What is the "funding formula" for assisted living?

3 answers | Last updated: Oct 22, 2016
Mareva asked...

We live in Wisconsin. Mom has Medicare, Medicaid, VA Aid & Attendance pending - what is the 'funding formula' for Assisted Living? In long-term care she only receives $45/mo and $90 from VA since Medicaid funds it.


Expert Answers

Rita Files, LPN, VSR, a nationally recognized expert on the elderly, has more than 30 years of experience in the health care industry, with 20 years focused on eldercare. She has developed programs for many leading providers in the senior living industry. Accredited through the V.A. in veterans' benefits, she is an advocate and powerful resource committed to educating veterans and their families about the nonservice connected pension benefit and providing them with accurate information. She is cofounder and COO of Aging with Grace.

Although Mom is only able to keep $90.00 from her VA benefit, the balance of the benefit is used to pay nursing costs and Medicaid supplements the balance. If Mom were to leave the nursing home and move to an assisted living community, the full VA Pension for the Aid & Attendance benefit would be restored and go directly to her. Although VA Disability Pension for Aid & Attendance is non-taxable, Medicaid considers VA Pension as income. For Mom this additional income may result in not being eligible for Medicaid if her income exceeds the Medicaid income threshold in your state.

The VA Pension for Aid & Attendance is factored on both income and monthly out of pocket medical expense. The benefit amount is based on assets and countable income. Countable income known as [IVAP (income for VA purposes)] (http://www.vba.va.gov/bln/21/rates/comp04b.htm#BM02) is determined by subtracting eligible monthly out of pocket medical expense from the person's gross income. This could be considered the "funding formula" for assisted living. In the case of Medicaid, gross income dictates eligibility. There is no ability to deduct any expenses.

First, ask yourself if Mom could manage without Medicaid assistance in assisted living, since she likely will not be able to receive both Medicaid and the VA Disability Pension for Aid & Attendance for this level of care. Then consult with someone for a review of VA, Medicaid and Medicare and how each may apply to your Mom's situation.

UPDATE: The VA Non-Service Connected Disability Pension can provide up to $1056.00 per month to help supplement the cost of assisted living. Please keep in mind that although the VA Benefit is non-taxable, it is considered as income for Medicaid purposes and may affect Mom's eligibility for continued Medicaid benefits.

I'm happy to provide a free VA Benefit analysis. Visit AWG Veteran Services to download the questionnaire or complete the questionnaire online.


Community Answers

A fellow caregiver answered...

I have a mother in GA. in aa assisted living facility with a federal monthly anniunty of $1,680. She uses Medicare A & D and Medicade. The cost in GA is low. I have to move her to CA where I am. She does not have enough money to find an assisted living place. My Dad, her deceased husband was a vet (1945 to 1947) with an honorable discharge. I have all the papers. Can you give me a ballpark money figure that she might be eligible for? Do you have any idea how long the paperwork takes? We need help getting more money. Any suggestions? Thank you very much.


A fellow caregiver answered...

The good news is that you at least get $90 instead of $45 for spending money.