VA Aid And Attendance Benefits Available For The Spouse Of A Veteran

Are VA Aid And Attendance Benefits Available For The Spouse Of A Veteran And, If So, How Much Can The Spouse Expect To Receive?
August 20th, 2008 · No Comments
(The following is based upon a real discussion that recently took place on an elder law listserv for attorneys. It illustrates the misinformation that is often inadvertently provided to consumers by government agency personnel concerning the availability of and eligibility criteria for needs-based public benefits.)

Question: I recently contacted the Veterans Administration (VA) about applying for Aid & Attendance Benefits (VA A&A Benefits) for my client, who is the surviving spouse of a World War II Veteran. I was told that in order to get VA A&A Benefits, the surviving spouse had to be collecting a VA pension based on the deceased spouse’s military service. The deceased spouse never received a VA pension, but he received VA medical benefits and died in a VA nursing home. Am I receiving correct information about my client’s eligibility for VA A&A Benefits? Also, if my client qualifies for VA A&A Benefits and later enters an assisted living facility, will the VA A&A Benefits make her ineligible for Medicaid by putting her over the assisted living income cap even after she spends down all of her assets and is otherwise eligible for Medicaid?

Answer: No, unfortunately you did not receive correct information. In order for your client to receive VA A&A Benefits, she must have been married to the veteran when he died. The veteran must have served at least 1 day in the military during a war time period and have served at least 90 days total in the military. Further, in order to qualify medically your client must either need assistance from another to help her with her activities of daily living, or be unsafe in her own environment without supervision. It is presumed the client needs the assistance if she lives in an assisted living facility; however, the client would still need a physician’s affidavit documenting her medical needs. If she meets all of those criteria, the client must still meet the asset and income requirements. The client’s income cannot exceed $998 per month in 2008. However, in order to qualify financially under the program, she can reduce her gross income by deducting all medical expenses, including the cost of the assisted living facility. In many cases, the assisted living facility costs alone, when deducted from her income, will reduce her income down to below $0.00. With regard to assets, the standard is whether the applicant has sufficient means to pay for her own needs, including her care needs. The informal asset limit is $80,000.

Assuming your client receives the maximum from the VA, she will get $998 per month in 2008. With regard to Medicaid, all of the VA A&A Benefits are excluded from income in New Jersey in determining eligibility for assisted living facility Medicaid. In other states, a portion of the VA A&A Benefits are considered to be “pension” and are included in the income cap calculation and the other portion is considered to be “aid and attendance” which is exempt from the income calculation. The “pension” portion is $624 per month and the A&A portion is $373 per month. In states other than NJ, once Medicaid is approved, you or the client must to notify the VA that she is receiving Medicaid by using VA Form 21-0779. Then, the VA will reduce the A&A to $90 per month which takes the place of the normal personal needs allowance. All of the $90 per month received from the VA is exempt from the Medicaid income calculation.

Uninsured Veterans

1.8 Million Veterans Lack Health Coverage
Harvard Study Finds Sharp Increase Since 2000
Nearly 6 Million Uninsured Americans are Veterans or their Families

Of the 47 million uninsured Americans, one in every eight (12.2 percent) is a veteran or member of a veteran's household, according to a study by Harvard Medical School researchers published in the December, 2007 issue of the American Journal of Public Health (galley version available here). 1.8 million Veterans (12.7 percent of non-elderly veterans) were uninsured in 2004, up 290,000 since 2000, the study found. An addition 3.8 million members of their households were also uninsured and ineligible for VA care.

The study is based on detailed analyses of government surveys released between 1988 and 2005. Veterans were only classified as uninsured if they neither had health insurance nor received ongoing care at Veterans Health Administration (VA) hospitals or clinics. A preliminary review by the study's authors of 2006 data released last month (while this study was in press) shows little change in the number of uninsured veterans since 2004.

"Like other uninsured Americans, most uninsured vets are working people - too poor to afford private coverage but not poor enough to qualify for Medicaid or means-tested VA care," said Dr. Steffie Woolhandler, an Associate Professor at Harvard Medical School who testified before Congress about the problem earlier this year. "As a result, veterans and their family members delay or forgo needed health care every day in the U.S. It's a disgrace."

Other findings of the study include:
The number of uninsured veterans has increased by 290,000 since 2000, when 9.9% of non-elderly veterans were uninsured, a figure which rose to 12.7% in 2004.
Of the 1.768 million uninsured, 645,628 were Vietnam-era veterans while 1,105,891 were veterans who served during "other eras" (including the Iraq and Gulf Wars)
Of uninsured veterans, 56.5% were older than 44.

Uninsured veterans had as much trouble getting medical care as other uninsured persons. 26.5% of uninsured veterans reported that they had failed to get needed care due to costs; 31.2% had delayed care due to costs; 49.1% had not seen a doctor within the past year; and two-thirds failed to receive preventive care
Nearly two-thirds of uninsured veterans were employed.

Many uninsured veterans are barred from VA care because of a 2003 Bush Administration order that halted enrollment of most middle income veterans. Others are unable to obtain VA care due to waiting lists at some VA facilities, unaffordable co-payments for VA specialty care, or the lack of VA facilities in their communities.

"Since President Bush took office the number of uninsured vets has skyrocketed, and he's cut eligibility, barring hundreds of thousands of veterans from care. This administration has put troops in harm's way overseas and abandoned them and their families once they got home," said Dr. David Himmelstein, co-author of the study and co-founder of Physicians for a National Health Program. "We need a solution that works for veterans, their families, and all Americans - single payer national health insurance."

"I see uninsured vets in my clinic every week," said Dr. Jeffrey Scavron, a former Navy physician now practicing in Springfield, Massachusetts. "In many cases, they're too sick to work, but not yet sick enough for full disability which would qualify them for Medicare. Only the government can put men and woman into military service and only the government can guarantee that they are covered after they serve." Dr. Scavron is a founding member and former president of Physicians for a National Health Program.