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


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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
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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:
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
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
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

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
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

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
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

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:
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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
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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:
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

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?