Dad is in a nursing home, Medicaid is paying part or all of the bill, and someone says his Aid and Attendance pension will be reduced to $90 a month. Do not treat that statement as a complete answer. VA describes a special $90 monthly pension rate for certain pension recipients in Medicaid-covered nursing facilities, but the result depends on Dad's facility, Medicaid coverage, dependents, and current VA benefit.[1]

This is a benefits calculation, not a nursing home price quote. Before the family budgets around any VA payment, get the facility and VA file to answer the same questions.

Run the four checks

First, is this a Medicaid-covered nursing facility? Medicaid helping with home care, adult day services, or assisted living does not by itself establish the nursing facility condition described on VA's $90-rate page. Medicaid long-term-care coverage and eligibility vary by state and setting.[1][2] Ask the billing office whether Medicaid covers all or part of Dad's nursing home costs and whether the facility is Medicaid approved.

Second, does Dad have a dependent? VA's public explanation of the $90 rate addresses a person living in a Medicaid-covered nursing facility who has no dependents.[1] Check the VA record rather than assuming that widowhood, separation, or an adult child's age settles the issue.

Third, what VA benefit is Dad receiving now? Pension and disability compensation are different programs. VA says a person cannot receive pension and disability compensation at the same time. If VA finds a veteran eligible for both in this situation, VA may award pension at the $90 rate instead of compensation.[1] Put the current VA award letter on the table and identify the benefit by name before comparing dollars.

Fourth, has the nursing home verified the facts? VA Form 21-0779 is the Request for Nursing Home Information in Connection with Claim for Aid and Attendance. A nursing home official uses it to verify the patient and qualifying facility information.[3] The form asks whether the facility is Medicaid approved, whether the patient applied for Medicaid, whether Medicaid covers the patient, and when that coverage began.[4]

What the $90 changes

VA says that when it awards this special pension rate, the nursing facility cannot count the $90 monthly payment as income toward the cost of care. The recipient keeps it for personal expenses.[1] That protection is the point of the rule.

It does not mean every Medicaid nursing home resident automatically receives $90. Dad still has to qualify for VA pension. Veterans Pension requires qualifying service and discharge, income and net worth within VA limits, and the applicable age or disability condition.[5] Medicaid has its own financial and functional eligibility rules, administered by the state.[2]

Do not subtract $90 from a quoted nursing home bill and call the budget finished. Ask the Medicaid caseworker what income Dad must contribute under the state calculation, ask the facility which charges Medicaid does not cover, and ask VA whether the proposed pension election would replace a current compensation payment. VA specifically warns that the $90 pension replaces disability compensation or Dependency and Indemnity Compensation when that election applies.[1]

The forms to put in one packet

For a veteran filing a pension claim, the application is VA Form 21P-527EZ.[6] If Dad is seeking Aid and Attendance, VA Form 21-2680 supplies the examination information. If he is in a nursing home, VA also directs the filing of VA Form 21-0779.[3][7]

Do not fill in the nursing home's answers for it. Give Form 21-0779 to an official who can confirm the Medicaid and patient information. Before submission, compare the resident name, VA file number, facility name, Medicaid status, and coverage information against the admission and Medicaid records. VA's upload instructions warn that mismatched personal details can cause delays and that the upload system does not check the form for mistakes.[8]

If Dad already receives pension and Medicaid coverage begins, ends, or changes, contact VA or his accredited representative promptly and ask what evidence VA needs to update the award. Keep the Medicaid approval notice, facility billing statements, completed Form 21-0779, and VA submission receipt together.

If the claimant is Mom

The same cost issue can arise for a surviving spouse receiving or seeking Survivors Pension. VA says that a qualifying survivor in a Medicaid-covered nursing facility may receive the $90 pension rate instead of Dependency and Indemnity Compensation, and that the two benefits cannot be paid at the same time.[1] The survivor pension application is VA Form 21P-534EZ, while the nursing home verification remains VA Form 21-0779.[3][9]

That makes the current award letter essential. Confirm whether Mom receives Survivors Pension, Dependency and Indemnity Compensation, or another payment before anyone predicts what she will keep.

Who can check the file without charging a claim fee

A VA-accredited Veterans Service Organization representative can help with a VA benefits claim without charging for that service.[10] Bring the current VA award letter, Medicaid notice, nursing home bill, dependent information, and any unfinished forms. Ask the representative to answer three questions in writing or in your appointment notes: which benefit is currently being paid, whether the $90 rule appears applicable, and which form or evidence must be filed next.

For St. Louis filing options, use Local Help: St. Louis Offices. You can also call the VA benefits hotline at 800-827-1000 and ask VA to identify the benefit on the account and the evidence needed for the Medicaid nursing home status.[11]

Private-pay care can begin while a VA claim is pending, but the family remains responsible for the care contract and bills unless another payer has accepted them. Do not make the nursing home budget depend on an unissued VA decision. Compare the private-pay obligation, the Medicaid effective coverage, Dad's required contribution, uncovered facility charges, and the VA benefit that would be replaced or retained.

Sources

[1] VA.gov, “$90 VA pension rate if you're in a Medicaid-covered nursing facility.” [2] VA.gov, “Medicaid Benefits and Long Term Care.” [3] VA.gov, “VA Form 21-0779.” [4] VA.gov, VA Form 21-0779, “Request for Nursing Home Information in Connection with Claim for Aid and Attendance.” [5] VA.gov, “Eligibility for Veterans Pension.” [6] VA.gov, “VA Form 21P-527EZ.” [7] VA.gov, “Aid and Attendance benefits and Housebound allowance.” [8] VA.gov, “Upload VA Form 21-0779.” [9] VA.gov, “Applying for Benefits,” pension benefits for survivors. [10] VA.gov, “Get help from a VA accredited representative or VSO.” [11] VA.gov, “Pension Basics FAQ.” The site's source-checking policy is explained on How We Write This Briefing.