BUSINESS OFFICE 44-02-006
The Division of Veterans Healthcare Services (DVHS) requires each of the New Jersey Veterans
Memorial Homes (VMH) to develop and implement policies and procedures to ensure that every
applicant to, and resident of, a VMH obtains and maintains primary and supplemental health
insurance coverage prior to and after becoming a permanent resident of a NJ VMH.
The purpose of this policy is to ensure that residents are covered under Medicare Part A, Medicare Part B, Medicare Part D and a supplemental health insurance plan that will help to pay for their medical care, physician services, therapy services, medications, and any possible future hospitalizations.
Admission means the procedure for entering one of the New Jersey Veterans' Memorial Homes.
Aid and Attendance is a financial benefit determined by the U.S Department of Veterans
Affairs (VA) for a veteran who is in need of the regular aid and attendance of another person to
perform the necessary activities of daily living (ADL), or who is permanently housebound.
Surviving spouses of wartime service veterans are also eligible for this pension.
Allowable Deductions means those approved items which will be subtracted from the gross income, including the personal needs allowance, when calculating care and maintenance fees.
Care and Maintenance Fee means the actual cost of services for an individual in one of the
New Jersey Veterans Memorial Homes.
Gross Income means all income and/or revenue received by the resident for a given period.
Includes, but is not limited to, funds received for labor or services, Social Security, pensions,
Aid and Attendance, net rental income of property, proceeds of business or enterprises, and
investments, not to include losses. Disability compensation funds shall not be counted as gross
Medicare Part A (Hospital Insurance) – is a system of federal governmental insurance for
American citizens over the age of 65 and certain disabled citizens under age 65, that pays for
in-patient care in a hospital, home health care, blood, hospice care, and skilled care in a long-
term skilled care nursing facility.
Medicare Part B (Medical Insurance) – is a system of federal government insurance for
American citizens over the age of 65 and certain disabled citizens under age 65, that provides
medical services or supplies that are needed to prevent, diagnose or treat a person’s medical
condition(s) and that meet accepted standards of medical practice.
Medicare Part D (Prescription Drug Coverage) – Medicare prescription drug coverage is
available to everyone with Medicare. The staff at the VMH will assist every resident not
currently enrolled to sign up for the Medicare Part D plan (often called a Medicare Prescription
Drug Plan or PDP) as soon as the resident is admitted to the VMH.
Needy Veteran, for medical insurance purposes, means an individual who has no source
of income or accountable assets.
Supplemental Insurance means a health insurance policy in addition to the primary
insurance carrier (e.g. private health insurance in addition to Medicare; a Medigap
On the day of admission the applicant must provide documentation of primary and supplemental health insurance coverage.
The applicant must sign “Part 16-Certification” of the Admission Application, which states that as a condition of admission and continued stay at a NJ Veterans Memorial Home, the applicant must maintain primary and supplemental health insurance policies.
Medical expenses not paid by an insurance carrier will be the responsibility of the applicant/responsible payor.
If the applicant does not provide proof of health insurances, admission will be delayed until the applicant has obtained the required health insurances.
Requests for exemptions must be submitted to the CEO/designee and/or the Division Director for review and approval.
If a secondary insurance policy is not purchased, the resident/responsible payor is to be notified that no medical deduction will be granted for the resident/ spouse/ eligible other, and that the resident and/or the responsible payer will be responsible for all related costs.
Applicants who maintain HMO health insurance policies must comply with one or more of the following:
Change insurance for the applicant to a non-HMO plan,
Handle all required referrals for care and treatments prior to services being rendered,
Permit the facility’s primary physicians to assume responsibility over all medical management. The resident and/or the responsible payer will assume responsibility for all medical related expenses, or
Arrange for the primary HMO physician to continue medical management and ensure that all state, federal, and VMH requirements are maintained.
Residents who reside in the VMH are required to maintain both primary and supplemental health insurance.
Health insurance premiums are an allowable deduction and will be deducted from the income.
If a resident does not carry primary and/or supplemental health insurance and has no source of income, the VMH is authorized to purchase a basic health insurance
policy for this resident after consultation with the CEO/designee.
The Social Service Department shall refer any resident to the Veterans Entitlement Counselor that may potentially be eligible for Aid and Attendance in order that an application for the VA’s Aid and Attendance may be processed and submitted.
Once Aid and Attendance is received, if health insurance is being provided by the VMH, payment for the health insurance will be deducted from this income source.
Residents/representative payors who drop primary and/or supplemental health insurance will:
Become responsible for all medical expenses incurred by the resident;
Not be allowed deductions for medical expenses for the resident as long as this required health insurance is not maintained;
Have referrals made for collection if payment for services is not received;
Have discharge from the VMH recommended if debt remains uncollected,
Be advised by the Social Service Department that the VMH may purchase supplemental health insurance policies at the resident's expense.
The process for collection of unpaid debts will occur in accordance with procedure
44-02-013 - Delinquent Accounts.
Revised: June 2011
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