Cash & Counseling programs (also referred to as self-directed or consumer-directed programs) give seniors and their families logistical and financial support for long-term care as well as the freedom to choose how, when and by whom these services are provided. Self-direction is commonly associated with Medicaid programs that are unique to each state, but there is another program that provides person-centered and participant-directed long-term care services and supports (LTSS): the Veteran-Directed Care (VDC) Program.
What Is the Veteran-Directed Care Program?
The VDC Program gives veterans who wish to avoid nursing home placement a budget for long-term care and control over the home and community based services they use—including the option to pay family members to be caregivers. This program was originally referred to as Veteran-Directed Home and Community Based Services (VD-HCBS) and is jointly administered by the Veterans Health Administration (VHA) and the Administration for Community Living (ACL).
Veterans who enroll in the VDC Program arrange VA payments for elder care products and services that enable them to live independently in their own homes, family members’ homes or independent living communities.
Who Is Eligible for Veteran-Directed Care?
The VDC Program is part of the standard medical benefits package available through the Veterans Health Administration. (You can read about detailed eligibility for VA health care at VA.gov/health-care/.) A veteran must be enrolled in VA health care benefits and meet the clinical need for “nursing home level care” in order to be eligible for VDC.
When it comes to determining whether a veteran requires a nursing home level of care, the VA’s eligibility requirements are often flexible to an extent. Factors like a veteran’s age, health condition(s), disability rating, functional status, and level of informal support from family/friends (or lack thereof) can all impact whether they qualify for the VDC Program. The VA conducts a comprehensive needs assessment to identify a veteran’s clinical needs and conditions, taking all these factors into account when making a benefits determination.
Generally, a veteran must live in their own home or community and require help with three or more activities of daily living (ADLs) or have significant cognitive impairment (which typically results in ADL impairments). Veterans who are 75 or older, live alone in the community, have been diagnosed with clinical depression, are receiving hospice care, and/or require help with instrumental activities of daily living (IADLs) may face less strict requirements for enrollment in the VDC Program.
Unlike Medicaid cash and counseling programs, there are no financial criteria, such as asset or income limits, that veterans must meet to qualify for VDC. However, a veteran may have to pay a small co-pay for the services they receive depending on their service-connected disability status, income and other factors. You can read more about how the VA determines health care costs and who is exempt from copayments here. It is also important to note that receiving any type of VA pension, including Aid and Attendance or Homebound pensions, does not preclude a veteran from eligibility for the VDC Program.
Unfortunately, VDC is not yet available nationwide. A veteran may qualify to self-direct their services, but if they live in an area where the VDC Program is unavailable, then they may need to rely on other programs that support community living, such as the VA’s home care program.
How Does Veteran-Directed Care Work?
First, a veteran must contact their local Veterans Affairs Medical Center (VAMC) to determine if they are eligible for the VDC Program. If they are, a comprehensive assessment is conducted to determine a veteran’s needs and functional limitations. The results of this evaluation are used to create a flexible budget of VA funds that will be used to pay for home and community based services.
Next, the veteran is referred to a local Aging and Disability Network Agency (ADNA) that has chosen to become a VDC provider and assigned an options counselor. This counselor assists with developing a care plan that fits their budget, arranges fiscal management services, and provides ongoing guidance to program participants and their caregivers.
Once the veteran’s final care plan and budget are approved, they can begin hiring and scheduling care providers and purchasing supplies needed for community living. An authorized representative may be appointed to make these care decisions for veterans who lack the capacity to participate in such matters. Paid providers might include adult day care centers, in-home care companies, independent caregivers, and friends or family members. The ability to pay adult children, a spouse and other family caregivers is often cited as one of the most attractive aspects of the VDC Program, but note that wages paid to informal caregivers are taxed.
Another difference between Medicaid cash and counseling programs is that veterans who enroll in VDC do not receive their funds directly from the VA. Instead, the VDC provider receives this money and issues payments for care services and reimbursement for supplies that are part of the veteran’s care plan. While there is a lot of effort involved in selecting care providers, managing their services and evaluating their performance, the VDC provider conveniently handles most of the financial aspects of paying for care. A veteran or their representative must only track their spending to ensure they stay within the set budget and authorize payments.
How to Apply for the Veteran-Directed Care Program
Geographic location is one of the largest barriers to enrolling in this program. According to the ACL, 70 VAMCs have provided at least one referral for VDC. It has taken many years for VDC to gain traction since its inception in 2009, and access will continue to increase as more veterans request assistance that enables them to age in place in their homes and communities.
Contact your VA social worker at your local VAMC to ask if the VDC is available in your area or through another medical center nearby. You can use the search tool on VA.gov/find-locations to find a VAMC near you and its contact information.