Do states require vets to have applied for VA benefits, such as Aid and Attendance, before applying for Medicaid?
Like many topics Medicaid related, there isn’t a straightforward yes or no answer. According to federal regulation, a Medicaid applicant is required to apply for all benefits, including the Department of Veterans Affairs (VA) benefits (i.e., Aid & Attendance and Housebound pensions) prior to applying for Medicaid. This is because Medicaid, in theory, will not make payments until all other potential sources of assistance has been exhausted. Given the enforcement of this rule falls on each state, it is difficult to say which states are enforcing it. At the time of this writing, we believe that New York and Georgia are two such states. However, regardless of which state you reside in, if you are a vet, it is best to reach out to your Medicaid agency to inquire how this situation is handled. (Contact information for all state Medicaid agencies can be found here.)
Note that even if one’s state requires veterans to first apply for VA benefits, it is possible for them to be eligible and receive benefits simultaneously from Medicaid and the VA. As an example, let’s say that a veteran has established eligibility for the Aid & Attendance (A&A) pension; a monetary monthly cash benefit that is an “add on” benefit to the basic pension. (A&A is intended to help veterans with the costs of long term care, such as in-home care, adult day care, assisted living, and nursing home care. To see eligibility criteria for the basic pension and the A&A pension, click here.) However, the vet requires nursing home care, and even with the A&A pension, he cannot afford the cost of this type of care. Therefore, he applies for nursing home Medicaid.
While Medicaid has income and asset limits for eligibility purposes (see state-by-state eligibility criteria here), the money received from the Aid & Attendance pension often does not count towards Medicaid’s income limit. Remember, A&A is an additional monetary benefit above and beyond the basic pension. Therefore, the combined cash benefit can be broken down into an amount for the basic pension and an amount for Aid & Attendance. Some states don’t count the A&A benefit amount towards Medicaid’s income limit, but count the basic pension benefit amount, while other states disregard the basic pension plus A&A benefit amounts in its entirety.
It is important to mention that single veterans who receive the A&A pension and meet the eligibility criteria for nursing home Medicaid will have their A&A monthly cash benefit amount reduced to $90. To be clear, this reduction does not happen if a veteran has a spouse who isn’t also residing in a nursing home or has a dependent child.