Casey Matuszak MOPH NSO Training Orlando, FL March 2012 1
SMP TYPES OF SMP APPLICATIONS MEDICAID/P&T AND NURSING HOME DEDUCTIBLE MEDICAL EXPENSES MOPH NSO Training Orlando, FL March 2012 2
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 2012 3
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 2012 4
SMP-TYPES HOUSEBOUND 100 disability (P&T) + housebound in fact 100% disability (P&T) + 60% disability Age 65 + 60% Hartness v Nicholson - Fast Letter 06-28 Exception C&P advisory opinion MOPH NSO Training Orlando, FL March 2012 5
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 2012 6
SMP VETERAN MAPR P&T $12,256.00 HB $14,978.00 A&A $20,447.00 MOPH NSO Training Orlando, FL March 2012 7
SMP - APPLICATIONS A&A w/o nursing home status VA Form 21-2680 p. 5/6 VA Form 21-8416 A&A w/nursing home status (licensed) VA Form 21-0779 p.7 HOUSEBOUND VA Form 21-2680 VA Form 21-8416 MOPH NSO Training Orlando, FL March 2012 8
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 2012 9
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 2012 10
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 2012 11
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 2012 12
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 2012 13
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 2012 14
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 2012 15
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 2012 16
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 2012 17
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 2012 18
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 2012 19
SMP TYPES OF SMP REQUIREMENTS MEDICAID/P&T AND NURSING HOME DEDUCTIBLE MEDICAL EXPENSES MOPH NSO Training Orlando, FL March 2012 20
SMP MOPH NSO Training Orlando, FL March 2012 21