What long term care benefits are available to veterans through the Veterans Administration?All enrolled veterans are eligible for the following long term care services:
Nursing home and domiciliary care (VA facility that provides care on an ambulatory self-care basis) are not automatically available to all veterans in the VA health plan. Which veterans qualify for unlimited nursing home care?The following veterans automatically qualify for unlimited nursing home care:
The VA may provide nursing home care to other veterans if space permits. Veterans with service-connected disabilities receive priority. Does the VA charge co-pays for long term care services?Veterans with a compensable service-connected disability do not pay long-term care co-payments. Nonservice-connected veterans and non-compensable zero percent (0%) service-connected veterans may be subject to a long-term care co-payment. The first 21 days of long-term care are free. Co-payments start on the 22nd day. Long-term care co-payments are based on the individual veteran’s financial status. Veterans must complete a financial assessment to determine their co-payments. The co-payments are adjusted for each individual veteran based on his or her ability to pay. Where are VA nursing home services provided?The VA provides nursing home services through three national programs. VA owned and operated nursing homes, state veteran’s homes and operated by the states, and the community nursing home program. Each program has admission and eligibility criteria specific to the program. Will the VA cover nursing home care in a non-VA facility?The VA can only pay for care in nursing homes that participate in its contract program. Nursing homes that do not participate in its contract program are not covered. How can I get additional information about long term care benefits?Veterans and their families should contact the nearest VA facility for information or call 1-800-827-1000 or go to the internet at http://www.va.gov/elig. Veterans Administration Benefits that Increase Income to Pay for Long Term Care ServicesWhat Veteran’s Administration (VA) benefits are available that can increase a veteran’s or a surviving spouse’s income to pay for long term care services?There are three Improved Pension programs that can assist in increasing an eligible veteran’s or a surviving spouse’s income to pay for long term care services:
Which veteran’s are eligible for these benefits?All of the following criteria must be met before a veteran or a surviving spouse of a veteran can receive Improved Pension benefits:
How do the eligibility criteria differ between the three Improved Pension Programs?Basic Benefits –veteran or surviving spouse does not have to be physically disabled. Housebound Benefits – veteran or surviving spouse require a certain level of regular assistance with their daily routine. Aid & Attendance Benefits – veteran or surviving spouse is blind, living in a nursing home; OR needs assistance with the following activities: dress/undress, or keep himself or herself ordinarily clean and presentable; eating; toileting; OR has a physical or mental capacity that requires assistance on a regular basis to protect them. Can a veteran or surviving spouse receive both Aid & Attendance and Homebound benefits at the same time?No. Also, you can’t receive a service-connected and a non-service connected pension at the same time. What is the limit on assets to qualify for the Improved Pension Programs?As a general rule assets cannot exceed $80,000. A home, used as a residence, vehicles and difficult-to-sell property are generally excluded from the asset test. The VA will allow assets to be transferred or converted to income in order to meet the asset test. There is no look back penalty for transferring assets as there is with Medicaid. What is the income test for the Improved Pension Programs? Can a household with income above the maximum limit qualify for an Improved Pension Program?The household “countable income” must be less than the pension amount (see chart on next page) to be eligible for all or a portion of the pension. Countable income is the amount of income a veteran, surviving spouse, and/or his/her dependents receives each year AFTER deducting all unreimbursed, recurring health care expenses. This includes nursing home costs, assisted living costs, home health care, insurance, Medicare premiums, and on-going pharmacy costs. A dependent’s health care costs can also be used to reduce the countable income amount of the household. What is the Maximum Annual Pension Rates (MAPR) for 2008?
How is the pension benefit calculated?The monthly award is based on the VA totaling 12 months of estimated future income and subtracting from that 12 months of estimated future, recurring and predictable medical expenses. Allowable medical expenses are reduced by a deductible (5% of the MAPR above) to produce an adjusted medical expense which in turn is subtracted from the estimated 12 months of future income. The new income derived from subtracting adjusted medical expenses from income is called “countable” income or IVAP (Income for Veterans Affairs Purposes). This countable income is then subtracted from the Maximum Allowable Pension Rate (see above). The result is divided by 12 to determine the monthly income Pension award. This award is paid in addition to the family income that already exists. Example: Veteran is in assisted living with aid and attendance allowance. Monthly family income is $4,000 a month. Spouse is living at home. Unreimbursed medical expenses include prescription drugs, Medicare premiums, Medicare supplement premiums, and 12 months of prospective assisted living monthly costs. Family meets the asset test. 12-month future, family income from all sources : $48,000 Less future unreimbursed medical expenses adjusted for 5% of MAPR: $39,600 Total countable income or IVAP: $8400 Couples MAPR with aid and attendance allowance: $ 22,113 Less countable income: $8,400 Yearly pension calculation: $ 13,713 Monthly pension award (yearly divided by 12) : $ 1,143 Will the pension benefit pay a nonlicensed homecare provider and/or a family member to provide care at home?The VA does not pay providers directly but only indirectly through extra income. If the beneficiary receiving care in the home has been approved for aid and attendance or homebound, the VA will allow the expenses paid to a licensed or nonlicensed homecare provider and/or family member for care to be counted as unreimbursed medical expenses to qualify for the benefit. The care arrangement must be legitimate and appropriate evidence must be provided. Will the pension benefit pay the costs of a nursing home and/or assisting living facility?The VA will automatically apply the monthly cost of the nursing home in determining the pension benefit. If the applicant is single with no dependent children at home and is eligible for Medicaid, the VA is required to stop any payment of full benefits and only provide the veteran with $90 a month. If the beneficiary is receiving care in an assisted living facility and has been approved for aid and attendance or homebound; the assisted living costs, including room and board, can be counted as unreimbursed medical expenses. The cost of assisted living being used as a retirement residence is not considered a medical expense and can’t be deducted. How can you apply for Improved Pension benefits?You can apply for benefits by filling out VA Form 21-526, Veteran’s Application for Compensation or Pension of VA Form 21-534 if you are a surviving spouse. If available, you should attach copies of dependency records (marriage and children’s birth certificates) and current medical evidence (doctor and hospital records). You can apply online at http://vabenefits.vba.va.gov/vonapp.  |
1375 Broadway, Suite 1100 Phone: 646-278-9942 Email:Lauren Kamens, President lauren@cityhomecompanion.com
|
||||||||||||||||||||||||||||||||
