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M21-1, Part V, Subpart iii, Chapter 3 – Pension Reductions for Medicaid-Covered Nursing Facility Care

Overview


In This Section

This section contains the following topics:
Topic
Topic Name
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1.  General Information on Pension Reductions for Medicaid-Covered Nursing Facility Care


Change Date

June 11, 2015

V.iii.3.1.a.  Provisions for Pension Reductions for Medicaid Covered Nursing Facility Care

38 CFR 3.551(i) limits to $90 per month the amount of pension that can be paid to a Veteran or surviving spouse with no dependents or to a surviving child who
  • is in a Medicaid-approved nursing facility, and
  • is covered by a Medicaid plan for services furnished by the nursing facility.
No part of the $90 monthly pension may be used to reduce the amount of Medicaid paid to a nursing facility.

2.  Medicaid Definitions


Introduction

This topic contains information on Medicaid definitions, including

Change Date

June 11, 2015

V.iii.3.2.a.  Definition:  Medicaid Plan

Medicaid Plan is a State plan for medical assistance per Title XIX, section 1902(a), of the Social Security Act (42 U.S.C. 1396a(a)).
Medicaid is available only to certain low-income individuals and families. Medicaid does not pay money to individuals; instead, it sends payments directly to health care providers.

V.iii.3.2.b.  Definition:  Medicaid-Approved Nursing Facility

Medicaid-approved nursing facility is a nursing facility other than a State home that is approved to accept Medicaid patients per Title XIX, section 1919, of the Social Security Act (42 U.S.C. 1396r).
References:  For information on

V.iii.3.2.c.  State Medicaid Home and Community-Based Waiver Program

Some beneficiaries receive Medicaid-paid services under a State Medicaid Home and Community-Based Service Waiver Program. 
If Waiver Program Medicaid Services are being received in an assisted living facility, personal care home, the person’s home, or any other facility that is not listed on Medicare.gov’s Nursing Home Compare web site, then the beneficiary is not considered to be in a Medicaid-approved nursing facility, and is therefore not subject to the reduction to $90 under 38 U.S.C. 5503(d).

V.iii.3.2.d.  Definition:  Covered by a Medicaid Plan

A beneficiary covered by a Medicaid plan for services furnished by the nursing facility, has been found eligible for Medicaid coverage for services that the nursing facility provides.
The facility is reimbursed under Medicaid for services furnished to the extent that the expenses
  • qualify for payment under the State’s Medicaid plan, and
  • are not payable by a third party.

V.iii.3.2.e.  When the Medicaid Eligibility Process Begins

The beneficiary’s Medicaid eligibility process begins when he/she files an application with the local Medicaid office.  The date of receipt of the application generally determines the effective date of Medicaid coverage.
When Medicaid coverage is established, a decision notice includes the effective date for the coverage.
Reference:  For information on confirming the status of Medicaid coverage, seeM21-1, Part V, Subpart iii, 3.4.h.

3.  Identifying Medicaid-Covered Facilities


Introduction

This topic contains information on identifying Medicaid-covered facilities, including

Change Date

June 11, 2015

V.iii.3.3.a.  Identifying Medicaid-Approved Nursing Facilities

Use Medicare’s Nursing Home Compare web site to determine whether or not a nursing facility participates in a State Medicaid plan.  If this website confirms that the facility participates in a State Medicaid plan, then the facility is considered to be a Medicaid-approved nursing facility.
Reference:  For the definition of a Medicaid-approved nursing facility, see M21-1 Part V, Subpart III, 3.2.b.

V.iii.3.3.b.  Beneficiaries in State Homes

Beneficiaries who are in State homes are exempt.; Do not reduce pension under these provisions if the Medicaid-approved nursing facility is a State home per 38 CFR 3.551(i).

4.  Verifying Nursing Facility Status and Medicaid Plan Coverage


Introduction

This topic contains information on verifying nursing facility status and Medicaid plan coverage, including

Change Date

June 11, 2015

V.iii.3.4.a.  Applying for Medicaid

A VA pensioner is not required to apply for Medicaid.
However, a Medicaid applicant must apply for all benefits to which he/she may be entitled before Medicaid payments will be made to reimburse a facility.

V.iii.3.4.b.  Determining Medicaid Eligibility

In determining Medicaid eligibility, a Medicaid office considers the amount of income remaining after deducting certain allowances for needs not met by the facility.
A Medicaid office can process Medicaid applications and determine eligibility while claims for other benefits are pending.  Medicaid eligibility is re-determined at least annually.
Note:  The income limit for a Medicaid applicant is determined by the State Medicaid plan and may differ from State to State.

V.iii.3.4.c.  When Review and Confirmation of Nursing Facility/Medicaid Status Is Required

When a current-law pension beneficiary who has neither spouse nor child is currently residing in a nursing facility, but not at VA expense
  • determine if the
    • nursing facility is Medicaid approved, and
    • beneficiary is covered by a Medicaid plan for services furnished by the nursing facility, and
  • confirm the date the beneficiary was admitted to the nursing facility.

V.iii.3.4.d.  When a Medicaid Application Is Pending Concurrently With a Claim for VA Benefits

A Medicaid application can be pending simultaneously with a claim for VA benefits.  Medicaid eligibility can be established retroactive to the date of application and can be effective from the month of admission to the Medicaid approved facility.
When a beneficiary has a Medicaid application pending, assume that the beneficiary will be covered by a Medicaid plan retroactive to the date of admission to the nursing facility.  Advise the beneficiary of this in any applicable contact/correspondence with the beneficiary related to this assumption.

V.iii.3.4.e.  Assumed Medicaid Coverage, When Determining VA Benefits

Assume that Medicaid coverage began the month of admission to a Medicaid-approved nursing facility if
  • a beneficiary is found to be Medicaid eligible (or the beneficiary has a Medicaid application pending), but
  • the date that the Medicaid coverage began (or will begin) cannot be specifically determined.
Advise the beneficiary that VA has assumed that Medicaid coverage began the date of the beneficiary’s admission to the nursing facility, and if the assumption is incorrect, the beneficiary should provide confirmation of his/her Medicaid status.

V.iii.3.4.f.  Action Taken When There Is No Running Award and Medicaid Status Must Be Confirmed

Delay the award action pending confirmation of a beneficiary’s Medicaid status when the beneficiary
  • lives in a nursing facility, but does not have a running award, and
  • is a
    • Veteran who has neither spouse nor child
    • surviving spouse without children, or
    • surviving child.
Reference:  For information on confirming a beneficiary’s Medicaid status, see

V.iii.3.4.g.  Action Taken When There Is a Running Award and it Appears Reduction Under 38 CFR 3.551(i) Would Apply

When the case of a beneficiary with a running award is reviewed for any reason, and it appears that the $90 nursing home/Medicaid reduction under 38 CFR 3.551(i) would apply
  • confirm Medicaid status, and
  • follow due process procedures described in M21-1, Part I, 2.B, before taking action to reduce benefits.
Important:  A beneficiary may waive the 60-day due process period by requesting an immediate reduction in payments.

V.iii.3.4.h.  Confirming Medicaid Status

Follow the steps below to confirm the beneficiary’s Medicaid status.
Step
Action
1
Determine whether the facility is Medicaid approved.
Reference:  For information on determining whether a facility is Medicaid approved, see M21-1, Part V, Subpart iii, 3.3.a.
2
If the facility is approved, determine
  • whether the nursing facility is providing Medicaid-covered care (or whether a Medicaid application is pending)
  • the date Medicaid coverage began (or the date VA will assume that Medicaid coverage began, if the exact date cannot be determined)
  • the date the beneficiary entered the nursing facility, and
  • whether the beneficiary is a patient or resident of the facility.
3
When it is necessary to obtain the beneficiary’s Medicaid status, contact either the
  • beneficiary
  • fiduciary
  • nursing home, or
  • local Medicaid office.
If the beneficiary’s Medicaid application is pending, assume Medicaid-covered care in accordance with the provisions in M21-1, Part V, Subpart iii, 3.4.d and e.
4
Document the information obtained through telephone contacts or written correspondence for the claims folder.

V.iii.3.4.i.  Obtaining Medicaid Status Information on Incompetent Veterans

The fiduciary activity may be able to provide information on the Medicaid status of incompetent beneficiaries for whom they provide fiduciary oversight.

V.iii.3.4.j.  When Medicaid Coverage Is Terminated

When Medicaid eligibility is terminated, the Medicaid office provides formal notice, including the termination date.
Medicaid is terminated prospectively at the end of the first calendar month that begins more than 10 days from the date of notice.
Examples:
  • If notice is given March 1, Medicaid is terminated April 1.
  • If notice is given March 25, Medicaid is terminated May 1.

5.  Effective Dates for Payments Related to Nursing Home/Medicaid Status- No Running Award


Introduction

This topic contains information on effective dates for pension payments related to nursing home/Medicaid status when there is no running award, including

Change Date

June 14, 2018

V.iii.3.5.a.  Action to Take When There Is No Running Award for Claims Involving the $90 Limitation Required by 38 CFR 3.551(i)

For claims when there is no running award, once development is complete, and it is confirmed that a
  • Veteran with no dependents
  • surviving spouse with no dependents, or
  • surviving child,
who
  • is in a Medicaid-approved nursing facility, and
  • is covered by a Medicaid plan for services furnished by the nursing facility,or
  • states that he or she is covered by a Medicaid plan, or
  • has a Medicaid application pending,
then:

V.iii.3.5.b.  Determining When to Pay the $90 Rate Required by 38 CFR 3.551(i) in an Original or Reopened Award

Use the table below to determine when to pay the $90 nursing home/Medicaid rate required by 38 CFR 3.551(i) in an original or reopened award involving Medicaid-covered nursing home care.
If the effective date of the pension award is …
Then …
one or more months earlier than the month in which Medicaid coverage began (or VA assumes it began)
  • pay full benefits from the beginning of the pension award through the end of month in which the Medicaid coverage began, and
  • reduce to $90 effective the first day of the following month.
in the same month or after the month Medicaid coverage began (or VA assumes it began)
pay $90 from the beginning of the pension award.

V.iii.3.5.c.  Example:  Original Pension Award Involving Medicaid Application

Situation:
  • The Veteran’s original pension claim, received on October 14, 2010, shows the Veteran has no dependents, resides in a nursing home, and has applied for Medicaid.
  • The nursing home is Medicaid approved per Medicare.gov’s Nursing Home Compare web site.
  • According to the nursing home manager, the Veteran’s Medicaid application is still pending.
Action:
  • Assume Medicaid will be approved retroactive to October 2010.
  • Award pension of $90 per month per 38 CFR 3.551(i) from November 1, 2010, which is the earliest effective payment date for this award.

6.  Effective Dates for Reductions – Running Award


Introduction

This topic contains information on the effective dates for reductions to $90 based on 38 CFR 3.551(i) when there is a running award, including

Change Date

June 14, 2018

V.iii.3.6.a.  Action to Take for Running Awards, for $90 Reductions Based on Nursing Home/Medicaid Status

For $90 reductions based on nursing home/Medicaid status as required by 38 CFR 3.551(i), after:
  • development is complete
  • a notice of proposed adverse action is sent, and
  • the time period for submitting additional evidence has expired,
reduce the award to $90 per month, as of the effective date shown in M21-1, Part V, Subpart iii, 3.6.c, and provide a decision notification as stated in M21-1, Part III, Subpart v, 2.B.1.b.
Note:  For beneficiaries whose full benefits are already $90 per month or less, reductions for Medicaid do not apply.

V.iii.3.6.b.  Establishing and Maintaining Controls for the Proposed Adverse Action for Reductions Based on Nursing Home/Medicaid Status

See M21-1, Part I, 2.C for detailed procedures for establishing and maintaining controls, once a notice of proposed adverse action is sent for $90 reductions based on nursing home/Medicaid status as required by 38 CFR 3.551(i).
Clear end product (EP) code 135, and establish EP code 600 at the time a notice of proposed adverse action is released to the beneficiary for this issue.

V.iii.3.6.c.  Determining the Effective Date of Reductions Based on Nursing Home/Medicaid Status

Under 38 CFR 3.103(b)(2), the effective date of a reduction of current-law Pension to or for a nursing home/Medicaid covered beneficiary is the latest of the following dates:
  • the first day of the month after the month in which Medicaid coverage begins
  • the first day of the month after the month following 60 days after issuance of a reduction notice, or
  • the earliest date on which payment may be reduced without creating an overpayment (that is, the date of last payment (DLP)).
Note:  When the beneficiary willfully conceals information necessary to make the reduction, the date of reduction is the first day of the month following the month in which the willful concealment occurs.

V.iii.3.6.d.  Beneficiary Liability for Overpayment for Excess Pension Paid Over the $90 Nursing Home/Medicaid Rate

A nursing home/Medicaid covered beneficiary is not liable for excess pension paid over the $90 monthly limit, unless VA failure to reduce the amount is due to the beneficiary’s willful concealment of information necessary to make the reduction.

7.  Retroactive Increases for Running Awards During Period of Medicaid-Covered Nursing Facility Care


Introduction

This topic contains information on retroactive increases for running awards during a period of Medicaid-covered nursing facility care, including

Change Date

June 11, 2015

V.iii.3.7.a.  Nursing Home/
Medicaid
Beneficiaries Without Dependents Receiving $90 or Less

When monthly benefits are $90 or less for nursing home/Medicaid beneficiaries who would otherwise be subject to the $90 limit per 38 CFR 3.551(i), an adjustment for nursing home/Medicaid status does not apply.  However, if monthly benefits become greater than $90 through retroactive increase, the $90 limit for nursing home/Medicaid status does apply.

V.iii.3.7.b.  Action Taken When a Nursing Home/Medicaid-Covered Beneficiary Receives a Retroactive Increase

If a beneficiary is eligible for a retroactive increase, and the retroactive increase involves a period where Nursing Home/Medicaid-covered status, subject to the $90 limit stated in 38 CFR 3.551(i), begins, pay the retroactive increase through the last day of the calendar month in which Medicaid coverage began, with payment then limited to no more than $90 from the first day of the next month.
A notice of proposed adverse action is not required as long as the action does not reduce a running award or create an overpayment.

V.iii.3.7.c.  Example:  Retroactive Increase for a Nursing Home/Medicaid-Covered Beneficiary

Situation:
  • A Veteran, current-law pension beneficiary has been receiving Medicaid- covered nursing facility care since September 7, 2013.
  • The Veteran received pension at the rate of $70 per month effective January 1, 2013, and $74 per month effective December 1, 2013.
  • In 2014, the Veteran reports 2013 medical expenses that result in increased pension rates of $105 per month from January 1, 2013, and $110 per month from December 1, 2013.
Result:  Pay $105 per month from January 1, 2013 (or February 1, 2013, if 38 CFR 3.31 applies), and $90 per month from October 1, 2013.

V.iii.3.7.d.  No Retroactive Increase in Monthly Rate After Medicaid Coverage Begins for Beneficiaries Receiving Over $90 per Month

Once Medicaid nursing facility coverage is established, limit the beneficiary’s award to $90 per month for any period after the month in which Medicaid coverage began.
However, the actual reduction to $90 may take place months after the Medicaid coverage began.
Therefore, when a greater rate of payment is established, based on a change in circumstances, no retroactive increase can be made for any period after the month in which Medicaid-covered nursing facility care began.  The monthly benefits received during this time cannot be increased, because $90 per month should have been paid.

V.iii.3.7.e.  Continuing the Nursing Home/
Medicaid $90 Limit

The effective date of the $90 limited nursing home/Medicaid rate is binding on retroactive award adjustments.

V.iii.3.7.f.  Making a Retroactive Increase for Medicaid/Nursing Home Beneficiaries Subject to 38 CFR 3.551(i)

For Medicaid/nursing home beneficiaries subject to the $90 limit, per 38 CFR 3.551(i), make any retroactive increase (such as need for aid and attendance (A&A) established, or income change due to unreimbursed nursing home fees or other medical expenses) in accordance with the facts found.
Award the beneficiary increased benefits through the end of the month in which Medicaid coverage began.  Then, continue the old rate, from the first day of the next month after Medicaid coverage began, through the month before the $90 limited rate begins.

Note:  Complete the appropriate Veterans Service Network (VETSNET) INSTITUTIONALIZATION screens when adjusting a beneficiary’s award to $90. Do not establish a withholding to adjust for the $90 per month limit.


V.iii.3.7.g.  Example 1:  Retroactive Increase Pending Notice of Proposed Adverse Action for $90 Nursing Home/Medicaid Rate

Situation:
  • A Veteran pension beneficiary is admitted to a nursing home on March 20, 2013.
  • Medicaid coverage began in May 2013, and the reduction to $90 is pending a notice of proposed adverse action.
  • Entitlement to A&A is now established, based on nursing home patient status.
Result:
  • Adjust the beneficiary’s running award to pay the A&A rate from April 1, 2013.
  • Reduce the award to the rate without A&A from June 1, 2013.
  • Further reduce the award to the $90 Nursing/Medicaid rate following the expiration of the notice of proposed adverse action period.

V.iii.3.7.h.  Example 2: Retroactive Increase – Notice of Proposed Adverse Action Required for $90 Nursing Home/Medicaid Rate

Situation:
  • A Veteran beneficiary received pension at the rate of $200 per month effective January 1, 2013, and $212 per month effective December 1, 2013.
  • 2014 correspondence from the Veteran indicates the Veteran is receiving Medicaid and is entitled to a retroactive adjustment for medical expenses.
  • A review of the evidence shows that the Veteran has been receiving Medicaid covered nursing home care since September 2013.
Result:
  • The medical expense adjustment results in a new pension rate of $300 per month from January 1, 2013 (or February 1, 2013, if 38 CFR 3.31 applies) and $316 per month effective December 1, 2013.
  • Pay the increase to $300 per month from January 1, 2013, (or February 1, 2013, if 38 CFR 3.31 applies).
  • Pay the previous rate of $200 per month effective October 1, 2013, (first of the month after Medicaid coverage began).
  • Pay the previous rate of $212 effective December 1, 2013, and continue that rate pending notice of proposed adverse action to $90 per month.

8.  Restoration of Full Benefits From the $90 Nursing Home/Medicaid Rate Upon Discharge From a Nursing Home, Change to Nursing Home Private Pay Status, or Establishment of a Dependent


Introduction

This topic contains information on restoration of full benefits from the $90 nursing home/Medicaid rate upon discharge from a nursing home, change to nursing home private pay status, or establishment of a dependent, including

Change Date

June 11, 2015

V.iii.3.8.a.  Cases in Which Limited $90 Nursing Home/Medicaid Rate No Longer Applies With a Change in Status

A beneficiary’s full monthly pension should be restored, from the $90 nursing home/Medicaid rate
  • upon discharge from Medicaid-covered nursing facility care
  • upon return to private pay status in a Medicaid-approved nursing facility, or
  • with the establishment of a spouse or dependent child.
Note:  If the beneficiary transfers from one facility to another, the status of Medicaid coverage must be re-determined.

V.iii.3.8.b.  Effective Dates for Restoration to the Full Rate of Pension from the $90 Nursing Home/Medicaid Rate

Restore the beneficiary’s full rate of pension, including A&A, without regard to the provisions of 38 CFR 3.31, if awarded but not paid due to the $90 nursing home/Medicaid limitation from the date
  • of discharge or release from the institution providing Medicaid-covered nursing facility care
  • on which an institutionalized beneficiary returns to private pay status, or
  • on which the beneficiary gains a spouse or dependent child.
When adding a dependent, add the dependent to the award in accordance with the provisions of 38 CFR 3.31.
Example:
Situation:
  • A single Veteran is receiving care in a Medicaid-covered nursing facility.  The Veteran is eligible for A&A.
  • On October 14, 2013, the Veteran marries.  The Veteran’s spouse has no income.
Result:  Adjust the pension award to
  • remove the $90 limit, and pay the increased A&A rate, effective October 14, 2013, and
  • add the spouse to the award effective November 1, 2013 (per 38 CFR 3.31).
Note:  If the spouse’s income had reduced the pension rate to below $90 per month, the spouse would have been added to the award on October 14, 2013, the date of marriage.

V.iii.3.8.c.  Considering Veteran Admitted to a VAMC Who Is Currently Receiving the $90 Nursing Home/Medicaid Rate

When a Veteran, who is currently receiving the $90 nursing home/Medicaid rate, is admitted to a VA medical center (VAMC), the length of time Medicaid continues to cover nursing home expenses, in order to hold a bed, varies from State to State.
Therefore, continue the $90 nursing home/Medicaid payment until Medicaid indicates that the Veteran is no longer covered by Medicaid.

9.  Elections Involving Pension Entitlement

 

Introduction

This topic contains information on elections involving pension entitlement, including

Change Date

September 14, 2016

V.iii.3.9.a.  Entitlement Under More Than One Law

For information on the procedures to follow for entitlement under more than one law after an election is received, see M21-1, Part III, Subpart v, 4.A.4.

V.iii.3.9.b.  Awarding  Compensation as the Greater Benefit to a Veterans Pension Beneficiary Also Eligible for the $90 Nursing Home/Medicaid Rate

When a Veterans Pension beneficiary is
  • in a Medicaid approved facility
  • covered by Medicaid
  • without dependents, and
is entitled to both compensation at a rate greater than $90 and Veterans Pension, award Veterans Pension at the $90 rate as the greater benefit, and inform the Veteran that
  • compensation is the greater VA benefit, but his/her lesser benefit, $90 per month Veterans Pension
    • is protected for Medicaid purposes, and
    • may provide the Veteran more money for his/her personal use, and
  • he/she can elect compensation at any time in the future by submitting a written request expressing a desire to receive that benefit.

V.iii.3.9.c.  Surviving Spouses With Entitlement to DIC or the $90 Nursing Home/Medicaid Survivors Pension Rate

A surviving spouse with entitlement to Dependency & Indemnity Compensation (DIC) may elect Survivors Pension per 38 U.S.C. 1317.

Monthly DIC rates currently exceed the amounts payable under the current Survivors Pension program.  Normally, it is not to a surviving spouse DIC recipient’s advantage to elect Survivors Pension.  If, however, a surviving spouse having no child is in a Medicaid-approved nursing facility and covered by a Medicaid plan, election of the lesser $90 nursing home/Medicaid pension benefit would ensure that the beneficiary is allowed to keep $90 each month for his/her personal use.


V.iii.3.9.d.  Awarding  DIC as the Greater Benefit to a Surviving Spouse Pension Beneficiary Also Eligible for the $90 Nursing Home/Medicaid Rate 

When a surviving spouse pension beneficiary is,
  • in a Medicaid approved facility
  • covered by Medicaid, and
  • without dependents,
is awarded DIC as the greater benefit without a formal election or reelection, inform the surviving spouse that
  • DIC is the greater VA benefit, but a lesser benefit, $90 per month Survivors Pension
    • is protected for Medicaid purposes, and
    • may provide him/her with more money for his/her personal use, and
  • he/she can elect Survivors Pension at any time in the future by submitting a written request expressing a desire to receive the lesser benefit.

V.iii.3.9.e.  Action Taken When a Surviving Spouse’s Election Is Received to Receive the $90 Nursing Home/Medicaid Rate

When an election is received from a surviving spouse eligible for the $90 nursing home/Medicaid rate, take action to award $90 per month Survivors Pension from the date last paid.  Follow due process procedures for running awards.  Do not create an overpayment.
Important:  A beneficiary may waive the 60-day due process period by requesting an immediate reduction in payments.

V.iii.3.9.f. Action Taken When a DIC-eligible Surviving Spouse Is No Longer Eligible for the $90 Nursing Home/MedicaidRate

When evidence is received that a DIC-eligible surviving spouse, receiving the $90 nursing home/Medicaid pension rate, is no longer eligible for this $90 limited rate, take immediate action to award DIC as of the date Medicaid coverage is terminated.
Note:  The delayed payment provisions of 38 CFR 3.31 do not apply in this situation, because the award of DIC is considered an exception under 38 CFR 3.31(c)(3)(iii).

V.iii.3.9.g.  Election Between Pension Programs for Nursing Home/Medicaid Beneficiaries

Defer award action if the $90 per month nursing home/Medicaid rate is less than the current monthly rate under the prior pension law, when an election of current-law Pension is received from a Medicaid beneficiary who is a
  • Veteran or surviving spouse currently receiving Section 306 Pension or Old-Law Pension, or
  • surviving spouse receiving Spanish American War Pension.
Exception:  Do not defer award action if the Veteran or surviving spouse, or his/her fiduciary, requests an immediate reduction to the $90 nursing home/Medicaid rate.

V.iii.3.9.h.  Deferring Award Action for Prior Law Pension Beneficiaries Electing Current-Law Pension, and Eligible for the $90 Nursing Home/Medicaid Rate as the Lesser Benefit

If award action must be deferred when an election of current-law pension is received from a prior pension law beneficiary eligible for the $90 nursing home/Medicaid rate as the lesser benefit, inform the Section 306 or Old-Law Pension Medicaid beneficiary by a locally-generated letter
  • the exact monthly rates payable under each law for the periods indicated, and
  • that further action on the election will not be taken unless he/she furnishes a signed statement expressing a desire to receive the lesser benefit.
Note:  At the time of the deferral letter, clear EP 150.

V.iii.3.9.i.  Confirmation of Election of $90 Nursing Home/Medicaid Rate as the Lesser Benefit for Prior Law Pension Beneficiaries

Do not maintain a control for confirmation of the election of the $90 nursing home/Medicaid rate, as the lesser benefit, for prior law pension beneficiaries.
When confirmation of the election is received, award $90 per month current-law Pension from the date last paid.
Note:  No overpayment will be created when an election between pension programs is processed.

10.  Medicaid Nursing Home Care (NHC) Reporting Requirements


Change Date

June 11, 2015

V.iii.3.10.a.  Medicaid NHC Reporting Requirements

Only cases actually adjusted under the provisions of 38 U.S.C. 5503 are to be reported on the Medicaid/Nursing Home portion of the Omnibus Budget Reconciliation Act (OBRA) Report, RCS 20-0834.
Note:  RCS Form 20-0897, DIC Spouses Electing Improved Pension, is no longer required.
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