VA Cash Benefits And VA Medical Coverage Prepared by Prof. Tony Szczygiel for the NGA Agenda Outline cash benefits for a ward who is a veteran or is a veteran’s surviving spouse, child, parent Outline medical benefits for a ward who is a veteran, or rarely, a veteran’s surviving spouse Identify the steps a guardian or advocate can take with respect to these benefits Department of Veterans Affairs (VA) Benefits Veterans Benefits Administration Veterans Health Administration Monetary Benefits Medical Benefits http://benefits.va.gov/benefits/ http://www1.va.gov/health/ Veterans Benefits Administration VBA administers cash benefits: Compensation for a veteran with a service-connected disability Improved Pension for a veteran with a non-service-connected disability or over age 65 Survivors’ benefits for surviving spouses, children or parents of qualifying veterans Also: Life insurance Home loan guarantees Employment assistance Education and training VA Cash Benefits Compensation Service-connected disability or illness No income or asset eligibility criteria Pension Non-serviceconnected disability OR age 65 and older Moderate income and moderate net worth Compensation – Veteran’s Eligibility Service-connected disability: injuries or diseases that occurred while on active duty, or made worse by active military service. *Also paid to certain veterans disabled from VA health care Discharged under other than dishonorable conditions No income or asset criteria Compensation – How Much is the Benefit? The amount of monthly VA compensation depends on how disabled you are, as determined by the VA. The VA rates disability from 0% to 100% in 10% increments (e.g. 10%, 20%, 30% etc.) For 2014, a single veteran receives: with a 10% disability rating $130.94/month With a 50% disability rating $822.15/month 100% disability rating - $2,858.24/month See, http://www.benefits.va.gov/COMPENSATION/resources_comp01.asp Compensation – Important Details Annual cost-of-living adjustments (COLAs) for VA Compensation matches those for Social Security benefits. For 2014, the COLA was 1.5%. See, http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2503 The VA increases Compensation rates slightly if you have a spouse and/or dependents (children and/or parents). Special Monthly Compensation pays a higher rate based on special circumstances, e.g. a need of aid and attendance by another person or a specific disability, such as loss of use of one hand or leg. VA Compensation is tax-free income. Dependency & Indemnity Compensation (DIC) Eligibility For a surviving spouse or dependent child of a servicemember who: died while on active duty or training or died from a service-connected disability after other than dishonorable discharge Basic DIC benefit for surviving spouse is $1,215/month, with increases based on military pay grade, dependent child, spouse’s need for Aid and Attendance VA Form 21-534, Application for Dependency and Indemnity Compensation, Death Pension and Accrued Benefits by a Surviving Spouse or Child Parents’ DIC Eligibility For a surviving parent of a servicemember who: died while on active duty or training or died from a service-connected disability after an other than dishonorable discharge Maximum basic benefit for sole surviving parent is $590/month; Aid and Attendance supplement adds to this amount Parent’s income will reduce benefit, with no benefit when sole surviving parent’s income exceeds $8,113/month (2014) Other amounts apply to differing circumstances. Complete VA Form 21-535, Application for Dependency and Indemnity Compensation by Parent(s) Compensation & DIC Role of the Guardian Compensation usually is initially addressed while the veteran is in the service or shortly thereafter Your role: Screen for eligibility – veteran, surviving spouse, dependents Assess whether current disability rating understates the degree of disability Where appropriate, apply or appeal VA Improved Pension (VAIP) A needs-based payment to a veteran who has a non-service-connected disability “SSI on steroids” Can reimburse veteran for some out-ofpocket medical costs Underutilized VAIP Basic Eligibility Age 65 or older OR permanently and totally disabled Receipt of SSD or SSID establishes disability Veteran served at least 90 days of active military service, 1 day of which was during a war time period (rules change for service after September 7, 1980) Discharged from service under conditions other than dishonorable Eligible Wartime Periods World 1946 War II - December 7, 1941 – December 31, Korean 1955 Conflict - June 27, 1950 – January 31, Vietnam Era - August 5, 1964 – May 7, 1975 (or starting February 28, 1961 for Veterans who served in the Republic of Vietnam at that time) Gulf War - August 2, 1990 – through a future date to be set by law or Presidential Proclamation) VAIP Financial Eligibility “Net worth” is not “excessive” Income is below a yearly limit (Maximum Annual Pension Rate) set by Congress See, http://benefits.va.gov/PENSION/rates.asp Benefit levels are set to allow veterans and their survivors to live out their lives in dignity. VAIP “Net Worth” Determination Includes most assets/savings of the veteran and his or her dependents Excludes the veteran's residence No hard numbers: net worth cannot be “excessive” Rule of thumb: less than $80,000 Can vary due to age, dependents etc. VAIP 2014 Maximum Annual Pension Rate The VAIP benefit you receive is the difference between your annual countable family income and the Maximum Annual Pension Rate (MAPR) for your category. MAPR Single Veteran: with A&A supplement Veteran with One Dependent with A&A supplement $12,652 $21,107 $16,569 $25,022 VAIP Supplement: Aid and Attendance (A&A) A veteran who qualifies for the basic VAIP pension gets the A&A supplement if he/she: Needs the aid of another person in order to perform personal functions required in everyday living OR is a patient in a nursing home due to mental or physical incapacity OR is blind, or “nearly blind” A&A adds about $8,450/yr ($700/mo) to the veteran’s MAPR VAIP Supplement: Housebound Benefits If the veteran does not qualify for A&A, he/she may be eligible for “Housebound” supplement Generally, due to a disability the veteran is permanently and substantially confined to home The “housebound” supplement adds about $2,810/yr ($234/mo) to the veteran’s MAPR VAIP Budgeting & Unreimbursed Medical Expenses The VA deducts Unreimbursed Medical Expenses (UME) from the veteran’s income before determining eligibility for VAIP To be deducted, medical expenses must exceed 5% of 2014 basic MAPR or: $ 632/yr for a veteran with no dependents $ 828/yr for a veteran with one dependent UME Examples: Medicare Part B premium ($1,258.80/yr); insurance co-pays and deductibles; home care costs; cost for assisted living facility VAIP for Surviving Spouse The Survivors Pension benefit, which may be referred to as Death Pension, is a monetary benefit payable to a low-income, un-remarried surviving spouse and/or unmarried child(ren) of a deceased Veteran with wartime service The VA budgeting rules for this benefit follow those for the VAIP The Survivors Pension benefit levels are lower than for the VAIP. VAIP Survivors Benefit 2014 Maximum Annual Pension Rate The VA Survivors Benefit you receive is equal to the difference between your countable family income and the Maximum Annual Pension Rate (MAPR) For a single survivor the MAPR is: $8,485 Basic With One Dependent $11,107 A&A, No Dependents $13,563 A&A, One Dependent $16,180 VAIP – Important Details Annual cost-of-living adjustments (COLAs) for VAIP matches those for Social Security benefits. For 2014, the COLA was 1.5% See, http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2503 The VA increases Pension rates if you have a spouse and/or dependents (children and/or parents) VAIP is tax-free income VAIP & Medicaid– Important Details Unlike Compensation, some or all of the VAIP payments are exempt income for SSI and Medicaid budgeting A single veteran residing in a nursing home and covered by Medicaid receives a reduced pension of $90/mo. This is added to the personal needs allowance provided by Medicaid VAIP Role of the Guardian Pension usually is addressed years after the veteran was in the service Your role: Screen for eligibility – veteran, surviving spouse, dependent If possibly eligible, submit a “clean application” ASAP. Benefits may be paid as of the application date Have patience, but be persistent Applying for Cash Benefits Can be a long process: Difficult for veterans to understand Requires supporting documents that may be difficult to obtain or track down (medical records, service records, marriage certificates, etc.) May require understanding the of the laws and regulations governing benefits and the VA’s processing of benefits Applications VA goal is to make an initial decision on claims within 125 days Claims backlog has been reduced by 1/3 from 2012 to 2014 Still, about 50% of applications have been pending for more than 4 months (125 days) Pension claims are processed much faster than compensation claims Compensation & Pension Fully Developed Claim The Fully Developed Claims (FDC) program is a “fast track” option for compensation, pension, and survivor benefit claims Submit all relevant records you have or can easily obtain Certify that you have no further evidence to submit Who can help you apply for VAIP? VBA staff has a duty to help claimants Upon receipt of a “substantially complete” application, the VA will make reasonable efforts to help a claimant obtain evidence necessary to substantiate the claim. E.g., VA can request records from the Social Security Agency Who else can help you apply for VAIP? Veterans Service Organizations (e.g., American Legion, Disabled American Veterans, Veterans of Foreign Wars, Vietnam Veterans of America) or State Veterans Service Offices Assist veterans with gathering documents and other evidence required to support claim May help to demystify the process Help from Private Attorneys Attorney must be “accredited” by the VA, and complete Continuing Legal Education approved by VA Cannot charge for helping veterans prepare an application Once veteran is denied benefits and files an appeal, then a private attorney can charge a fee Department of Veterans Affairs (VA) Benefits Veterans Benefits Administration Veterans Health Administration Monetary Benefits Medical Benefits http://benefits.va.gov/benefits/ http://www1.va.gov/health/ Veterans Health Administration VHA provides medical benefits to veterans and, in some cases, for their families. Covered services include: Hospital Care Primary Care and Specialist Physician Prescription Drug Benefits Long Term Care Services Dental Services Mental Health Services Medical Benefits VA provides care at VA facilities and through public or private health care providers under contract with VA. Co-pays, but no premiums Prescription drug benefit is “creditable coverage” – equal to or better than a Medicare Part D plan. Medical Benefits - Eligibility All uniformed service personnel, including reservist or National Guard member called to active duty by Federal Order and completed full call-up period Other than dishonorably discharged Minimum duty of 24 months for younger veterans Veterans are assigned to Priority Groups 1-8 that VA uses to balance demand with resources. Medical Benefits - Eligibility Some veterans do not need to enroll to receive VA health benefits. You have 50% or higher disability rating from service-connected conditions or Are seeking care for a VA rated service connected disability only or It is less that one year since you were discharged for a disability that the military determined was incurred or aggravated by your service, but that VA has not yet rated. Long Term Care Extended Care Services include: Geriatric evaluation Nursing home care in VA facility Community nursing home with a VA contract (limited to one to six months) Adult day care Respite care Long Term Care - Initiatives Home Based Primary Care VA physician supervises care VA social worker coordinates services Home visits by Dr, PA or NP Veteran-Directed Home and Community Based Services Partnership between VA & Aging Network Call your local Area Agency on Aging Individual with non-service connected disability has co-pay starting day 21 Amount of co-pay depends on income Some state VA nursing homes Long-Term Care Benefits Information VA Office of Geriatrics and Extended Care http://www.va.gov/geriatrics/ Audience: Veterans with multiple chronic conditions, life-limiting illness, frailty or disability associated with chronic disease, aging or injury Your local VA medical center has the most complete information about geriatric and long-term care and services in your area. Civilian Health and Medical Program of the Department of Veterans Affairs CHAMPVA provides coverage to the spouse, widow(er), dependent children of a qualifying veteran who: is rated permanently and totally disabled due to a service-connected disability or so rated at the time of death, or died of a service-connected disability, or died on active duty, and the dependents are not otherwise eligible for Department of Defense TRICARE benefits. Civilian Health and Medical Program of the Department of Veterans Affairs To apply for CHAMPVA benefits, you must submit the Application for CHAMPVA Benefits, VA Form 10-10d and related documents. For more details, see http://www.va.gov/hac/forbeneficia ries/champva/apply.asp How do I Register for VA Health Care Benefits? Fill out VA form 10-10EZ: In person at VA Health Care facility Online at http://www.va.gov/healthbenefits/apply/ By Telephone 1-877-222-VETS (8387) Monday-Friday, 8:00 am to 8:00 pm EST. Benefits Information Department of Veterans Affairs http://www.va.gov Veterans Benefits Administration www.vba.va.gov/VBA Federal Benefits for Veterans, Dependents and Survivors @ http://www.va.gov/opa/publications/benefits_book.asp Veterans Health Administration http://www1.va.gov/health Veterans Health Benefits Handbook @ http://www.eBenefits.va.gov Apply online: http://www4.va.gov/healtheligibility Budgeting Example for VAIP Joe enlisted in the Army on January 30, 1955, when he was 20 years old. He was honorably discharged after he finished his four year term. Joe’s income from Social Security and a small pension is $36,000/year. His only savings, a bank account, amounts to $60,000. He owns his house. Joe suffered a stroke and has the early signs of dementia. Joe received Medicare-covered home care after his stroke. Those services ended when the physical therapist determined that Joe no longer needed therapy supervised by a professional. Now, Joe is private paying a home care agency for 4 hours of care each day, at the rate of $20/hour ($29,000 for a year). Joe applies for the VAIP. What will the VA do? Budgeting Example for VAIP Does Joe meet the non-financial criteria for the VAIP? He served for more than 90 days, and at least one day was during a period of war. He had an other than dishonorable discharge. He is over 65 years of age. Budgeting Example for VAIP Does Joe meet the net worth criteria for the VAIP? He does not have excessive net worth, with less than $80,000 apart from his house. Does Joe meet the income criteria for the VAIP? Joe’s countable income is $36,000/year minus UME. His out-of-pocket medical costs are $29,000/yr for home care plus another $4,632 (Part B premium, co-pays, etc.). Thus, his total UME is $33,632. The UME exceeding 5% of the MAPR ($632) is $33,000. Joe’s countable income for VA purposes is $3,000/year. Joe meets the criteria of needing Aid and Attendance. The 2014 MAPR for a single veteran needing A&A is $21,107. Joe meets the financial criteria for the VAIP Budgeting Example for VAIP What will Joe’s VAIP award letter say? The VA will determine that Joe is eligible for a VAIP benefit of $18,107. This is calculated by deducting his countable income ($3,000) from his MAPR ($21,107). The VA will determine that Joe’s VAIP eligibility started when his guardian submitted his application 3 months ago. Joe will get a monthly payment of $1,509 for this month and future months. Joe will get a $4,527 payment for 3 months of retroactive benefits QUESTIONS?