Last week we were discussing the VA Aid and Attendance benefit and how it could “knock you off” some of New Jersey’s Medicaid programs – specifically the assisted living and home based programs – because some of the VA pension will be considered income for Medicaid purposes. That could cause total income to exceed the strict New Jersey Medicaid income cap of $2130 per month of gross income. This realization would lead some to conclude that they shouldn’t apply for the VA benefit. But, as I said last week, in most cases that is ill advised and now I’ll tell you why.
If you scroll down to my posts on this blog for February 18 and February 25, you’ll find my discussion about the conversation about Medicaid that typically occurs between a prospective resident’s family and the assisted living facility director of admissions or marketing. There is a lack of understanding about how different New Jersey’s assisted living and home based Medicaid programs are when compared to New Jersey’s nursing home Medicaid programs.
In order to qualify for any of these programs, the applicant must meet the medical test of needing nursing home care. This is the case even if he/she is in an assisted living facility. So, if I spend down Mom’s money over a 2 or 3 or 4 year period – whatever the time frame is – and run out of money, I can’t automatically qualify for Medicaid. The question remains whether Mom’s health has deteriorated to the point where she needs nursing home level care. If she is too healthy, then we can’t qualify even if I prove to Medicaid that I spent every last dollar on her care.
And let’s say she does meet the medical test because her needs are so great that she requires 24/7 – nursing home level – care. Well, then, it will likely be necessary for her to move to a nursing home because the assisted living can’t provide that type of care. And if she is at home, the home based Medicaid program won’t pay for 24/7 care. Maybe it will cover 50 hours a week, but then how is she supposed to pay for the rest of the care if she spent all her money? She can’t and unless I am willing and able to pay for it out of my pocket, she’ll need to move to a nursing home where Medicaid will pay for 24/7 care.
So, you see, the assisted living and home based programs, which are referred to as New Jersey’s Global Options program, are really an illusion for most. Most people will never qualify anyway. That’s why, when I explain to clients that we can get a VA benefit now to help pay for care but that will take certain Medicaid programs “out of play” so to speak, for many that shouldn’t be a real concern. The old saying, “a bird in the hand is worth two in the bush”, applies here. The VA benefit you can get now is worth more than the potential (but so often illusory) Medicaid benefit “down the road”.
I must caution you, however, that every situation must be examined individually. The mistake I see made all the time is trying to oversimplify what is a complex question to answer, “what is the right fit or right choice in my situation?” That requires a careful analysis of the facts in each and every case, best done by a qualified elder care attorney who has knowledge of the relevant laws and regulations as well as an the experience to guide his clients in finding the right mix now as well as down the road.