Medi-Cal and VA Aid & Attendance Benefits
Medi-Cal Benefits are available under three major types programs for adults, generally known as the “Categorically Eligible Medi-Cal” programs, the “Needs-based (Community) Medi-Cal” programs, and the “Medically Needy (Long-term Care) Medi-Cal” program. There are also other types of programs for certain children and for persons who suffer from specific illnesses, including End-stage Renal Failure (needing dialysis), Tuberculosis, and Breast or Cervical Cancer.
To qualify for any of the three main types of Medi-Cal programs, the individual must be either blind, aged 65 or over, or permanently and totally disabled. In addition, the individual must be “financially needy” for any of the three main types of programs. The Categorically Eligible Medi-Cal program only covers persons who are eligible for Supplemental Security Income (SSI) or who would be eligible for SSI but for the annual cost of living income increases by Social Security (this is called the Pickle Program). For the Medically Needy (Long-term Care) Medi-Cal program, the individual must also need medical care provided by a skilled nursing facility. Generally, this last requirement means that the person must be residing in a skilled nursing facility. However, there is a Medi-Cal “waiver” program that provides for some in-home or assisted living facility care for persons who would otherwise have to be in a skilled nursing facility. Unfortunately, there are relatively few slots available under the waiver program and it is only available in a few counties in California at this time.
The most common Medi-Cal program used by elders has historically been the Medically Needy (Long-term Care) Medi-Cal program as generally elders have been most concerned about the cost of skilled nursing facilities in case they need “long term care”. However, there appears to be a shift happening such that elders and their families increasingly are determined to keep the elder at home (or in the home of one of his/her children) rather than send him or her to a skilled nursing facility, unless that is simply not an option. If the elder does not have the resources to pay for skilled nursing facility care or desires to protect his/her resources for his/her spouse and family, the knowledgeable Elder Law lawyer will explain the options to the elder and his/her family to protect assets and qualify for Medi-Cal benefits.
The rules for the Medically Needy Long-term Care Medi-Cal program and the Needs-based (Community) Medi-Cal program differ with regard to the treatment of assets and income and are quite complicated. It is recommended that you make an appointment with an Elder Law lawyer, like those at Carney Elder Law, to discuss your planning for Medi-Cal benefits. For a simplified explanation of some of the Medically Needy Long-term Care Medi-Cal rules, we recommend that you review the information on the Medi-Cal pages of the Santa Clara County Superior Court Probate Department’s self-help website.
The information found there was provided by Janis Carney for the court. You may also want to check back on this website for additional information and blog postings that we put onto the site from time to time with more in depth information about Medi-Cal.
VA Aid & Attendance Benefits
Veterans Benefits are available to persons who served in the U.S. Military and, under certain circumstances, to their surviving spouses and other dependents. To understand Veterans Benefits, one must first understand that there are two separate VA agencies: the Veteran’s Health Agency (VHA) and the Veteran’s Benefit Agency (VBA).
The VHA provides medical and related services for Veterans only. We emphasize the word “services” as this agency does not provide any money to the veteran. The services it provides include:
- VA owned/operated hospitals, clinics and nursing homes
- VA pharmacy
- VA outpatient Services
- Day-Care Services
- In-home care Services
- Therapy Services
The VBA provides financial compensation or assistance programs for veterans and certain family members who are the veteran’s dependents. The programs include:
- Dependency and Indemnity Compensation
- Improved Pension
- Home Loans
- Educational Assistance
- Burial Benefits
The VA Compensation Program provides financial “compensation” to veterans who have a disability that can be “connected” to an injury or illness the veteran suffered due to his or her active military service. This compensation is more liberal than most civilian disability benefits as almost any injury or illness incurred while on active duty, even while on leave-but not if engaged in criminal or other wrongful activity, may entitle the veteran to monetary compensation. The amount of the compensation depends on the level of disability. Veterans seeking service-connected compensation are directed to contact an attorney who is a member of the National Organization of Veterans Advocates (www.vetadvocate.com) for assistance. This program is rarely used to help an elderly veteran pay for care giving as it requires a “service-connected” illness or injury. The one situation where it is being used for elders is for those veterans who suffer from a previously undiagnosed Post-Traumatic Stress Disorder (PTSD), sometimes dating back to their experiences while in the military, usually many decades ago.
The Dependency and Indemnity Compensation (DIC) Program is for the surviving dependent family members of deceased veterans who died either while on active duty, due at least in part to a service connected disability, or while rated 100% service connected disabled for a required period before death. Dependent family members may include a surviving spouse, minor or disabled children, and parents. DIC may be claimed AT ANY TIME after the Veteran’s death while the dependant family member claimant is eligible. It is important to note that DIC is NOT the continuation of the veterans’ compensation for his or her service-connected disability, but is a separate program that must be applied for separately by the surviving dependent family member. The VA will not automatically provide this benefit to the surviving dependant family members and may even misleadingly tell the family member that they are not entitled to the “veteran’s compensation” after the veteran’s death, which is correct as this is a separate program. As an Elder Law Lawyer, I have applied for and obtained DIC benefits for my elderly clients whose deceased spouse died due to the illness or injury incurred during his service in the military. It is also important to note that, except for eligibility for DIC payments to a dependent parent, DIC does not require a showing of a financial or medical need, unlike the Improved Pension with Aid & Attendance discussed below.
The VA’s Improved Pension Program, until now, has probably been the VA’s best-kept secret. Despite calling this program the “Improved Pension”, it is not a typical pension at all. What it is, is a welfare type benefit, available only to a veteran or the surviving dependent family member of a deceased veteran. To qualify for the Improved Pension, the veteran or surviving dependent family member must be either permanently and totally disabled (disability not service connected) or over the age of 65 and “poor”. In addition, the veteran must have served at least 90 days in the active military, at least one day of which was during a WAR-TIME period and have been discharged “other than dishonorably” from the military service.
The “poor” requirement for the Improved Pension is a financial need test, composed of both an asset test and an income limit. The Asset Test divides assets into “countable” and “exempt” categories. Countable assets are those that the veteran and/or the veteran’s spouse either owns or controls. It is a means based test which asks, does the applicant have Sufficient Means to pay for own care for a reasonable length of time. There is no maximum or minimum amount of countable assets allowed. The determination of whether a person has sufficient means to pay for his/her own care for a reasonable length of time is determined based on three (3) factors: the applicant’s age and life expectancy, the amount his/her (and his/her spouse’s) expenses exceed his/her income (plus his/her spouse’s income) per month, and the liquidity of his/her assets. Exempt assets are considered at all, regardless of value, in the Sufficient Means test above. Exempt assets may include the applicant’s personal residence and any tangible personal property (household automobiles, furnishings, etc) that are reasonably needed for the applicant and spouse’s livelihood. If an individual would qualify for the Improved Pension but for the financial need test, it is possible for the applicant to do planning in order to reduce his/her assets to the level allowed for this program. Doing such planning is extremely complex and requires the assistance of a knowledgeable accredited veteran’s lawyer to make sure that what is done does not itself cause ineligibility. At Carney Elder Law, our attorneys are accredited by the VA to represent veterans and their surviving dependent family members before the VA and are able to guide our clients through the maze of planning options and restrictions to qualify for the VA Improved Pension.
In addition to the Asset Test, there are also rules regarding the veteran’s (and his/her spouse’s) income, or the income of the surviving dependent family member applicant, that the VA will apply in determining how much of the total VA benefit the applicant will receive. In essence, the VA sets off the allowable Pension benefits against the applicant’s (and his/her spouse’s) “countable income”. Countable income is the applicant’s (and spouse’s) total gross income (other than welfare payments) less the applicant’s (and spouse’s) “unreimbursed medical expenses”. Unreimbursed Medical Expenses (UMEs) include typical medical expenses such as hospital, doctor, and pharmacy costs; plus the following care expenses under certain circumstances: in-home caregiver costs, care costs in independent living facility, all licensed assisted living facility costs, all licensed skilled nursing facility costs, and travel costs to/from doctor appointments.
In addition to the VA Improved Pension, there are two supplements that enhance the pension benefit for a veteran, or surviving dependent family member, under certain circumstances. The first, called “Housebound”, requires that the applicant be either 100% disabled and confined to his/her premises, or have two disabling conditions, one that is deemed (by the VA) to be 100% disabling and the other is deemed (by the VA) to be at least 60% disabling. In the second circumstance, it is not necessary that the disabled person be confined to his/her premises.
The second supplement, called “Aid and Attendance” (commonly referred to as “A&A”) is much more commonly applicable to the conditions of elders. To qualify for this supplement, the applicant must be either in a nursing home, in need of assistance with activities of daily living (at home or otherwise outside a nursing home), or be blind.
The VA benefits can be very useful in helping to provide the resources for an elderly veteran, or his surviving spouse (or other surviving dependent family member) to pay for care at home or in an assisted living facility. If the elder still cannot afford the cost of care at home (but not in an assisted living facility) it may be possible to also qualify the individual for Medi-Cal benefits, including In-Home Supportive Services, which may pay $2000 to $3000 to the in-home caregiver. The interaction of these programs is confusing and an individual with too much income may not be able to qualify for the Medi-Cal program. However, in the right case, it may mean that an individual can stay in his/her home rather than be forced into a facility for care. At Carney Elder Law, we regularly help our clients qualify for both VA and Medi-Cal benefits, often making it possible for them to have the quality of life they desire for much longer than would otherwise be possible.