Follow
Share

My mother has been receiving the VA Aid and Assistance pension for about two years. She has now been approved for one of the New Jersey Medicaid programs. I know that the Personal Needs Allowance under the VA program is $90. Under the New Jersey Medicaid program it's $109. Is she entitled to just one or the other or to both allowances?


I ask this because the state wants to take her entire VA pension and turn it over to the assisted living facility where she resides. This seems to be at odds with the VA guidelines, which state that no part of the $90 monthly Improved Pension may be used to reduce the amount of Medicaid paid to a nursing facility. The guidelines, based on regulations, derive from Federal law.


As one might surmise, it's difficult to get a clear answer on this, either online or from the VA itself. If I decide to appeal to the state of New Jersey I want to make sure I have a basis for doing so.

This question has been closed for answers. Ask a New Question.

14 Answers

Most
Helpful Newest
First Oldest
First
Such $90/month payment is not considered income and does not have to be paid to the nursing home, and it is paid in addition to the personal needs allowance.
.
Note that the $90 limit only applies if the veteran (or spouse of veteran) has no spouse or child. However, if the child has their own money (i.e., is not a dependent) then they are not counted as a child for these purposes (see https://www.law.cornell.edu/uscode/text/38/1522#b)

You also may like to know that on February 6, 2015, the state of New Jersey settled a class action lawsuit by agreeing not to count VA payments as income for Medicaid purposes

Here's the actual rule: 38 U.S. Code § 5503 and 38 CFR 3.551(i).
Helpful Answer (0)
Report
A person is only allowed one personal allowance, either medicaid or VA the reason is they are both federal programs and there is no double dipping. Usually once a person is approved for medicaid all VA funding stops except for 90.00 personal allowance, now in most states that is more than medicaid would give for instince in michigan medicaid only gives 60.00. In your case medicaid gives more so its better for you to take medicaid allowance. She is not intitled to both, but at least the 109 is more than most states give. Just make sure to spend the money on her each month because you dont want it to build up and put her over the 2000 asset limit and become disqualified, and believe me that can happen.
Helpful Answer (1)
Report
ramiller -- Thanks for your input, but it conflicts with the response posted by Gabriel Heiser. I can live with what you've posted, but it runs counter to the law governing the A&A program. I probably will bring this to the attention of the state. It will be interesting to see how they respond.
Helpful Answer (2)
Report
Yes pls keep us updated. My information comes directly from my VA rep here in michigan. Would like to know if her information is correct or not. Thanks
Helpful Answer (1)
Report
One quick question is her AL private pay or medicaid paid?
Helpful Answer (0)
Report
I was to understand that if private pay the A&A can be used towards the AL. Once Medicaid takes over than the A&A stops. Like said, they r both government.
Helpful Answer (0)
Report
The Social Service person at the facility should know what is what.
Helpful Answer (0)
Report
Yes Joanne that was what i was told by my va rep.
Helpful Answer (0)
Report
The case is GALLETTA v. VELEZ et al, No. 1:2013cv00532 - Document 44 (D.N.J. 2014) and Mr. Heiser is correct, the VA money is NOT countable in determining Medicaid eligibility.
Helpful Answer (1)
Report
The difference here is AL verses nursing home. If she were in a nursing home a&a would stop once medicaid started. However for other programs such as in home adult day care and AL the case sited would apply. And this is only in NJ other states may be different.
Helpful Answer (1)
Report
Excellent question, jandrinpsca, and I am dealing with a very similar situation with my mother in NJ as well. In fact, I just had a discussion with the VA rep yesterday about this very subject. My mother resides in an AL in southern NJ which accepts Medicaid and she is waivered in under the current state program. Her SS check is $793 and she receives $1,149 in VA A&A. The facility takes the bulk of her SS and a "cost share" of $1,020.85 of the A&A. The balance of the money goes to her cable TV and phone charge at the facility and misc. spending like haircuts, etc. and other personal items. The VA rep told me that the AL facility isn't on their list (not exactly sure what that means) but it results in my mother's A&A staying at $1,149 until such time as she is either moved to a nursing home (at which point the amount drops to $90 per month) or passes away (and it will obviously be terminated at that time. So, for the time being, this is how my mother's situation is being handled. Not sure if this helps you with your questions but since we're in the same state, thought I'd give you the benefit of my very recent experience and exchange with the VA. Good luck in dealing with your mother's situation and make sure to take care of yourself as well - this stuff can become all consuming, unfortunately.
Helpful Answer (0)
Report
Once you get Aid and Attendance and you apply for Medicaid, the Aid and Attendance will get shifted towards his Medicaid. You may get some for yourself but you will not have any control over it.
Helpful Answer (0)
Report
jandrinpsca, we were told the same by the medicaid office here in new jersey. We would need to pay the entire amount of A&A to the assisted living facility. VA on the other hand is saying my MIL would be entitled to the $90 but they don't say if that would be in addition to or in lieu of the medicaid allowance. It's very hard to get a consistent straight answer on the subject. Very frustrating and time consuming.
Helpful Answer (1)
Report
My mother is in the State of NJ nursing home. Originally, she was in a AL paying self pay with VA and SS. The PNA was $109 per month. She ran out of money so I got her on Medicaid.  It took the state of NJ 8 months to get their paperwork together because of staff changes and backlog so in the end it was retro back 9 months.  I informed the VA immediately providing them with State documents, medical info, nursing home forms, the VA support forms requested, etc.  They responded that there was not change to amount of VA benefit. Knowing this was wrong I called, faxed and mailed the forms again. Another letter from the VA stated no change. I called today and they put in a report to another department to look into the situation.  Hopefully it will be resolved. I don't want a situation where I pay the NH the VA money then the VA demands it back.  Any feedback on situation?

My mother only gets $35.00 personal needs allowance being in a NJ nursing home. Why would she not get the $109.00 PNA? 

Final question... If and when VA reduces to $90.00 and mom is straight Medicaid and SS does she get to keep the $90.00 for PNA? I know about keeping under $2K. Since they have not been doing $109 and have been doing $35. I am majorly confused.
Helpful Answer (0)
Report
This question has been closed for answers. Ask a New Question.

Recent Questions


Popular Questions


Related Questions

Ask a Question
Subscribe to
Our Newsletter