By Sandy Morris
The U.S. Department of Veterans Affairs (VA) is divided into three separate organizations. The Veterans Health Administration (VHA) provides health care services to qualified veterans, the National Cemetery Administration (NCA) maintains most of the country's national cemeteries and administers burial benefits for eligible vets. Lastly, the Veterans Benefits Administration (VBA) is the branch that handles compensation and pension programs. This is the one I will address in this article.
The pension side administers the Aid and Attendance (A&A) benefit. A&A is an ongoing, tax-free payment made to veterans and their current or surviving spouses. It’s a stacked benefit comprised of basic pension, homebound pension and aid and attendance funding. This distinction is important for some state Medicaid programs and may determine how much a recipient can keep if they go on Medicaid. A&A funding is paid directly to the benefit recipient, and the recipient uses it to pay their expenses as they choose.
A&A is a needs-based benefit intended to help seniors pay for their long-term care expenses. It can be used for medical and non-medical home care, medical and non-medical care in independent living communities, and for care in assisted living, skilled nursing and long-term care facilities. There are four qualifications for a veteran and their current or surviving spouse to get the benefit.
First, a veteran must have served during a recognized period of war.
They must have served a total of 90 days of active duty service, with at least one day during a defined wartime period. The veteran can have served anywhere in the world, including stateside, and is eligible with anything but a dishonorable discharge.
The periods of conflict that Congress recognizes for this benefit are:
- World War II: 12/7/1941 to 12/31/1946
- Korea: 6/27/1950 to 1/31/1955
- Vietnam (if served in Vietnam): 2/28/1961 to 5/7/1975
- Vietnam (if served outside Vietnam): 8/5/1964 to 5/7/1975
- Gulf War: 8/2/1990 to present (total active duty must be 24 months)
Secondly, the veteran must have a doctor’s order that they need help with the five activities of daily living (ADLs) that the VA allows.
The VA has a less stringent standard than most state Medicaid programs and only requires that the beneficiary need some help. This includes prompting and cuing for anyone with a cognitive disability.
The five ADLs that the VA assesses for the benefit are bathing and showering, dressing, eating and/or drinking (not including meal preparation, but it does cover monitoring for choking and aspiration), mobility (getting in and out of bed, chairs, etc.) and personal hygiene (tooth-brushing, toileting, diapers, etc.).
Veterans who are bedridden, live in a nursing home due to physical or mental incapacity, or have extremely impaired vision may also be eligible for A&A.
Next, a veteran or their spouse’s cost of medical care must exceed the couple’s joint income.
This does not include ordinary household and personal expenses and pertains only to medical expenses. It doesn’t matter how much income they have, as long as it’s less than their medical expenses.
Lastly, the VA looks at the applicant’s assets, excluding their home and car.
There’s no published benchmark for allowed assets, although there are many sites on the internet that indicate set dollar amounts like $80,000. Those are incorrect. The formula the VA applies seems to look at the age of the applicant, life expectancy at that age, and the assets they’re likely to need to meet their medical expenses for the duration of their life. The VA has posted some possible changes to this qualification on their website for public comment, but it’s unknown when or if those changes might be enacted.
Individuals pursuing the informal claims process can expect to wait somewhere between eight and twelve months for a decision on their application. The applicant must be alive at the time the benefit is awarded, or they receive nothing. If approved, the benefit is paid retroactively from the date of application.
For instance, a successful claim filed and approved in October would mean the benefit begins the first day of the following month, in this case November. However, like Social Security, this program pays at the end of the month. That means the first possible payment would be made on December 1.
Claimants can also file using the Fully Developed Claim process by retaining a VA-accredited claims agent or VA-accredited attorney to file on their behalf. Claims filed by this method are usually awarded in one to two months from date of application for veterans and two to four months for current and surviving spouses. The agent or attorney will charge for their services, but only a disinterested third party can make this payment. A disinterested third party is someone who will receive no gain from the award of the benefit.
Therefore, spouses can’t pay for each other, but relatives and friends can pay on their behalf.
In 2017, the maximum monthly payment for each A&A beneficiary status is as follows:
- Two marrried veterans (both with A&A): $2,846
- Married veteran with A&A: $2,127
- Single Veteran with A&A: $1,794
- Veterans’s Widow with A&A: $1,153