Should I Go After Medi-Cal or VA Benefits–Which is Better?

When someone’s health declines to the point that care assistance is needed either in the home or in a facility, it quickly becomes apparent that the cost of this care is quite expensive.  Many folks contact our office for information about and assistance with applying for public benefits for the payment of long term care .  Understanding how to proceed is a good place to start because many factors are often involved in the process.

Two of the key public benefit healthcare programs that are important but not widely understood are the Aid & Attendance Non Service Connected Disabililty program from the federal Department of Veterans Affairs (VA) and the Medi-Cal program (Medicaid in other states). In previous entries, we have discussed important events surrounding Medicare and Medicare basics  in addition to the Medi-Cal program. In other entries, we have discussed various aspects of the VA Aid & Attendance Non Service Connected Pension program in relation to assisted living.

Sometimes a question we get is which program is best for us? The answer can be complicated. However, here are some basic considerations. The VA pension program is not available for everyone.  Only certain wartime veterans and their surviving spouses can qualify for these benefits.  The spouses of living veterans (although not technically correct) can also qualify in a manner of speaking.

Both the VA Aid & Attendance program and Medi-Cal cover in-home care assistance. Medi-Cal’s is very limited.  The VA Aid & Attendance benefit can help pay for a skilled nursing facility, assisted living facility or in-home care.  One qualifies for the Aid & Attendance benefit if they are in need of the aid and attendance of another for the basic activities of daily living  (ADL’s) or are “housebound.”    There are some limited exceptions to this ADL requirement. ADLs would include ambulation, feeding oneself, toileting, bathing, transferring from a bed to upright, etc.   Medi-Cal has several in home programs under the general name of In-Home Supportive Services, or IHSS. Here’s another take on the IHSS program from a non-government source.

Keep in mind that the Aid & Attendance program does not pay for the services, it just provides a fixed amount to you each month that you then can use toward paying for the service.  As to the IHSS program, your capability of being approved depends on whether the county offers this specific program and whether they have enough money available to take another person.  In other words, there ususally is a waiting list.  Also, remember that while the VA Aid & Attendance Non Service Connected pension is an award, not a loan; many (but not all) Medi-Cal benefits are the exact opposite as it is a loan, not an award.  That means that (for the Medi-Cal programs that allow this) Medi-Cal can come after your assets after you die.  In other words, it is paid back from the inheritance that you expected to go to your children.  Proper planning can avoid this disaster through the use of various techniques including a special QMap Trust.

I hope everyone had a happy and healthy New Years Holiday!