| Veterans Aid and Attendance Pension Benefit -- Long | | | | assets that can be readily converted to cash. In the |
| Term Care Benefits for Veterans What Is the Aid | | | | end, the decision as to allowable assets is a |
| and Attendance Benefit? The Veterans Benefits | | | | subjective decision made by a service representative. |
| Administration offers a disability income available to | | | | In certain cases a benefit award could be denied |
| veterans who served during a period of war or to | | | | even if assets are below $20,000 or $10,000 or even |
| their surviving spouses. This special benefit is officially | | | | zero dollars. There are legal ways to get around the |
| called "pension" but is more popularly known as the | | | | asset test if assets are too high. These are described |
| "veterans aid and attendance pension benefit". For a | | | | in our book. |
| pension benefit for veterans younger than 65, | | | | What proofs and documents are required with the |
| evidence of total of disability must be provided. | | | | pension claim? We have already discussed the |
| Veterans 65 and older do not have to disabled. | | | | requirements for power of attorney and fiduciary if |
| The National Care Planning Council estimates that as | | | | they apply. In addition, an original copy of the |
| much as 30% of the US population over the age of | | | | discharge from service -- typically DD 214 or form |
| 65 would qualify for the aid and attendance pension | | | | WD -- is required and the discharge must have been |
| benefit under the right circumstances. That's how | | | | honorable. If there is a question about the marriage |
| many war veterans or surviving spouses of veterans | | | | relationship, a marriage certificate or other proof may |
| there are. The benefit is such a well-kept secret that | | | | be necessary. Birth certificates of dependent children |
| only a small fraction of these eligible veterans are | | | | are usually not required but may be necessary under |
| actually receiving it. Death pension -- a benefit | | | | certain conditions. A dependent child is a minor, a |
| available to a surviving spouse-- is a lesser amount | | | | dependent student under age 23, or a totally |
| based on the same rules for applying for a living | | | | dependent adult child. There are certain documents |
| pension claim. In other words, the deceased veteran | | | | that need to be submitted to prove future recurring |
| must have met the rules for pension -- with the | | | | medical expenses and to prove need for aid and |
| exception of being totally disabled or over age 65 -- | | | | attendance or housebound allowances. VA does not |
| or have been receiving pension in order for his or her | | | | furnish these documents nor provide any information |
| spouse to receive the lesser benefit. In addition, in | | | | that they are required. Sample documents that could |
| order to be eligible or keep receiving the benefit, the | | | | be used for these purposes are included in our book. |
| surviving spouse must remain single. | | | | Can someone charge to help fill out the form? |
| Who can submit a claim? A claim is submitted by the | | | | Federal code and VA regulations prohibit an agent, |
| veteran or by the veteran's single surviving spouse in | | | | advisor or attorney from charging a fee to fill out |
| the case of a death claim. A duly appointed service | | | | and file a claim for pension. Most practitioners or |
| organization, an employee of the local regional VA | | | | providers help their clients for free, sometimes in the |
| office, or a VA approved agent may file a claim on | | | | context of solving other retirement issues or |
| behalf of the veteran or the spouse. A claim cannot | | | | providing long term care services. Some practitioners |
| be filed with a general or durable power of attorney. | | | | offer application advice for a fee (which is legal) but |
| The application will be sent back requesting proper | | | | will send their clients to a veterans' service |
| documentation for a VA power of attorney. The | | | | organization to complete the application. Some |
| veteran must sign a document specifically authorizing | | | | assisted living facilities or home care providers also |
| a power of attorney for someone to submit an initial | | | | offer free advice or help and this seems to be an |
| claim for him. Many chagrined children with a durable | | | | acceptable practice. An agent or attorney can also be |
| power of attorney have submitted claims on behalf | | | | paid by a disinterested third party under certain |
| of a parent only to have the claim rejected by VA. | | | | conditions to complete an application. However, a |
| What happens if the veteran is incompetent? If the | | | | home care agency, assisted living facility or nursing |
| veteran cannot submit the original application or sign a | | | | home that pays an agent or attorney to complete an |
| power of attorney for a surrogate to file an | | | | application on behalf of a resident or client does not |
| application, then a duly appointed guardian can | | | | meet the definition of a disinterested third party is in |
| complete the application. VA also allows the spouse, | | | | violation of the prohibition for charging a fee |
| a parent or next of kin, or a friend to complete and | | | | How are assets, income and unreimbursed medical |
| submit an application on behalf of an incompetent | | | | expenses determined? The applicant must submit |
| veteran if that person submits the proper power of | | | | details on the application of all income and all assets |
| attorney request and indicates the applicant could be | | | | including retirement savings accounts such as IRAs. |
| considered incompetent for financial affairs. Even | | | | Almost any type of money received or anything |
| though the veteran or surviving spouse may be | | | | received that can be converted into money is |
| incompetent for financial affairs, he or she should | | | | income. The only exclusions for assets are a personal |
| always sign the power of attorney request if he or | | | | residence (occupied by the veteran or spouse) and a |
| she is competent to do so. VA may appoint a | | | | reasonable amount of land it sits on as well as |
| fiduciary to take over the claim and the affairs for | | | | vehicles and other personal possessions. Personal |
| the claimant if VA determines he or she is | | | | possessions used as an investment such as a coin |
| incompetent. | | | | collection are counted as assets. Unreimbursed |
| How does VA handle power of attorney? Employees | | | | medical expenses can be almost any expense related |
| of VA and veterans service organizations already | | | | to medical needs. |
| have authorization for power of attorney to file an | | | | Are there any other reporting requirements? VA |
| application on behalf of the veteran. They have | | | | requires that any change in income or assets be |
| forms for the veteran to sign to allow this to happen. | | | | reported immediately. The award is calculated for 12 |
| An attorney representing the veteran in other affairs | | | | months in advance, but at the beginning of each |
| can also request a power of attorney in the proper | | | | calendar year, a formal report called an EVR (Eligibility |
| format and on his or her letterhead. Any single | | | | Verification Report) must be filed detailing all income, |
| individual may also submit a letter requesting power | | | | assets and unreimbursed medical expenses for the |
| of attorney to submit an application if it is signed by | | | | coming calendar year. For example if the award is |
| the veteran and if the letter provides certain required | | | | granted in April for 12 months in advance, an EVR |
| information. There is also a VA form in the book | | | | must be submitted in January of the next year that |
| support packet that can be submitted for power of | | | | could affect the award amount for the remaining |
| attorney. All attorney requests submitted for power | | | | four months of the initial 12 month period. The EVR |
| of attorney must state that the veteran is not | | | | will be used for determining benefits for the calendar |
| paying a fee to file the application on his or her | | | | year on which it is based. |
| behalf. | | | | What is a veteran's federal fiduciary, and does that |
| What is an "aid and attendance" or "housebound" | | | | affect the application? VA can appoint a number of |
| rating? A "rating" is granted by a veteran service | | | | different types of fiduciaries to manage the funds on |
| representative where a condition exists that makes | | | | behalf of an incompetent veteran. A federal fiduciary |
| the disability more severe. Medical evidence is | | | | is typically an individual such as the spouse or a child |
| required unless someone is a patient in a nursing | | | | whom the VA is most likely to appoint. If VA is not |
| home, and then the requirement is waived. The rating | | | | notified with the application that the veteran may be |
| allows VA to pay an additional monthly amount of | | | | incompetent and that a fiduciary appointment is |
| pension or compensation to a veteran or a surviving | | | | requested, this could slow down the application and |
| spouse for additional costs associated with this | | | | approval process. |
| disability. | | | | Will the pension benefit pay a nonlicensed homecare |
| How does one qualify for aid and attendance or | | | | provider? VA does not pay providers directly but |
| housebound rating? The application form has a block | | | | provides extra income to make up for the cost of |
| allowing for a request for either rating. Submitting | | | | licensed medical care. Medical conditions or injuries or |
| medical evidence in advance instead of waiting for a | | | | diseases that require a need for ongoing licensed |
| request from VA can help expedite the process of | | | | homecare will allow the applicant to reduce household |
| getting this rating. We have provided in the book | | | | income by the cost of homecare making it possible |
| support packet, a sample form that might be used | | | | to receive the additional income from a pension |
| for this purpose. This form is also designed around | | | | award. If the beneficiary has an aid and attendance |
| information that VA is looking for and may be a | | | | or housebound allowance, VA will allow deductions for |
| more effective presentation of the facts than typical | | | | nonlicensed providers as well. |
| medical records from the doctor. | | | | Will the pension benefit pay a member of the family |
| What is the effective date? The effective date is | | | | to provide care at home? As explained above, VA |
| generally the day VA receives an original application. | | | | will not pay providers directly but only indirectly |
| If it takes three months for the process of approval | | | | through extra income. If the beneficiary receiving |
| or six months, it doesn't matter. The effective date | | | | care in the home has received a rating for aid and |
| still reverts to receipt of the original application. | | | | attendance or housebound, VA will allow expenses |
| When does payment begin? Generally, payments | | | | paid to a family member for care to be counted as |
| start on the first day of the month following the | | | | unreimbursed medical expenses to qualify for the |
| month of the effective date. This means that if it | | | | benefit. The care arrangement must be legitimate |
| took six months to get approval, at least five | | | | and appropriate evidence must be provided. |
| months of benefit will be paid retroactively. VA | | | | Does the pension benefit pay the costs of a nursing |
| requires automatic deposit of awards in a checking or | | | | home? The application form has provision for |
| savings account. | | | | indicating residency in a nursing home and whether or |
| What happens if the veteran dies during the period | | | | not the applicant is eligible for Medicaid. VA will |
| of application? If the veteran dies during the period | | | | automatically apply the monthly cost of the nursing |
| of application and the application was not approved | | | | home in determining the pension benefit. If the |
| prior to the death, there may be accrued benefits. If | | | | applicant is single with no dependent children at home |
| the regional office had all of the information in its | | | | and is eligible for Medicaid, VA is required to stop any |
| possession that would have led to an approval, then | | | | payment of full benefits and only provide the veteran |
| there is an accrued benefit payable. Otherwise there | | | | with $90 a month. |
| is none. The full benefit is available for the month of | | | | Does the pension benefit pay the costs of assisted |
| death of the veteran and to a surviving spouse | | | | living? As explained above, VA will not pay providers |
| through an application on Form 21-534. This is the | | | | directly but only indirectly through extra income. If |
| same form a surviving spouse uses for a death | | | | the beneficiary receiving care in assisted living has |
| benefit claim for himself or herself. VA will award | | | | received a rating for aid and attendance or |
| either an accrued benefit or death benefit to the | | | | housebound, VA will allow expenses paid to assisted |
| surviving spouse whichever is larger. If there is no | | | | living for aid and attendance or housebound ratings -- |
| surviving spouse or dependent child, VA will pay the | | | | including room and board -- to be counted as |
| unreimbursed costs of last illness and burial to the | | | | unreimbursed medical expenses. The cost of assisted |
| person who paid those costs. A special claim must be | | | | living being used as a retirement residence is not |
| submitted for these costs, not Form 21-534. | | | | considered a medical expense. It does not warrant a |
| What is a veteran's federal fiduciary, and does that | | | | rating and cannot be deducted. |
| affect the application? For a veteran who is | | | | What are the requirements to receive a death |
| considered incompetent to handle his own financial | | | | pension benefit? The applicant must be a surviving |
| affairs, VA will appoint a fiduciary to receive the | | | | spouse or a dependent child of an eligible veteran. VA |
| money and pay the bills. A federal fiduciary is an | | | | form 21-534 is used to apply for death pension, |
| individual appointed for this purpose, usually a spouse | | | | death compensation, accrued benefits, or |
| or a family member. In most cases -- except for the | | | | dependency and indemnity compensation (DIC). The |
| spouse living with the veteran -- there is an interview | | | | surviving spouse must be single. A surviving spouse |
| required and mounds of paperwork. This process can | | | | of any age is eligible as long as the deceased veteran |
| take a long time, and it is to the advantage of the | | | | served at least 90 days during a period of war. They |
| person filing an original claim to request the | | | | had to be married at least a year prior to death or |
| appointment of himself or herself as a fiduciary or for | | | | have a child as a result of the marriage. There is no |
| some other appropriate person or organization to | | | | requirement for total disability for the surviving |
| help expedite the process. VA always makes the final | | | | spouse nor for the deceased veteran to have been |
| decision on whom it appoints as a fiduciary. In fact, | | | | totally disabled or older than age 65. |
| the agency might well ignore court appointed | | | | How does one prove that unreimbursed medical |
| fiduciaries. In general, the decision favors declaring the | | | | expenses will recur every month? VA has specific |
| veteran competent and avoiding a fiduciary where at | | | | rules for proving future recurring medical expenses. |
| all possible. | | | | Information in our book outlines the type of |
| What is the income test for pension? If the | | | | paperwork that must be submitted for each type of |
| household income adjusted for unreimbursed medical | | | | long term care service. The book also contains |
| expenses and a deductible is greater than the | | | | appropriate forms for this purpose. Neither the claims |
| maximum allowable pension rate -- MAPR -- there is | | | | form nor information from the regional office |
| no benefit. In 2007, the maximum allowable rate for | | | | provides any guidance on the rules for proving future |
| a couple with aid and attendance allowance is $21,615 | | | | recurring medical expenses for home care or assisted |
| a year. For a single it is $18,234 a year. Without aid | | | | living. One simply has to know how to do it. This one |
| and attendance or housebound allowance the | | | | crucial step often makes the difference between a |
| maximum couple's rate is $14,313 a year and for a | | | | successful claim and a denial. |
| single it is $10,929 a year. Death pension rates are | | | | What if the veteran or spouse is currently receiving |
| lower. People seeking a benefit with adjusted | | | | Medicaid? Our interpretation of the rules leads us to |
| incomes greater than these levels will be denied. | | | | believe that VA will not consider Medicaid payments |
| Can a household with income above the maximum | | | | as income. However, Medicaid will consider the |
| limit qualify for pension? A quirk in the way benefits | | | | nonallowance portion of the pension to be income. |
| are calculated can allow individuals and couples earning | | | | This could affect Medicaid eligibility in income test |
| between $24,000 to $60,000 a year to still qualify | | | | states. There is evidence that some income test |
| for a benefit. It has to do with the treatment by VA | | | | states count the entire pension benefit including the |
| of the very large recurring medical costs associated | | | | allowance as income. According to federal Medicaid |
| with home care, assisted living, or nursing home care. | | | | rules this should not happen. |
| What is the pension household asset test, and what | | | | What happens when the veteran or spouse wants |
| can be done if the asset test is not met? As a | | | | to receive pension & Medicaid together? Federal |
| general rule assets cannot exceed $80,000. A | | | | law requires that a single veteran receiving Medicaid |
| veteran or spouse occupied-house, a reasonable | | | | with no spouse or dependent children can receive no |
| amount of land upon which it sits and a vehicle are | | | | more than $90 a month from VA. Veterans in state |
| exempt from the asset test. In reality there is no | | | | veterans homes are exempt from this requirement. |
| specific test in the regulations. Veterans service | | | | The veteran with a spouse can receive the benefit |
| representatives are required to file paperwork | | | | to help defray the costs of a nursing home. As a |
| justifying their decision if they allow assets greater | | | | general rule, the pension benefit would probably not |
| than $80,000. Thus this amount has become a | | | | work if Medicaid were paying the bill. But the benefit |
| traditional ceiling. The service representative is | | | | does work well for non-Medicaid nursing home beds |
| encouraged to analyze the veteran's household needs | | | | and while the recipient is going through the Medicaid |
| for maintenance and weigh those needs against | | | | spend down. |