North Carolina Medicaid and the VA Aid & Attendance Program
If you qualify for Aid and Attendance, you should consider how the Aid and Attendance funds are viewed in by Medicaid in North Carolina. The website for the North Carolina Medicaid reference guide is http://info.dhhs.state.nc.us/olm/manuals. First, it is important to understand what you have been award. A veteran or surviving spouse may not be qualified for any pension under the VA rules until they meet the medical and financial criteria for Aid and Attendance. However, once they meet the criteria, the award they are granted may be comprised of Basic Pension (Maximum Annual Pension Rate (MAPR)) and Aid and Attendance. This is important because A&A and Reimbursement of Medical expenses does not. To be safe, you can assume at least the A&A breakout on the A&A Table contained on this website would be considered A&A, or check the figures on www.VA.gov.
Basically, A&A does not count against you in North Carolina, but if the receipt of the money increases your assets over $2,000 you have 1 month after the month of receipt to spend the money and get below $2,000 - since it is received every month, you need a plan. If you haven't prepaid a funeral, need additional compainion care, etc. make a plan to keep the assets below $2,000.
Adult Medicaid Manual MA-2250 INCOME
VIII. COUNTABLE UNEARNED INCOME
(VIII.D)
3. Budgeting
a. Count the monthly VA benefit entitlement for the budget unit member unless:
(1) The a/r is a student who is receiving VA benefits to pay for tuition, fees, or other necessary educational expenses;
(2) The VA payment is Aid and Attendance and/or Unreimbursed Medical Expenses; this does not apply to veterans who reside in a North Carolina State Veterans Nursing Home. Refer to MA-2270, Long Term Care Need and Budgeting; or
(3) The VA payment is the Reduced Improved Pension up to $90 received under P.L. 102-568.
b. Aid and Attendance (A&A)
(1) Aid and Attendance benefits are only issued to veterans or the spouse of veterans. The Adult Helpless Child allowance is not the same as Aid and Attendance and is countable unearned income.
(2) Need for aid and attendance is considered to exist when the veteran is so nearly helpless that he cannot care for himself without the services of another person. VA recipients who receive aid and attendance are entitled to higher VA income limitations or additional VA benefits, depending on the type of pension received. Aid and attendance can be received by:
(a) A VA recipient who is a patient in a nursing home, who is otherwise determined by VA to be in need of the regular aid and attendance of another person; or
(b) A VA recipient who is permanently housebound (unable to leave his home) due to his condition, who is otherwise determined by VA to be in need of the regular aid and attendance of another person.
c. Unreimbursed Medical Expenses (UME)
Reimbursement from VA for medical bills that the veteran has paid. This can be a lump-sum payment or included in monthly benefits.
d. Reduced Improved Pension
An institutionalized veteran or a surviving spouse of a veteran may choose to have his Improved Pension reduced to $90 or less under P.L. 102-568.
e. Contact VA to verify amounts for A&A, UME, educational benefits, and Reduced Improved Pension. You may contact the school directly for educational benefits.
(1) Exclude the amount for A&A and/or UME, educational benefits, and/or Reduced Improved Pension from VA benefits in both private living and long term care budgeting except for veterans who reside in North Carolina State Veterans Nursing Homes. Refer to MA-2270, Long Term Care Need and Budgeting.
(2) Veterans may receive A&A, UME, and/or Reduced Improved Pension included in their pension checks. Remember to determine amount and exclude from countable income.
Adult Medicaid Manual MA-2230 FINANCIAL RESOURCES
REVISED 01/01/10 - CHANGE NO. 09-10
I. POLICY PRINCIPLES
A. Resource Policy Rules
6. The following are not considered resources in determining Medicaid eligibility or transfer of assets.
a. Cash to purchase medical or social services, cash placed in an irrevocable burial account, (see XIII. for applying to the burial exclusion), money used as part of a Plan for Achieving Self-Support (PASS) see H. below, and past due SSI benefits placed in a Dedicated Account for a child under age 18 who has a representative payee, (see I. below).
For one calendar month following its receipt, cash paid by a recognized medical or social services program is not a resource provided the cash is not income and not repayment for a bill already paid.
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