§ 1.1
INTRODUCTION
Most
of
America's
25 million veterans are eligible for at least some benefits through the
VA, although many are unaware of the benefits that are available to them.
The VA can provide significant assistance in helping the veteran
meet health care and long term care needs.
The
United
States
has a comprehensive benefits system for veterans, primarily through the
Department of Veterans Affairs (VA).
VA has about 1,300 care facilities, including 163 hospitals, 850
ambulatory care, and community-based outpatient clinics, 206 counseling
centers, 137 nursing homes, 43 domiciliary facilities, and 73
comprehensive community-based outpatient clinics. As a result of
technology and changes in national and VA health care trends, VA has
evolved from a hospital-based system to a primarily outpatient-focused
system. More than 4.5 million people received care in VA health care
facilities in 2002, with the VA treating 564,700 patients in VA hospitals
and contract hospitals, 50,267 in nursing homes, and 22,541 in
domiciliaries. There were 46.5 million visits to VA outpatient clinics.
The system has experienced a steady growth in the past few
years, with a 9.5 percent increase from 2001 to 2002.
In October, 2002, there were 6.8 million veterans enrolled.
To
receive a VA benefit an individual must meet both general eligibility
qualifications and the specific entitlement criteria for the benefit.
The rules of the various VA benefit programs are different.
One general requirement is that the claimant must be a
“veteran” or the dependent or survivor of a veteran.
A veteran is a “person who served in the active military, naval,
or air service, and who was discharged or released therefrom under
conditions other than dishonorable.”
National
Guard and Reserve duty is not considered to be active service unless
disability or death arose from the duty.
However, members of the National Guard and Reserve who are called
up to active duty are eligible for the same benefits as other veterans.
There
are many classifications of veterans, including:
-
veterans who are retirees, having given at least 20 years of credible
service to the military,
-
veterans who are service-connected disabled,
-veterans
who are non-service connected disabled,
-
veterans with no disabilities, who served less than the number of years
required to receive retirement.
Different
combinations of classifications determine eligibility for benefits and
services.
§ 1.2
HEALTHCARE BENEFITS
TRICARE and TRICARE for LIFE for Retired Military
Military
retirees and their spouses who are under 65 are eligible for TRICARE which
provides care at military installations and healthcare benefits through a
system of HMOs. These benefits are also extended to reservists and their
spouses, at age 60, who are drawing reserved retired pay.
Military
retirees who are 65 or older and Medicare eligible may enroll in TRICARE
for Life. TRICARE for Life is
most appropriately thought of as a secondary payer to Medicare. It
provides wraparound healthcare coverage similar to Medicare supplement
policies, with no premium costs and no Medicare inpatient deductibles. It
is available to all retired uniformed service members (Active, Reserve,
and Guardsmen), eligible family members, certain former or surviving
spouses who are enrolled in Medicare Part B, and have up to date
information in DEERS (Defense Enrollment Eligibility System).
There is no cost for the coverage, except the Medicare Part B
premium.
Medicare
is the typically the primary payor with TRICARE secondary.
However, there are some services, such as pharmacy and mental
health counselors, which are covered by TRICARE (with an annual deductible
and a co-payment) but not Medicare. Other services, such as chiropractic
care, are payable by Medicare (with co-payments), but are not covered by
TRICARE. Some services, including routine eye exams, hearing aids, and
long-term custodial care are not payable by either Medicare or TRICARE.
Given
the gaps in coverage, a veteran who has other health insurance will
normally want to keep their existing coverage at least until they are
entitled to TRICARE, and possibly longer depending upon the medical
conditions. If a veteran chooses to keep private health insurance, TRICARE
becomes a third payer.
Medical
coverage is provided for eligible dependents under TRICARE and TRICARE for
LIFE. Long-term care services
are not covered.
For
more information on TRICARE and TRICARE for Life, call: 1-888-DOD-LIFE
(1-888-363-5433) or www.tricare.osd.mil.
For more information on enrolling in Medicare Part B, call:
1-800-772-1213, or www.ssa.gov.
To update information in DEERS, call 1-800-538-9552.
VA HEALTH CARE BENEFITS
Enrollment
There
are exceptions to the enrollment requirement:
(1) the veteran has a service connected disability of 50% or more;
(2) the veteran is seeking care for a disability that the military
determined was incurred or aggravated in the line of duty, but that the VA
has not yet rated, during the 12-month period following discharge; or
(3) the veteran is seeking care for a service connected disability
only.
Veterans
who fall into these three categories are still strongly encouraged to
enroll, to ease the VA scheduling burden.
Priority Groups
Veteran’s
benefits are dependent upon Congressional appropriations. To the extent
that Congressional funding is limited, enrollment is based upon priority
groups. When veterans enroll, they are placed in priority groups or
categories based upon several factors, including their service connected
disability ratings, service in a period war, and income. This helps the VA
manage health care services within budgetary constraints and to provide
quality care to those enrolled.
The
VA is required to manage health care resources by providing
care first to patients with higher access priorities. There are eight
enrollment priorities for veterans, with priority group 1 being the
highest. There may be additional priorities established within each of the
priority groups.
Priority
group 8, comprised of those veterans who have high incomes, was
established on
October
1, 2002
.
This category has income and asset limitations, so veterans who fit into
this category and have not applied for VA medical care before
January
17, 2003
,
will not be afforded care in the VA system until such time as the
enrollment criteria are changed. Enrollment will be reviewed once a year
and veterans will be notified in writing of any change in enrollment
status.
Enrollment
in the VA health care system will be based upon the following priorities:
1.
Veterans with service-connected disabilities who are rated at 50%
or more disabled.
2. Veterans with
service-connected disabilities who are rated 30% or 40% disabled.
3.
Veterans who are former POWs or were awarded a Purple Heart,
veterans with 10% or 20%, and veterans awarded special eligibility for
disabilities incurred in treatment.
4.
Veterans who are receiving aid and attendance or housebound
benefits and veterans who have been determined by the VA to be
catastrophically disabled.
5. Veterans who are determined to be unable to defray the expenses
of needed care.
6.
All other eligible veterans who are not required to make
co-payments for their treatment. This includes veterans seeking care
solely for a disorder associated with exposure to a toxic substance or
radiation, for a disorder associated with service in the Southwest Asia
theater of operations during the Gulf War, or for any illness associated
with service in combat in a war after the Gulf War or during a period of
hostility after November 11, 1998; and veterans with zero percent
service-connected disabilities, who are nevertheless compensated,
including veterans receiving compensation for inactive tuberculosis.
7.
Non service-connected veterans and non-compensable zero percent
service-connected veterans with income below both the VA national
threshold and the VA geographically based threshold, whose net worth
exceeds VA’s ceiling (currently $80,000) and who agree to pay
co-payments for services.
8.
All other non service-connected veterans and zero percent non
compensable service-connected veterans with income above the VA national
threshold, who agree to pay co-payments. (Note:
Effective
January
17, 2003
,
no veterans are being accepted into priority group 8).
Priority
care is to be given to severely disabled (50% and higher) veterans.
However, many of these veterans were still waiting in excess of six
months, at times, to see a physician.
In January, 2004, further measures were taken to give those
veterans with service connected disabilities priority.
Those veterans with service-connected disabilities will now be
afforded a primary care appointment within 30 days. However, despite the
veteran’s priority group, VA medical facilities will see a veteran
immediately if that person’s medical condition is critical and he or she
needs care right away. To determine eligibility for health care services,
the following numbers are provided.
VA
Benefits
1-800-827-1000
Health
Benefits
1-877-222-8387
CHAMPVA
1-800-733-8387
Health
Eligibility Center
1-800-929-8387
A
consumer oriented description of the VA health care priority groups is
available online in the VA health care benefits guide booklet at
http://www.va.gov/healtheligibility/coveredservices/Benefits_Guide_v4.pdf.
Paying for Services
The
Department of Veterans Affairs may provide hospital and medical services
to certain veterans who were not disabled as a result of their service,
but only if they agree to pay a co-payment.
These veterans must complete a financial test referred to as a
“Means Test.” If a
veteran’s income is below the means test threshold, the VA must consider
their corpus estate to determine if the veteran is financially able to pay
a co-payment for care. Un-reimbursed medical expenses are the only
acceptable deductible. Those veterans whose incomes are above the “means
test” threshold must agree to pay co-payments for care.
If the veteran does not agree to make co-payments, the veteran will
be ineligible for VA care.
January
1st of each year, the Secretary of Veterans Affairs increases
the means test threshold amounts by the same percentage that the maximum
rates of pension benefits were increased. These pension benefit amount
increases must mirror the benefits increases under Title II of the Social
Security Act.
“Below
the means test threshold” is defined as those veterans whose
attributable income and net worth are such that they are unable to defray
the expenses of care; therefore, they are not subject to co-payment
charges for hospital and outpatient medical services.
Within the Veterans Health Information Systems and Technology
Architecture (
VistA
)
system, such veterans are designated as “Means Test CoPay Exempt.”
“Above
the means test and GMT threshold” is defined as those veterans whose
attributable income and net worth are such that they are able to defray
the expenses of care; therefore they must agree to pay a co-payment for
hospital care and outpatient medical services.
Within the
VistA
system these veterans are designated as “Means Test Copay Required.”
“Above
the means test and below the GMT threshold” is defined as those veterans
whose attributable income and net worth are such that they are able to
defray the expense of care, but whose inpatient medical care co-payments
are reduced to 80 percent. Within
the
VistA
system, these veterans are identified as “GMT CoPay Required.”
Means
Test Thresholds, effective
January
1, 2004-December
31-2004:
Veterans
with no dependents:
Below Means Test Threshold
$25,162
Above Means Test Threshold
$ 25,163
Veterans
with one dependent:
Below Means Test Threshold:
$30,197
Above Means Test Threshold: $30,198
Veterans
with two dependents:
Below Means Test Threshold: $31,885
Above Means Test Threshold: $31,386
Veterans
with three dependents:
Below Means Test Threshold: $33,573
Above Means Test Threshold: $33,574
The
income and/or asset threshold for net worth development:
$80,000
(References:
38 U.S.C. §§1705(a)(7) and 1722)
By
applying for enrollment in the VA healthcare system, a veteran does not
give up his or her right to use other sources of care nor does the veteran
have to pay any premium to the VA. All
veterans applying for VA medical care will be asked to provide information
on their health insurance coverage, including coverage provided under the
policies of their spouses. Veterans
may or may not have a private insurance policy, but this does not affect
their eligibility for VA care or their co-payment requirements.
VA is authorized to submit claims to health insurance carriers for
recovery of VA’s reasonable charges in providing medical care to non
service-connected veterans and to service-connected veterans for non
service-connected conditions. Money collected in this way is used to
maintain and improve VA’s health care system for veterans. VA cannot
bill Medicare at this time for medical services provided to veterans.
Although
veterans are not responsible for paying any remaining balance of VA’s
insurance claim that is not paid or covered by their health insurance,
veterans whose income is above the means test threshold are responsible
for the VA co-payments required by federal law.
However, when VA receives a payment from the veteran’s health
insurance company for the care furnished, VA credits that recovery toward
the amount of the veteran’s co-payment obligation.
Medical Benefits Package
The
Veterans’ Health Care Eligibility Reform Act of 1996
created a Medical Benefits Package that is available to all enrolled
veterans. It has also simplified the enrollment process.
The services provided include:
- Primary
health care
- Diagnosis
and treatment
- Surgery,
including outpatient surgery
- Mental
health and substance abuse treatment
- Home
health care
- Respite,
hospice, and palliative care
- Urgent
and limited emergency care
- Drugs
and pharmaceuticals
This
package does not usually include hearing aids and eyeglasses unless they
are necessary to treat a service connected disability.
Outpatient Healthcare
VA
outpatient healthcare is divided into three tiers. The first tier is for
preventative care,
laboratory tests, flat film radiology services, and electrocardiograms.
The veteran is not charged for these services. Basic (primary) care
outpatient visits comprise the second tier and require a co-payment of $15
per visit. The third tier
includes specialty care outpatient visits, like outpatient surgery,
audiology, and optometry, which require a $50 co-pay per visit.
Any veteran with 50 percent or greater service connected disability
or a veteran who is seen for a service-connected disability is not charged
for services. Additionally,
these co-pays are waived for those who are unable to defray the cost of
care under the means test, and for military retirees who are Medicare
eligible, or are eligible for care under the TRICARE program.
Most
veterans must be seen at least once per year to stay in the system,
otherwise re-enrollment is necessary.
The amount of actual visits per year required to maintain care
levels is determined by the physician. There is no medical coverage for
dependents, only the veteran.
Outpatient Pharmacy Services
Before
receiving prescription benefits, a veteran must first see a VA Primary
Care Physician (PCP). A $7 co-pay applies to each 30 day or less
prescription. After an
eligible veteran has reached the annual cap of $840, the remaining
prescriptions for that year will be furnished without cost.
Most prescriptions are filled by mail.
Hospital Care
For
hospital care, veterans who are above the income levels for the means test
are responsible for the Medicare deductible for the first 90 days of care
during any 365-day period. For each additional 90 days of hospital care,
the veteran is subject to charges which are based on the Medicare
deductible. In addition the veteran is charged $10 a day.
Medicare
cannot be billed if the veteran is in a VA hospital, but Medicare
supplement insurance can be billed. HMOs will not authorize payment if
care was provided in a VA facility. Except in case of emergency, hospital
care is covered only if provided in a VA facility. In case of emergency,
the VA will authorize care until the veteran is stable and can be
transferred to the VA hospital.
§
1.3 EXTENDED CARE SERVICES
Overview
Veterans
Health Administration (VHA) provides a comprehensive array of long term
care services that include direct VHA provided services, services
purchased in the local community, and services supported through
construction and per diem grants to states.
VHA also assists veterans and families in obtaining services
through other publicly-funded healthcare programs such as Medicare and
Medicaid, and provides assistance in obtaining services that are
personally financed by the veteran.
Services
provided through VHA include: Domiciliary Care, Respite
Care, Adult Day Health Care, Home Based Hospital Care, Comprehensive
Rehabilitation, Hospice, Geriatric Care Management, Alzheimer’s and
Dementia Units (provided in VA and community based facilities), and such
other non-institutional alternatives to nursing home care as are
appropriate.
While the VHA provides this
broad array of services, all services are not available to all veterans or
in all VA locations.
In
2003, the maximum co-payment rates that could be charged for short term
extended-care services were as follows:
- Nursing
home, inpatient geriatric evaluation, inpatient respite:
$109.50 per day
- Adult
day health care, outpatient geriatric evaluation, outpatient respite:
$15 per day
- Domiciliary
care: $5 per day
Non-Institutional
Care
Prior to
1999, the VA generally provided long term care on a discretionary basis.
With the passage of the
Millennium Health Care and Benefits Act,
the VA was required to offer some long-term care services to eligible
veterans in non-institutional settings.
However, the availability of non-institutional services, even those
required under the Millennium Act, are uneven.
In a manner similar to the Medicaid program, the proportion of VA
long-term care costs is growing as the VA tries to reduce its reliance on
inpatient care.
Respite Care
The
goal of the respite care program is to enable the chronically ill and
disabled veteran to remain at home. Respite is designed to reduce the
caregiving burden on the caregiver for up to 30 days per year. This
program is available at nearly all VA facilities. Respite care was
previously offered only at VA facilities, but was expanded to home and
other community settings under the Millennium Act.
Home and community programs have been initiated through a number of VA
facilities.
This
program is available to the families of all veterans.
If the veteran is at least 10% service-connected disabled, he or
she is not charged for this service. All
other veterans have co-payments at the long term care rate.
Adult Day Health Care (ADHC)
Adult
Day Health Care is an outpatient day care program designed to provide
rehabilitation and medical services to disabled veterans.
Veterans need to be enrolled in the VA health system and be able to
meet the eligibility criteria for admission to this program.
This program is included in the basic benefits package.
Home-Based Primary Care (HBPC)
This
program is available through selected VA medical centers. It provides
long-term primary care to chronically ill veterans in their homes.
This program is designed for those veterans who are housebound and thus
unsuitable for management in outpatient clinics. The VA contracts with
community nurses to provide the necessary care. As long as a veteran is
honorably discharged, and meets the medical criteria, he or she is
eligible for this service at no cost.
The veteran does not need to have a service-connected condition to
receive these services.
Contract Home Health
This
program supplies mainly home nursing services.
It is commonly referred to as “fee basis” home care.
Homemaker and Home Health Aide (H/HHA)
H/HHA
provides home-health aide and homemaker services to veterans with service
connected disabilities who meet the criteria for nursing home placement.
The services are purchased by VHA from public and private agencies in the
community. Case management is provided directly by VHA staff.
Hospice Care
A
number of VA medical centers have an interdisciplinary hospice/palliative
care consultation team that is responsible for planning, developing, and
arranging for the local provision of hospice care, directly by VA or
through contract or referral to community programs. Hospice/palliative
care programs offer pain management, symptom control, and other medical
services to terminally ill veterans or veterans in the late stages or
chronic disease process, as well as bereavement counseling and respite
care to their families. The
Hospice program is an inpatient program open to all veterans.
It is free to all veterans, regardless of whether the veteran has a
service-connected disability.
Community Residential Care
This
program involves room, board, and limited personal care services delivered
in a VA-approved community residential facility to veterans who do not
require institutional care but are unable to live independently. The
veteran pays the primary costs. The
VA pays administrative costs only. The
veteran receives outpatient medical care at VA facilities.
Other Programs
Domiciliary Care
Domiciliary
care is provided by selected VA and state homes. It provides short term
rehabilitation and long-term health maintenance services to veterans who
are recovering from medical, psychiatric, or psychosocial problems.
Domiciliary care is intended as rehabilitative care, with the goal of
returning the veteran to the community with an increased quality of life.
The
VA also provides psychiatric residential rehabilitation programs for
veterans suffering from substance abuse, post-traumatic stress disorder,
and transitional residences for homeless mentally ill veterans and those
recovering from substance abuse.
Geriatric
Care Programs
The
majority of VA medical centers offer geriatric evaluation and management
(GEM) and/or geriatric primary care programs. These programs provide both
primary and specialized care services to a targeted group of elderly
patients on an inpatient unit or in outpatient settings. On the inpatient
units, an interdisciplinary team of geriatric experts performs
comprehensive evaluations of patients with a goal of stabilizing the
patient and discharging him or her to the least-restrictive setting. The
outpatient geriatric primary care program can provide medical, nursing,
preventative care, and health education services to the geriatric veteran
allowing him or her to remain at home and avoid institutionalization.
Alzheimer’s and Dementia
Programs
Approximately
52 VA medical centers have developed specialized programs for the care of
veterans with dementia. These programs include inpatient and outpatient
dementia diagnostic programs, behavior management programs, adapted work
therapy programs for patients with early to mid-stage dementia,
Alzheimer's special care units within VA nursing homes and transitional
care units, and a model inpatient palliative care program for patients
with late stage dementia. Programs for family caregivers of dementia
patients include support groups and caregiver education, as well as
respite and adult day health care services for the patient that allow
"free time" for the caregiver.
Comprehensive Rehabilitation Program
This
is an inpatient program designed to provide rehabilitation services in a
federal VA nursing facility. The program is slated to provide 60 days of
care. There is no cost to
veterans who have 10% or greater service-connected disabilities, but
others may be required to pay the long-term care co-payment for services.
NURSING
FACILITY CARE
In General
The
VA must provide, at no cost, long term care at Federal VA Nursing Homes to
veterans who are considered severely disabled.
The
VA may furnish nursing home care to other veterans, if space permits. All
other eligible veterans, their spouses, and surviving spouses, may
receive, possibly at their own cost, long term care from State VA Nursing
Homes.
Federal
Nursing Home Care
If
the veteran has a service connected injury or illness rated at 70% or
higher, or if the veteran is rated as having a service connected
disability of 60% and is also rated 100% disabled because he or she is not
employable, or if the veteran is in need of nursing home care because of
his or her service connected disability, then he or she is eligible for
federal nursing home care, at no cost to the veteran.
Federal
nursing home care may be provided in a federal nursing facility, in a
community nursing home, or in a state veteran’s home approved by VA.
The responsibility of the VA to
furnish nursing facility care is subject to the limitation that any
requirements are effective in any fiscal year only to the extent and in
the amount provided in advance in appropriations Acts for such purposes.
Federal Application Process
Medical Eligibility
Medical
Eligibility is determined by the admissions committee. The committee is
comprised of doctors, social workers, and facility administrators. This
committee meets one or two times per week, and tries to process
applications in a matter of working days so that the placement is done in
a timely manner.
Waiting Lists for Federal
Facilities and Alternative
Placements
Because
of the high level of care required by veterans who qualify for long term
federal nursing home placement, there is often no waiting list in this
system. A veteran who qualifies for care but cannot be placed in the
federal facility will be placed in a non-VA facility through private
contract. These private contracts will not generally exceed six months.
Thereafter, if the veteran continues to need nursing home care, he or she
may be transferred to a federal VA facility or remain in a private
facility depending upon factors such as availability of beds and
geography. If a veteran normally resides a great distance from the nearest
VA facility, the VA sometimes continues contracting with a private nursing
facility located near the veteran’s home.
Location of Federal Facilities
Federal
Nursing home facilities are located at Federal VA Medical Facilities. Here
is a list of the Federal VA facilities in
Pennsylvania
.
Altoona
:
James E. Van Zandt VA
Medical
Center
; 68
Beds—28 Acute, 40 Long Term Care
Butler
:
Butler
VA
Medical
Center
; 199 Beds
Coatesville:
Coatesville VA Medical Center; 200 Nursing Beds, Assisted Living
Facility available
Erie
:
Erie
VA
Medical
Center
; 52 Nursing
Facility Beds
Lebanon
:
Lebanon
Medical
Center
; 136 Nursing
Facility Beds
Philadelphia
:
Philadelphia
VA
Medical
Center
; 240 Nursing
Facility Beds
Pittsburgh
:
VA
Pittsburgh
Healthcare
System, H. John Heinz III Progressive Care Center; Adult Day Care,
Geriatric Care Center, 50 DOM, 6 Hospice, 280 Nursing Beds, 336 total
Pittsburgh
:
VA Pittsburgh Healthcare System, Highland Drive Division; Respite,
ADC, DOM for homeless
Pittsburgh
: VA
Pittsburgh
Healthcare
System,
University
Drive
Division;
Geriatric Care, 240 Nursing Beds
Wilkes-Barre
:
Wilkes-Barre
VA
Medical
Center
; 165 Nursing
Beds
State
Veterans Nursing Home Care
Pennsylvania
State
veterans nursing homes are state-operated facilities that provide care
primarily to disabled veterans incapable of
incapable
of self-support. These homes
receive financial assistance from VA under its State Home Per Diem Grant
Program and State Home Construction Grant Program. State veterans nursing
homes represent one of VA’s principal means of providing and supporting
nursing home care for veterans.
Unlike
the veterans who receive services in federal nursing facilities, veterans
applying for admission to state homes do not need to have a documented
level of service-connected disability, only the medical need for nursing
facility care. Additionally, spouses or surviving spouses of eligible
veterans may be eligible for State Nursing Home care.
Some
veterans (and spouses) are not eligible for admission to a state nursing
home. Care in a state facility is not available to veterans who have a
mental or physical condition that causes a reasonable threat to the safety
or welfare of themselves or others, or who are merely in need of mental
health care or custody. Some veterans who have been convicted of a felony
are also not eligible for admission to a state nursing home.
Admissions
to
Pennsylvania
state facilities are on a first come, first served basis. However,
veterans are given first priority, followed by the spouses of veterans who
are residents of the home, and then by spouses and surviving spouses of
veterans who are residents of the home.
To order an application for a state VA home, call 717-861-8906.
There
are waiting lists of up to one year for admission to state VA nursing
facilities. If the veteran
needs immediate placement, the state VA may try to get the veteran
admitted to a private nursing home until a state bed becomes available.
The veteran is responsible for the cost of the private facility.
Financial
Issues for State Nursing Home Care
Maintenance Fees
Residents
of Pennsylvania State Veterans Nursing homes who have the financial ability
are required to make monthly payments for “maintenance fees.”
Maintenance fees are based on the cost of providing nursing or personal
care to individual residents of State Veterans Homes.
Veterans
who have high incomes must agree to pay for the services according to
their ability to pay.
To determine payment
responsibility, the veteran applying for state nursing home care services
may be required to provide additional income information on the VA Form
1010EC, Application for Extended Care Benefits.
Veteran’s Income
Maintenance
fees are determined on a case by case basis, but generally are calculated
from the veteran’s (and spouse’s) income, after disregarding $100 as
personal needs allowances and other personal expenses.
The veteran then becomes responsible to pay a flat rate.
Eighty percent of the remaining income over the flat rate is allocated to
the nursing facility, and twenty percent to the veteran. The maximum
monthly maintenance fee is 1/12th of the annual per capita cost
of maintaining the resident in the home.
SVH form 102 is used to determine the veteran’s responsibility for
maintenance fees.
A
resident of a State Veteran’s Home is required to make monthly payments
against maintenance fee liability in accordance with the resident’s
ability to pay. However,
monthly payments may be reduced or waived if an applicant is incapable of
self-support and demonstrates a financial need.
A person will not be denied admission to a State Veterans Home on
grounds of inability to pay maintenance fees.
An applicant is “incapable of self support” if he or she is unable to
earn a living in an amount over the minimum required to become eligible
for public assistance or welfare as set forth by the Department of Public
Welfare.
While
the law provides for $100 per month in personal needs allowances, in
practice, some state homes allow veterans a minimum of $150 per month.
If a veteran comes to the home with no income, or if his or her
income does not provide a minimum of $150 per month for personal
allowances, the resident receives a payment for the difference from a
state stipend fund.
Regulations
provide for appeal of determinations regarding monthly maintenance fees.
Veteran’s Assets
Spouse’s
Income
Basic Rule
Generally,
the community spouse of a State Veterans Home resident is allowed to have
$865 per month in income. If
the spouse’s income is less than $865, then the incomes of the resident
and spouse are combined, and the community spouse is allocated $865 from
that amount.
High Spousal Income
If
the community spouse has more than $865 per month in income, then the VA
state home has the ability to consider the veteran as a single person,
thereby giving the veteran more income, and also allowing the spouse to
keep all of his or her income.
Spouse’s Assets
Any
assets in the non-resident spouse’s name alone are her property, and she
can use them without restriction.
Joint Assets
Joint
assets in the name of the resident and spouse can be used freely by the
non-resident spouse with one exception: The non-resident spouse may not
make substantial gifts of the money. The
amount of gifting is not defined.
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