(The following is based upon a real discussion that recently took place on an elder law listserv for attorneys. It illustrates the misinformation that is often inadvertently provided to consumers by government agency personnel concerning the availability of and eligibility criteria for needs-based public benefits.)

Question: I recently contacted the Veterans Administration (VA) about applying for Aid & Attendance Benefits (VA A&A Benefits) for my client, who is the surviving spouse of a World War II Veteran. I was told that in order to get VA A&A Benefits, the surviving spouse had to be collecting a VA pension based on the deceased spouse’s military service. The deceased spouse never received a VA pension, but he received VA medical benefits and died in a VA nursing home. Am I receiving correct information about my client’s eligibility for VA A&A Benefits? Also, if my client qualifies for VA A&A Benefits and later enters an assisted living facility, will the VA A&A Benefits make her ineligible for Medicaid by putting her over the assisted living income cap even after she spends down all of her assets and is otherwise eligible for Medicaid?

Answer: No, unfortunately you did not receive correct information. In order for your client to receive VA A&A Benefits, she must have been married to the veteran when he died. The veteran must have served at least 1 day in the military during a war time period and have served at least 90 days total in the military. Further, in order to qualify medically your client must either need assistance from another to help her with her activities of daily living, or be unsafe in her own environment without supervision. It is presumed the client needs the assistance if she lives in an assisted living facility; however, the client would still need a physician’s affidavit documenting her medical needs. If she meets all of those criteria, the client must still meet the asset and income requirements. The client’s income cannot exceed $998 per month in 2008. However, in order to qualify financially under the program, she can reduce her gross income by deducting all medical expenses, including the cost of the assisted living facility. In many cases, the assisted living facility costs alone, when deducted from her income, will reduce her income down to below $0.00. With regard to assets, the standard is whether the applicant has sufficient means to pay for her own needs, including her care needs. The informal asset limit is $80,000.

Assuming your client receives the maximum from the VA, she will get $998 per month in 2008. With regard to Medicaid, all of the VA A&A Benefits are excluded from income in New Jersey in determining eligibility for assisted living facility Medicaid. In other states, a portion of the VA A&A Benefits are considered to be “pension” and are included in the income cap calculation and the other portion is considered to be “aid and attendance” which is exempt from the income calculation. The “pension” portion is $624 per month and the A&A portion is $373 per month. In states other than NJ, once Medicaid is approved, you or the client must to notify the VA that she is receiving Medicaid by using VA Form 21-0779. Then, the VA will reduce the A&A to $90 per month which takes the place of the normal personal needs allowance. All of the $90 per month received from the VA is exempt from the Medicaid income calculation.