Michigan Medicaid Benefits

Frequently, veterans that are residents of Macomb County who need assistance will consider applying for Medicaid benefits in addiiton to VA benefits. If you or your family fall into this category, it is important to understand the interaction between the different care systems as well as the differences in application of federal and state regulations.

Michigan Medicaid benefits fall into two categories: community based; and, long term care benefits. For the purposes of this discussion, we will consider long term care benefits. In order to qualify for this benefit, you must be: (1) over 65 and confined to a long term care facility; (2) be asset eligible; (3) be medically eligible; and, (4) reside at a facility that is certified to receive Medicaid benefits. In addition to this criteria you must also be free of any divestment penalties. Most people know this rule as the five (5) year “look back” period–and few actually understand what it means.

Pursuant to Medicaid regulations a divestment penalty is incurred for any transfer of an asset by an applicant for less than fair market value. This includes any sale of an asset for less than it is worth, any gift of an asset, or any other transfer in title to an asset. The resulting affect of such events is a one month penalty of ineligibility for every $6,300.00 of value transferred. The resulting penalty would begin to “run” when the Medicaid applicant is otherwise eligible to receive Medicaid benefits. While Medicaid has a “look back” period, the VA system does not. In fact, federal regulations provide that gifted assets prior to application for benefits should not be considered as part of the approval assets. However, any gifts made prior to application for VA benefits will trigger Medicaid penalties, if nursing home care occurs within five (5) years of the transfer. Accordingly, if you engage in Medicaid or VA planning it is important to work with an accredited individual that understands both Medicaid law and VA benefit planning, in order to avoid costly errors.

Finally, it is also important to understand that once a veteran or his or her spouse becomes eligible to receive Medicaid benefits in a nursing home, his or her VA aid and attendance benefits will be reduced to the amount of ninety (90) dollars a month. This is because the Aid and Attendance benefit is intended to provide a benefit to essentially keep a veteran out of a nursing facility. The benefit is more or less designed to provide supplemental income for veterans that require help and assistance and not necessarily 24 hour care. However, despite its limitations, if the proper planning is performed, it is possible to use the benefit to provide care, similar to the care that is provided at nursing homes, in assisted living facilities and senior independent living facilities that offer health care and assistance. In metro Detroit, veterans can find such care in several different facilities. In Sterling Heights and Macomb county, veterans will frequently look at moving into Pine Ridge, American House, or Oak Haven facilities.