Dad’s current VA deposit is not automatically the amount you should carry into a Medicaid nursing home budget. VA says a pension recipient with no dependents who lives in a Medicaid-approved nursing facility and is covered by Medicaid for the facility’s services may be limited to a $90 monthly pension payment. VA also says that payment cannot be used to reduce what Medicaid pays the nursing facility.1

Before anyone calculates Dad’s patient payment or signs an admission agreement, get four answers in writing: Is this facility Medicaid approved? Will Medicaid cover Dad’s nursing facility services? Does VA currently recognize any dependents on his award? Is his deposit pension, disability compensation, or another benefit? Those facts determine whether the special pension rule is even the right rule to examine.1

Do not start with the amount in Dad’s bank account

Identify the benefit from the VA award letter. VA pension and disability compensation are different programs, and VA does not pay both at the same time. VA says that when a person qualifies for both, it pays the benefit that results in the greater payment, subject to the special $90 pension option described for certain Medicaid nursing home residents.1

Then check dependency. The VA rule described on its Medicaid nursing facility page applies to a resident with no dependents. Do not assume Dad has no dependent merely because he is entering alone. Compare the award letter with his current spouse and dependent information, and ask VA or an accredited representative to confirm what VA’s record shows.1

Run the three pension gates before budgeting an award

A nursing home admission does not erase the underlying pension requirements. Dad still must clear the service gate, the age or disability gate, and the financial gate. VA pension generally requires qualifying wartime service and discharge status, at least one qualifying age or disability condition, and family income and net worth within VA limits.2

A nursing home resident may satisfy an age or disability condition if the admission is for long-term care because of disability. That does not prove qualifying service or financial eligibility. Pull the discharge record, list household income and assets, and identify any spouse before treating pension as available money.2

The forms depend on whether Dad already receives pension

If Dad has no pension claim, the paper application for Veterans Pension is VA Form 21P-527EZ. If he needs more time to assemble the application, VA Form 21-0966 can preserve a potential filing date when VA receives the completed pension application within the allowed filing window. Confirm receipt instead of treating a mailed form as filed.3

For Aid and Attendance, VA uses Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance. When the claimant is in a nursing home, VA also identifies Form 21-0779, Request for Nursing Home Information in Connection with Claim for Aid and Attendance. The nursing home completes the facility information on that form.4

If VA asks for additional income or asset detail, it may require Form 21P-0969. VA says a separate copy is needed for each reporting period when information must be provided for more than one period.3

The VA claim is not the nursing home payment plan

VA does not promise a fixed decision time for Aid and Attendance. It says claims are generally processed in the order received unless priority processing applies.4 The family therefore needs a separate plan for charges due before the decision.

Ask the facility for the private-pay rate, the Medicaid-effective point it expects to use, which charges Medicaid will not cover, the resident personal-needs allowance it will apply, and how it will treat each existing VA benefit while eligibility is pending. Do not authorize the facility to assume a future VA award amount. Care can begin under a private-pay arrangement while a VA claim is pending, but the signed facility contract, not the pending claim, controls what is due before Medicaid or VA acts.

Survivors use a different application

If the claimant is Dad’s surviving spouse or eligible child, do not use the Veterans Pension application. VA Form 21P-534EZ is the application for Survivors Pension, DIC, accrued benefits, and increased survivor benefits based on Aid and Attendance or housebound status.5

VA also describes a $90 pension option for an eligible survivor who lives in a Medicaid-covered nursing facility and has no dependents. If the survivor currently receives DIC, ask VA to compare the benefits before making the budget. VA says the $90 pension would replace DIC rather than be paid on top of it.1

Use two VA doors, but give each one a defined job

For claim filing and benefit questions, call VA benefits at 800-827-1000 or use the Pension Intake Center instructions attached to the applicable form. For local file review, use an accredited Veterans Service Organization representative. VA says accredited VSO representation on a benefit claim is free, while accredited attorneys or claims agents may charge in permitted circumstances.6

In St. Louis, start with the offices listed in Local Help: St. Louis Offices. Ask the representative to verify the benefit type, dependency record, Medicaid nursing facility status, required forms, and proof of VA receipt. Ask the facility’s Medicaid worker separately to explain the admission bill and patient-payment calculation. One office should not be expected to answer for the other program.

The budget check before admission

Put three columns on one page: what Dad must pay under the facility contract, what Medicaid is expected to cover, and what VA is actually paying now. Mark every future amount as unconfirmed until the responsible program issues its decision. If the budget works only when an unreleased VA award arrives by a chosen month, the budget does not yet work.

VA.gov footnotes

  1. VA.gov, “$90 VA Pension Rate If You’re in a Medicaid-Covered Nursing Facility.”
  2. VA.gov, “Eligibility for Veterans Pension,” and “Current Pension Rates for Veterans.”
  3. VA.gov, “VA Form 21P-527EZ,” and VA Form 21-0966, “Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC.”
  4. VA.gov, “Aid and Attendance Benefits and Housebound Allowance,” and “VA Form 21-2680.”
  5. VA.gov, “Apply for DIC, Survivors Pension, or Accrued Benefits Online,” VA Form 21P-534EZ.
  6. VA.gov, “Get Help From a VA Accredited Representative or VSO.”