Many people are aware that the U.S. Department of Veterans Affairs (VA) offers veterans comprehensive health care benefits through the Veterans Health Administration (VHA). But did you know that long-term care services such as in-home care are part of this standard medical benefits package? Read on to learn how veterans and their caregivers can take advantage of the VA’s Homemaker and Home Health Aide program (H/HHA).
Home care for veterans: What is the VA homemaker and home health aide care program?
The homemaker and home health aide care (H/HHA) program is one of many home and community-based services the VA offers. The goal of the program is to help veterans remain safe and independent while continuing to live in their own homes. Under the supervision of a registered nurse, trained homemakers and home health aides support veterans at home by providing assistance with personal care and daily activities, companionship, and respite care for their family caregivers.
The H/HHA program can also be combined with other VA home and community-based services, but availability may be limited.
Veterans home care benefits
Homemaker and home health aide care may include assistance with a wide range of daily tasks to help veterans continue living safely and independently in their own homes.
VA in-home care services
Homemakers and home health aides can help ensure patient safety and provide assistance with the following instrumental activities of daily living (IADLs):
- Light housekeeping necessary to maintain a safe and sanitary environment in areas of the home used by the patient
- Laundering essential to the comfort and cleanliness of the patient
- Meal preparation
- Grocery shopping
- Escorting the patient to necessary appointments
VA home health aide care services
Home health aides can provide assistance with the following activities of daily living (ADLs):
- Ambulating or transfers
- Active and passive exercises
- Assistance with medical equipment
- Routine health monitoring
VA home care isn’t just for the benefit of veterans; it also provides their family caregivers with valuable respite time and peace of mind. These services can be used with others, like adult day care, to ease the burden on families and delay or prevent nursing home placement for veterans.
Note that eligibility requirements for skilled home health care services like wound care, catheter care, physical therapy, and occupational therapy are different from those provided through the VA's home health care program.
Who is eligible for the veterans home care program?
To receive VA home care assistance, a veteran must meet the following criteria:
- Be enrolled in a VA health care benefits package
- Qualify for community care services
- Have a doctor’s order to receive home care services
These three general criteria are covered in greater detail in the following sections.
Qualifying for VA health care benefits
First, a veteran must be eligible for VA health care benefits. Most veterans who served in the active military, naval, or air service and didn’t receive a dishonorable discharge qualify for the VA’s standard medical benefits package. Typically, older veterans have already applied for and been receiving VA health care benefits long before the need for in-home care arises.
Veterans who aren’t signed up for VA health care but believe they’re eligible for coverage are encouraged to apply online. A veteran can also apply by phone at 877-222-8387, by mailing an application for health benefits form, or in person at a VA medical center or clinic.
Even if a veteran has applied for VA medical benefits before and been denied coverage, it may be worth applying again. Their medical condition and/or financial status may have changed, thereby qualifying them for coverage.
The VA assigns each applicant to a priority group based on their military service history, disability rating, income level, and whether they qualify for/are receiving other benefits like Medicaid, a VA pension, or VA disability compensation. A veteran’s priority group determines how soon they’re enrolled in health care benefits and how much (if anything) they’ll pay toward the cost of their care. Veterans with service-connected disabilities are assigned to the highest priority group, according to the VA.
Qualifying for VA community care services
Next, a veteran with VA health care coverage must also qualify for community care. When the VA can’t provide the care a veteran needs, community providers may be approved to deliver these services. The VA MISSION Act of 2018 established six expanded eligibility criteria for community care. Only one of these six requirements must be met. One criterion that triggers eligibility is that “no VA facility offers the hospital care, medical services, or extended care services the veteran requires.”
The H/HHA program is unique in that these extended care services are provided exclusively through non-VA providers in the community: public and private home care agencies. Since the VA doesn’t directly provide homemaker or home health aide services, any veteran seeking them qualifies for community care automatically.
Qualifying for H/HHA services
Lastly, a veteran must demonstrate a clinical need for H/HHA services. Their VA primary care provider or a geriatrics care team will conduct a comprehensive geriatric evaluation to assess their health and level of dependence in activities of daily living and instrumental activities of daily living.
A veteran meets clinical eligibility criteria for the VA homemaker and home health aide program if their assessment identifies one of the following:
- Dependencies in three or more ADLs
- Significant cognitive impairment
- Dependencies in two ADLs and the veteran meets any two of the following conditions:
- Has dependencies in three or more IADLs
- Is 75 years old or older
- Has been diagnosed with clinical depression
- Lives alone in the community
- Has been recently discharged from a nursing facility, or has an upcoming nursing home discharge plan contingent on the receipt of home and community based care services
- Has demonstrated high use of medical services defined as three or more hospitalizations in the past year, or has utilized outpatient clinics or emergency evaluation units 12 or more times in the past year
A formal care plan will document the findings of the official assessment, establish goals of care, and recommend the type(s) and duration of services needed. If a veteran meets the three general criteria above, then their VA primary care provider will order the appropriate H/HHA services and possibly others to supplement this care. Keep in mind that it's possible for a veteran who doesn’t strictly meet the criteria above to demonstrate a clinical need for in-home care and receive an order for services.
Once a VA staff member confirms a veteran’s eligibility for the H/HHA program, they’re referred to a home care agency in the VA’s community care network.
VA home care providers
The Veterans Health Administration uses a national Community Care Network (CCN) of licensed health care providers from which the VA can purchase care for veterans. The CCN is divided into five regional networks that are managed by third-party administrators (TPAs) on behalf of the VA.
According to the VHA handbook, “VHA referrals for home health care services are made to community agencies that are state-licensed or CMS-certified for the level of care provided and in good standing with state licensing bodies in the states where the agency provides care.” When possible, the VA gives priority consideration to patients’ preferences in selecting a home care provider.
Only home care companies in the CCN can provide these covered services. VA staff members can assist in connecting veterans with local providers. In some cases, they may even be able to add a desired provider to the VA’s network. Keep in mind that community care services, providers, and availability vary by location.
How much does the VA pay for in-home care?
The VA covers most of the cost of in-home care for eligible veterans. Many veterans qualify for free health care through the VA based on their disability rating, income level, military service record, and assigned priority group. As a rule, care related to a VA-rated service-connected disability doesn’t require a copayment regardless of a veteran’s disability rating or priority group assignment.
VA geriatric and extended care services, like the H/HHA program, are unique in that no copayments are assessed for the first 21 days of care provided in a 12-month period. If a veteran's responsible for copays (based on service-connected disability status and income), these will start on day 22 of care. In 2023, the daily copay rate for non-service-connected H/HHA services is “up to $15.” This rate is very reasonable considering the median hourly cost of home health aide care is $27, according to the most recent Genworth Cost of Care Survey.
Any other health insurance coverage a veteran has may help offset all or part of their required copayments. A veteran (or their legal representative) must file VA Form 10-10EC, Application for Extended Care Services to estimate their monthly copayment obligations.
Finally, the VA clearly states that “community providers cannot bill or collect a VA copayment directly from veterans.” Veterans who are responsible for copays have several easy options for making payments, disputing charges, and requesting financial assistance with medical expenses.
Support and next steps for finding the right veterans home care program
Finding the right home care option for your loved one through the veterans home care program can be complicated, but AgingCare can help you simplify your search. Our Care Advisors can connect you with home care providers in your area, which can be helpful for veterans who live outside of a VA network. For veterans who don’t qualify for the VA home care program, or need support the VA doesn’t provide, Care Advisors will work with you to find the right home care services to fit your loved one’s needs and budget. For support and advice on senior care, connect with other family caregivers on the AgingCare Forum.
Reviewed by Certified Elder Law Attorney Letha McDowell.
Long-Term Care Services for Veterans (https://sgp.fas.org/crs/misc/R44697.pdf)
Homemaker and Home Health Aide Care (https://www.va.gov/GERIATRICS/pages/Homemaker_and_Home_Health_Aide_Care.asp)
About VA Health Benefits (https://www.va.gov/health-care/about-va-health-benefits/)
S.2372 - VA MISSION Act of 2018: 115th Congress (2017-2018) (https://www.congress.gov/bill/115th-congress/senate-bill/2372#:~:text=(Sec.,(VA)%20health%20care%20providers)
Veteran Community Care Eligibility Fact Sheet (https://www.va.gov/COMMUNITYCARE/docs/pubfiles/factsheets/VA-FS_CC-Eligibility.pdf#)
38 CFR § 17.4010 - Veteran eligibility (https://www.law.cornell.edu/cfr/text/38/17.4010)
VHA DIRECTIVE 0999: VHA POLICY MANAGEMENT (https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9734)
Skilled Home Health Care (https://www.va.gov/GERIATRICS/pages/Skilled_Home_Health_Care.asp)
Your health care costs (https://www.va.gov/health-care/about-va-health-benefits/cost-of-care/)
Community Care (https://www.va.gov/COMMUNITYCARE/programs/veterans/General_Care.asp)