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 in-home care is 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.
Who Is Eligible for the Veterans Home Care Program?
There are three general eligibility requirements that a veteran must meet to receive home care through the VA.
Enrollment in 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 did not receive a dishonorable discharge qualify for the VA’s standard medical benefits package. Typically, elderly veterans have already applied for and been receiving VA health care benefits long before the need for in-home care arises.
Veterans who are not signed up for VA health care but believe they are eligible for coverage are encouraged to apply online, by phone at 877-222-8387, or by submitting an application for health benefits form by mail 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. Furthermore, the veteran’s medical condition and/or financial status may have changed, thereby qualifying them for coverage. You can find detailed information about VHA eligibility requirements here.
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 (e.g., Medicaid, VA pension, disability compensation). A veteran’s assigned priority group will determine how soon they’re enrolled in health care benefits and how much (if anything) they’ll need to pay toward the cost of their care. According to the VA, “We assign Veterans with service-connected disabilities the highest priority.”
Eligibility for Community Care Services
Next, a veteran who is signed up for VA health care must also qualify for community care. The VA MISSION Act of 2018 established six expanded eligibility criteria that can qualify a veteran to receive community care, only one of which 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 does not directly provide homemaker or home health aide services, any veteran seeking them qualifies for community care automatically.
Clinical Eligibility 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 assessment to evaluate, among other things, their level of dependence in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
A veteran meets clinical eligibility criteria for the VA Homemaker/Home Health Aide Program if their assessment identifies:
- Dependencies in three or more ADLs; or
- Significant cognitive impairment; or
- 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 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 twelve or more times in the past year.
The findings of the official assessment, established goals of care, and recommended type(s) and duration of services will be documented in VA Form 10-0415, Geriatrics and Extended Care (GEC) Referral. If a veteran meets all the criteria above, then the VA primary care provider will order the appropriate H/HHA services and possibly others to supplement this care. Keep in mind that it is 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.
From there, a “VA coordinator contacts the veteran to discuss his or her needs, determines amount of care to be provided based on clinical need, and makes a referral to a community home health agency. The VA reassesses the veteran’s need for care at least annually and assesses the agency’s quality annually.”
In cases where budget resources are insufficient to meet all identified H/HHA needs, some veterans may be placed on an electronic waiting list for these services. The VA prioritizes veterans who are currently receiving or in need of nursing home care primarily for the treatment of a service-connected disability and veterans who have a service-connected disability rated at 50 percent or more.
Services Available Through the VA Home Care Program
The H/HHA Program may include assistance with a wide range of daily tasks to help veterans continue living safely and independently in their own homes.
Homemaker Services (Help With IADLs)
- Light housekeeping necessary to maintain a safe and sanitary environment in the 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
- Ensuring patient safety
Home Health Aide Services (Help With ADLs or Personal Care)
- Ambulating or transfers
- Active and passive exercises
- Assistance with medical equipment
- Routine health monitoring
In-home care isn’t just for the benefit of veterans; it provides their family caregivers with valuable respite time and peace of mind. These services can be used in conjunction with others, like adult day care, to ease the caregiver burden on family members and delay or prevent nursing home placement for veterans.
Although veterans can receive more than one type of home and community-based service at a time, note that eligibility requirements for skilled home health care services (e.g., wound care, catheter care, physical therapy, occupational therapy) are different from those for the H/HHA Program.
VA Home Care Providers
The Veterans Health Administration is in the process of transitioning from the Patient-Centered Community Care (PC3) network to a national Community Care Network of licensed health care providers from which the VA can purchase care for veterans. The CCN is divided into six regional networks which are developed and administered by Third Party Administrators (TPAs) on behalf of the VA. TriWest Health Care Alliance and Optum Public Sector Solutions, Inc. are the TPAs currently responsible for regions one through five.
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 VA’s network 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.
Does the VA Pay for In-Home Care?
Many veterans are eligible for free health care through the VA based on their disability rating, income level, military service record and assigned priority group. As a rule, any care related to a VA-rated service-connected disability does not 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 is responsible for copays (based on service-connected disability status and income), these will start on the 22nd day of care. In 2021, the daily copay rate for non-service-connected H/HHA services is “up to $15.” Any other health insurance coverage a veteran has may help offset all or part of their required copayments.
Lastly, 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.
Sources: About VA Health Benefits (https://www.va.gov/health-care/about-va-health-benefits/); 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); Veterans Community Care Program, 84 Fed. Reg. 5635 - 5636 (proposed Feb. 22, 2019) (to be codified 38 CFR § 17.4010) (https://www.govinfo.gov/content/pkg/FR-2019-02-22/pdf/2019-03030.pdf); VHA HANDBOOK 1140.6 PURCHASED HOME HEALTH CARE SERVICES PROCEDURES (https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1457); Memorandum: Validity of VHA Policy Documents (https://www.va.gov/VHAPublications/ViewPublication.asp?pub_ID=3215); Long-Term Care Services for Veterans (https://fas.org/sgp/crs/misc/R44697.pdf); 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/); 2021 VA health care copay rates (https://www.va.gov/health-care/copay-rates/); General Community Care (https://www.va.gov/COMMUNITYCARE/programs/veterans/General_Care.asp)