Dual Eligibility for Medicaid & Veteran's Pensions: Comparing Benefits for Long Term Care

Overview

 Veterans should consider the eligibility requirements for both Medicaid and VA pensions when planning for care even though it is highly unusual to receive concurrent benefits.

While it is theoretically possible to be eligible for both Medicaid and a veteran’s pension, such as the Aid and Attendance (A&A) or Homebound benefits, in practice, individuals do not receive assistance from both programs at the same time. However, this does not mean that an individual should plan for one program or the other. Both programs should be considered when determining how to pay for home care, assisted living, and nursing home care. This is especially true since at different points in time, many individuals may require each of these types of care. Furthermore, the situation with married couples is different; One spouse can receive Medicaid assistance and the other can receive a veteran's pension.

 

Comparing Medicaid and Aid & Attendance

 Generally speaking, Medicaid is better suited for nursing home care and VA pensions are better for home care or assisted living.

There are many factors to consider when deciding from which program to seek assistance.  While this comparison table offers a quick view, it is important to read the detailed Consideration Factors below to apply this information to one's personal situation.

Aid and Attendance vs. Medicaid Comparison Table

Program

Medicaid

VA Aid & Attendance

Other Names

Medi-Cal, MassHealth and many other state specific names Homebound, Basic Improved Pension

Regulation

State Level Federal Level

2016 Income Limits

$2,205 / month (for an individual)* $1,794 / month (for an individual)*

2016 Asset Limits

$2,000* $80,000*

Application Approval Time

2-3 months 6-12 months

Best Suited For

Nursing Home Care Home Care or Assisted Living
*Approximate Limits. Many exceptions exist.

 

Important Consideration Factors

The type of care a person requires is usually the major deciding factor between choosing to apply for either Medicaid or a VA Pension. For those who require home care or assisted living, generally speaking, it is advantageous to use the Veterans Homebound or Aid and Attendance pensions. For those who require nursing home care, Medicaid is usually the better option. While Medicaid does cover home care and assisted living in many states, usually these are not entitlement programs. This means if one is eligible for services, they might not receive services, as there are limited slots for assistance available. In addition, very often there are long waits to receive assistance. While the Aid and Attendance benefit can be applied towards nursing home care, the maximum benefit amount is far less than the average cost of nursing home care.

A second major consideration is the amount of income and assets an individual or married couple has. Both programs have similar, but not identical income limits. However, Medicaid and VA pensions have vastly different asset limits and use different methods for determining what is considered a countable asset. In strict terms, one might qualify for Aid and Attendance, but not qualify for Medicaid. That being said, it is worth noting that a qualified Medicaid planning professional should be able to assist a veteran in structuring their finances so that they can qualify for either program or for both programs.

An unfortunate factor that must be considered when there is an immediate need for care is the application processing time. A Medicaid applicant can usually begin receiving benefits within 2-3 months, while it is not unusual for a veterans pension beneficiary to wait 6-12 months or longer for their application to be approved. Again, working with a professional planner can shorten the wait time significantly by submitting a Fully Developed Claim.

For some families it is possible to supplement care expenses during the application wait time with eldercare bridge loans. Veterans pension benefits are retroactive to the date of application, and most approved applicants will receive a large lump sum payment shortly after the award is granted. Therefore, it is a simple process to get a loan for the waiting period and re-pay that loan with the lump sum once they have been approved. Learn more.

Finally, marital status is a consideration. While a single individual cannot simultaneously receive Medicaid nursing home care and a veteran's pension, a married couple can be dually eligible. One spouse can receive Medicaid, and the other can receive the Aid and Attendance benefit. To be clear, one spouse can have their nursing home care paid for by Medicaid, while the other spouse can live at home or in an assisted living community and have some, or all of their care costs, paid for by a veteran's pension in the form of the Monthly Maintenance Needs Allowance” or “MMNA”. While this is possible, the administrative paperwork necessary to make this a reality is exceedingly complex. It is highly recommended that couples in this situation consult with a Medicaid planning professional who is also knowledgeable about veterans’ pensions and the Aid and Attendance benefit.

 

How to Apply

How best to apply for Medicaid and / or a veterans pension depends on the applicant's situation. As these applications are complicated, and the approval time lengthy, it is advantageous to get assistance from an expert prior to the initial application instead of waiting to seek guidance after the application is rejected.

If the applicant is single and they are certain that they meet all the eligibility requirements, they should contact their local Area Agency on Aging for Medicaid or their local Veterans Service Office for VA Pensions.


If the applicant is married, does not meet the strict eligibility limits or is at all uncertain about their eligibility, they should consult with a Medicaid Planner or Veterans Benefits Planner prior to application.