The VA pension with Aid and Attendance is a needs-based benefit paid by the Department of Veterans Affairs.[1] Medicaid is a separate program, funded jointly by the federal government and each state. In Missouri it is known as MO HealthNet and is administered through the Missouri Department of Social Services.[2] Each program has its own application, its own income and asset rules, and its own decision-maker. An approval from one does not decide the other.
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
What to check before you count on either
Ask the state office which income and asset rules apply to the person who will receive care, and whether the spouse at home is counted differently. Ask whether the answer changes for someone who is married, widowed, or living with family, because that changes which figures matter. Do not rely on a number from a friend or a rule of thumb from someone selling help. Get the rule from the office that decides the case, and get it in writing.
Ask whether a transfer of money or property made before applying will be reviewed, and how far back that review reaches. Medicaid looks back over a set period at gifts and transfers, and a gift to family can delay eligibility. If a gift has already happened, write down the date, the amount, and the recipient before anyone files, and bring that list to the first appointment.
Ask whether the program pays for home care at all
Coverage for care in a facility and coverage for care at home are not the same. Ask whether Missouri's long-term care options include a home and community-based program, what the enrollment process looks like, and whether there is a waiting period before services begin. Ask who assesses the care need, and what documentation that assessor will require from the doctor. Ask whether the agency you are considering accepts the program's payment and is enrolled as a provider. An agency that does not take the program cannot be billed under it, regardless of how the case is decided.
Keep the two decisions separate in your file
Keep one folder per program. The VA letters, the Medicaid notices, and the care agreement each go in their own place, with the date each arrived and the response deadline printed on it. A VA award letter does not show Medicaid eligibility, and a Medicaid notice does not show a VA pension amount. When a letter asks for income or asset detail, check which program sent it before you answer, because the two programs may request overlapping records covering different time periods.
Questions to bring to the office
Write the questions down and ask them of the person who makes the decision, not only the intake staff. Which income rule applies to this case. Which asset rule applies. Whether a transfer review applies, and for what period. Whether home care is covered under a waiver program and how the assessment is started. What the decision timeline is and how to request a status update. Ask for each answer in writing, and note the staff member's name, the office, and the date you asked.
What this briefing is not
This is a list of questions to compare, not legal or financial advice. Medicaid eligibility and transfer rules are technical, and a licensed elder law attorney can review the specific facts of a case. The Local Help: St. Louis Offices page lists places in the area that can help you find the right person to ask. The Sources page lists the references behind these notes, and How We Write This Briefing explains how each claim was checked.
Footnotes
[1] U.S. Department of Veterans Affairs, VA.gov, Veterans Pension Benefits, including the Aid and Attendance and Housebound pages.
[2] Missouri Department of Social Services, MO HealthNet program information. Program details are also summarized on VA.gov where VA pension rules reference state programs.