impact the Protected Earned Income Allowance.
In a situation in which a veteran does not have another source of income from which to deduct the $60 PNA, the PNA continues to be $90 and the co-payment is zero. In a situation in which a veteranís other source of income is less than $60, the PNA will be $90 plus the amount of other income, not to exceed $60. There is no state supplement to bring the PNA up to $60 if the veteran does not have other income from which to subtract the PNA. The PNA deduction comes first in the order of all co-payment deductions, including those for incurred medical expenses (IME).
For SAVERR and TIERS, enter the VA pension capped at $90 per month as income.
If a personís only income in a facility is the VA pension capped at $90 per month, certify the person for Medicaid, provided the person meets other program requirements, and refer the person for SSI.
For representation before the VA, ERBC refers to Servaes Consulting Group, LLC so you can be assisted by a VA Accredited Agent.
Neither Elder Resource Benefits Consulting nor the Servaes Consulting Group, LLC is affiliated with the Department of Veterans Affairs or any other government agency. Elder Resource Benefits Consulting and the Servaes Consulting Group, LLC are not Veterans Services Organizations.