Dear Sgt. Shaft:

My husband and I recently have been given the responsibility of taking care of his destitute grandmother, who receives Tricare benefits through her ex-husband. Because of laws under the Health Insurance Portability and Accountability Act, we have been having trouble trying to get any information about her plan, yet she won't make calls or grant us power of medical attorney. I have found Medicaid resources that will help us help her, but her daughter has decided that if she receives Medicaid benefits, she will lose those through Tricare.

I spoke with someone at Tricare who was able to speak with me in generalities about this situation, and she said that this was not the case. Has this been your experience, that once someone receives Medicaid, she loses Tricare benefits? Medicaid will help with assisted living, while Tricare does not, so I'm uncertain where to go.

My mother-in-law has become a danger to my family, which includes a 4-year-old. We need to know very quickly what the outcome will be if we begin the Medicaid application process.

Sincerely,
Cassandra B.
Colorado

Dear Cassandra:

My sources tell me that Medicaid is essentially a welfare program, providing medical benefits for people under various state welfare programs (such as Aid to Families with Dependent Children) or who qualify by reason of being determined to be "medically indigent" based on a means test.

Congress enacted P.L. 97-377 with the intent that no class of Tricare beneficiary should have to resort to welfare programs; therefore, Medicaid was exempted from these double coverage provisions. Whenever a Tricare beneficiary is also eligible for Medicaid, Tricare is always the primary payer.

Medicaid can supplement Tricare. Considering the major needs this person has for long-term care, it sounds like Medicaid might be the way to go.

Shaft notes:

The Sarge is looking forward to joining other members of the National Press Club and their guests tomorrow at a noon luncheon featuring Veterans Affairs Secretary James B. Peake.

Also appearing at the National Press Club, as we approach Memorial Day, is former Sen. Bob Dole, set to speak Friday. His topic will be "Making the System Work for Today's Veterans."

Mr. Dole will assess the changes being made to improve care for wounded veterans. The 28-year senator from Kansas is a decorated World War II veteran and is co-chairman of President Bush's Commission on Care for America's Returning Wounded Warriors. The bipartisan commission recommended a series of pragmatic changes to the system of care provided to returning veterans of the prolonged conflicts in Iraq and Afghanistan.

In its report released in August, the commission called for rules to simplify the confusing standards for determining disability and compensation; eliminate overlapping activities between the Defense Department and Veterans Affairs; reduce inequities; and provide the tools for injured veterans to return to productive civilian lives. The report was issued in the wake of disclosures of woefully inadequate treatment of veterans at the Walter Reed Army Medical Center in Washington, and at other military hospitals.

In his luncheon address, Mr. Dole will provide an update on the results of the commission's work and cover other issues. He served as majority leader of the Republican-controlled Senate for 12 years, chairman of the Republican National Committee in 1971 and 1972, vice-presidential running mate with President Ford in 1976, and Republican presidential nominee in 1996. As a veteran, he was gravely wounded while a platoon leader with the 10th Mountain Division in Italy in 1945. He holds a Bronze Star with Oak Leaf Cluster and two Purple Hearts.

A native of Russell, Kan., Mr. Dole is known as a speaker for his wit that carries a prairie bite. He is the author of two oft-quoted books: "Great Political Wit: Laughing almost all the way to the White House" and "Great Presidential Wit: I wish I was in the book."

For reservations for either luncheon, contact Pat Nelson at 202/662-7500. Cost of the luncheon is $16 for National Press Club members, $28 for guests of members and $35 for general admission. The National Press Club is located at 14th and F streets Northwest, one block west of Metro Center.

• Send letters to Sgt. Shaft, c/o John Fales, P.O. Box 65900, Washington, D.C. 20035-5900; fax to 301/622-3330; call 202/257-5446; or e-mail sgtshaft@bavf.org.