Paying for Care – Financial Assistance at MVH
Maine Veterans’ Homes is an independent, nonprofit organization separate from the VA. It’s important to understand that gaining Veteran health care benefits from the Department of Veterans Affairs (VA) is a separate process from gaining eligibility for services at Maine Veterans’ Homes.
Forms of payment that MVH accepts include VA Benefits, Medicare, MaineCare, long-term care insurance, and/or private funds. If the resident holds a long-term care insurance policy, their insurance company will reimburse the resident directly, and MVH will provide all the documentation to the insurance company to ensure the policyholder will be reimbursed.
Our Admissions Team will assist you in the benefits process as much as possible, helping you navigate a path forward. At Maine Veterans’ Homes, we have experience working with Veterans, Veterans’ organizations, and state and federal agencies to assist you with your application and will support you to understand if living at one of our Homes is a possibility for you and your family. Each of our Homes has a dedicated Admissions Team to help:
MVH Augusta: 35 Heroes Way, Augusta, ME 04330, Phone: 207-622-2454
MVH Bangor: 44 Hogan Road, Bangor, ME 04401, Phone: 207-942-2333
MVH Caribou: 163 Van Buren Road, Ste. 2, Caribou, ME 04736, Phone: 207-498-6074
MVH Machias: 32 Veterans Way, Machias, ME 04654, Phone: 207-255-0162
MVH Scarborough: 290 US Route 1, Scarborough, ME 04074, Phone: 207-883-7184
MVH South Paris: 477 High St, South Paris, ME 04281, Phone: 207-743-6300
Medicare A/Managed Care Coverage/ VA Coverage: Referrals will be reviewed for Medicare skilled eligibility, using the criteria established by the Centers for Medicare & Medicaid Services. Medicare requires a three-day hospitalization before paying for a skilled nursing facility. Once that requirement is met, a person must then meet clinical eligibility. Utilizing Medicare Coverage requires a three-night stay, whereas other forms of insurance do not. If a resident is not being covered by Medicare A, the Admissions Coordinator will obtain authorization from the managed care company to support your admission. Medicare A will pay 100% of the cost for your days of care 1 to 20; beginning on day 21, Medicare A will pay 80% percent of the daily rate up until day 100 if the resident meets Medicare requirements. If the potential resident has secondary insurance (such as Anthem or AARP), then days 21 to 100 may be paid by their plan. If there is no companion plan, the resident can apply for MaineCare or will need to pay privately. Residents who are recipients of VA Coverage as a 70% or greater eligible Veteran also qualify for Skilled Services.
To qualify for MVH Long-Term Care eligibility one must meet medical requirements through a completed Maximus evaluation and secure funding through either privately paid funds, obtaining coverage through MaineCare for Long-Term Care be the recipient of VA coverage as a 70% eligible Veteran.
To qualify for Respite Care Services, a Maximus assessment is not required, and your stay is paid for by private funding. 10-30 days of care are required for a Respite Stay. Respite care costs are privately funded by the resident. Medicare will only pay for respite care if the patient has a life-threatening illness and qualifies for the hospice benefit. In most cases the patient is being cared for at home, usually by a spouse or child. In the absence of that person caring for them, they would need to be in a nursing home, which means they qualify to receive respite care in one of our Homes, for a brief period. If this is the care arrangement you are currently offering, and the person you are caring for is 70 percent or more disabled, the VA will pay for them to stay at Maine Veterans’ Homes.
To qualify for Residential Care Services, one must meet medical requirements through a completed Maximus evaluation and secure funding through either privately paid funds, or obtaining coverage through MaineCare for Residential Care.
Frequently Asked Questions About Paying for Care
What types of funding assistance are available for Veterans?
- Aid and Attendance:
Veterans may be eligible to receive a daily stipend from the VA after admission to MVH. Eligibility for additional VA stipend monies is determined solely by the VA and relayed to the resident and the MVH billing team. Questions about this additional benefit can be directed to the resident’s local Veterans Affairs Office or the MVH Admissions Team. - Daily Stipend:
Veterans may be eligible to receive a daily stipend from the VA toward room and board for their long-term care, extended care, short-term stays, and rehabilitation care at Maine Veterans’ Homes. There are certain criteria to receive a daily stipend benefit, such as service, level of care or assistance needed, income, insurance, and other factors. - Provider Agreement:
Veterans who have a 70 percent or higher service-connected disability rating by the VA are eligible to have their care needs fully covered by the VA. This program applies to a nursing home level of care in a state Veterans’ home such as Maine Veterans’ Homes. MVH submits the stipend application automatically for eligible Veterans.
Am I missing out on eligible benefits?
The benefits you are eligible for are based on your care needs.
- Disability: If you haven’t filed a claim to see if you qualify for a service-connected disability bracket, you could be missing out on additional benefits. Veterans must apply for a service-connected disability through their local VA office.
- If you Have Been Previously Denied Coverage: If you were previously denied long-term care benefits, it does not necessarily mean you may not qualify now. With our assistance working with the agencies concerned, some situations can be resolved to gain Veteran benefits. Our Admissions team will assist you to determine your eligibility for benefits and provide you with the information to apply, if necessary.
