Can I stack LTC insurance, VA Aid & Attendance, and MI Choice to cover home care?
Key facts
- LTC + A&A stack
- No offset — both pay to their caps
- MI Choice stacking rule
- Cannot double-bill same shift; can cover different shifts
- Typical SE MI stack
- LTC (~6 hrs/day) + A&A (~3 hrs/day) + private pay gap
- Target coverage
- ~40 hrs/week without full private pay
- Recommended sequence
- Fastest activator first (LTC or A&A), then layer MI Choice
The stacking rules matter because no single payer covers full-day home care. A common Southeast Michigan stack: LTC insurance covers a $200/day cap (about 6 hours/day of Personal Care), VA A&A adds $2,795/mo cash for a veteran-plus-spouse case (about 3 more hours/day), and private pay fills any weekend or evening gap. That gets a case to roughly 40 hours/week without going all-private-pay.
LTC insurance and VA A&A do not coordinate benefits with each other. Both pay based on their own trigger and cap; the family submits paid receipts to LTC and documents unreimbursed medical expenses to VA. There is no offset.
MI Choice is different because it is Medicaid. The waiver assigns approved hours of care and pays the provider directly at a fixed Medicaid rate. Those hours cannot be double-billed to a private payer. What is allowed: MI Choice covers weekday daytime hours through a Medicaid-enrolled provider, and the family privately pays a separate agency for evening or weekend coverage. Two providers, different shifts.
The practical planning move is to identify the fastest-activating payer first (LTC insurance or A&A), start paid care, then layer MI Choice if the waitlist clears and the case still has capacity for Medicaid-covered hours. Skipping straight to MI Choice usually means months of gap coverage.
For the full breakdown, see the cornerstone: Paying for Home Care guide.
Related questions
- Can A&A be used to pay LTC insurance premiums?
- No. A&A must be used against unreimbursed medical expenses — care services, not insurance premiums.
- Does MI Choice count LTC benefits as income?
- Insurance reimbursements are generally not counted as income for Medicaid, but state rules vary; verify with the MI Choice waiver agent.
- Can two agencies coordinate different shifts?
- Yes. It requires a written coordination plan, but Southeast Michigan MI Choice agents routinely allow this.
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