Casey Matuszak. MOPH NSO Training Orlando, FL March

Transcription

1 Casey Matuszak MOPH NSO Training Orlando, FL March

2 SMP TYPES OF SMP APPLICATIONS MEDICAID/P&T AND NURSING HOME DEDUCTIBLE MEDICAL EXPENSES MOPH NSO Training Orlando, FL March

3 SMP QUESTIONS 1. Can a vet deduct fees as an UME paid to a family member who provides for his personal needs? 2. What happens to VA benefits when i. an SMP vet w/o dependents goes to a Nursing Home on Medicaid? ii. a DIC widow w/o dependents goes into a Nursing Home on Medicaid? MOPH NSO Training Orlando, FL March

4 SMP-TYPES AID & ATTENDANCE (A&A) 100% disability Needs assistance ADL Bi-lateral vision 5/200 or less Nursing home status - patient MOPH NSO Training Orlando, FL March

5 SMP-TYPES HOUSEBOUND 100 disability (P&T) + housebound in fact 100% disability (P&T) + 60% disability Age % Hartness v Nicholson - Fast Letter Exception C&P advisory opinion MOPH NSO Training Orlando, FL March

6 SMP SMP is NOT an additional amount of money like SMC RATHER SMP IS an increase in the Maximum Annual Pension Rate (MAPR) MOPH NSO Training Orlando, FL March

7 SMP VETERAN MAPR P&T $12, HB $14, A&A $20, MOPH NSO Training Orlando, FL March

8 SMP - APPLICATIONS A&A w/o nursing home status VA Form p. 5/6 VA Form A&A w/nursing home status (licensed) VA Form p.7 HOUSEBOUND VA Form VA Form MOPH NSO Training Orlando, FL March

9 SMP Medical Expenses General Rule Paid unreimbursed medical expenses (UME) for vet or relative. Exceed 5% of MAPR Normally allow after the fact Exception: Nursing home UME MOPH NSO Training Orlando, FL March

10 SMP Medical Expenses Nursing Home (NH)expenses NH verifies patient status Claimant Statement s to actual amount paid NH expenses > $15,000 - verified by VA. NH states amounts paid by claimant insurance and Medicaid MOPH NSO Training Orlando, FL March

11 SMP QUESTIONS What happens to VA benefits when an SMP vet w/o dependents goes to a Nursing Home on Medicaid? MOPH NSO Training Orlando, FL March

12 SMP Medical Expenses 38 CFR 3.551(i) limits Improved Pension to $90/month to a veteran (or surviving spouse) with no dependents who is in a Medicaid-approved nursing facility, and is covered by a Medicaid plan. The $90 monthly Improved Pension cannot be used to reduce the amount of Medicaid paid to a nursing facility. MOPH NSO Training Orlando, FL March

13 SMP Medical Expenses What is Medicaid? Medicaid is a health program for individuals and families low incomes and resources - means tested program funded by the state and federal governments managed by the states. MOPH NSO Training Orlando, FL March

14 SMP MEDICAL EXPENSES Medicaid Eligibility monthly income must be < the total: Medicaid rate for NH care + vet s monthly medical exp. Difference paid by Medicaid Once eligible for Medicaid, vet s pension Reduced to $90.00/monthly Effective month after Medicaid begins or after the expiration of due process notice MOPH NSO Training Orlando, FL March

15 SMP QUESTIONS What happens to VA benefits when a DIC widow goes to a Nursing Home on Medicaid? No reduction but DIC counted as income Can keep $57.28 monthly for personal needs Or, elects Death Pension and keeps $90.00 monthly MOPH NSO Training Orlando, FL March

16 In-Home Care Medical Expenses Rated A&A or HB: Deduct wages - attendant who provides medical/nursing services maintenance of the immediate environment Licensed health professional not required Can be a paid family member MOPH NSO Training Orlando, FL March

17 In-Home Care Medical Expenses Not rated A&A/HB and licensed MD has not stated need for in home attendant: Deduct wages ONLY if licensed health care professional and Performing services for personal care and maintenance of immediate environment MOPH NSO Training Orlando, FL March

18 SMP QUESTION Can a vet deduct fees as an UME paid to a family member who provides for his personal needs? Rated SMP? Not rated SMP? YES NO MOPH NSO Training Orlando, FL March

19 Adult Day Care, Rest & Group Homes Medical Expenses Rated A&A/ HB or licensed MD certifies need All reasonable fees provided facility provides medical/nursing services If not rated A&A/HB nor licensed MD certifies need Expenses only for medical/nursing services MOPH NSO Training Orlando, FL March

20 SMP TYPES OF SMP REQUIREMENTS MEDICAID/P&T AND NURSING HOME DEDUCTIBLE MEDICAL EXPENSES MOPH NSO Training Orlando, FL March

21 SMP MOPH NSO Training Orlando, FL March