VA
AID
&
ATTENDANCE/HOUSEBOUND
PENSION
APPLICATION
PACKET
Department of Veteran Services
294 Main Street ● Greenfield, MA 01301
Phone 413-772-1571 ● Fax 413-772-1401
www.greenfield-ma.gov
UPPER PIONEER VALLEY VETERANS’ SERVICES DISTRICT
Veteran Resource and Referral Center located in Greenfield, satellite locations throughout the district
Timothy Niejadlik, Director
Laura Thorne, Assistant
Christopher Demars, VSO
Brian Brooks, VSO
Dear Veteran:
You or a family member has made an inquiry about assistance in paying for costs associated
with visiting nurses, home health aides, assisted living or long-term care.
Attached is a handout describing a VA benefit available to wartime veterans and their
spouses/widows and known as Aid and Attendance/Housebound. Please review the
information to determine if it applies to you, your spouse or both. If it appears to apply, please
complete the two forms (VA Forms 21-2680 and 21P-8416) which are available at the links
provided and then complete the final application form (VA Form 21P-527EZ for veteran) or
(VA Form 21-534EZ for widow/widower of veteran), a VA 21-0779 if in nursing home, the
VA 21-0845(release form) Following are instructions for the two main forms.
VA Form 21-2680 http://www.vba.va.gov/pubs/forms/VBA-21-2680-ARE.pdf
This form must be filled out by a medical doctor and describe the specific tasks or daily
routines with which you require assistance. If you do not require assistance with any of these
tasks, the VA will not approve the benefit.
VA Form 21P-8416 http://www.vba.va.gov/pubs/forms/VBA-21P-8416-ARE.pdf
This form is a summary of all out of pocket medical expenses incurred by you or your spouse
during the previous 12 calendar months. These costs may include medical premiums such as
your Medicare B premium which is deducted from your Social Security, your Medigap
premium, Part D premium, all co-pays for treatments or prescriptions.
If you are incurring actual costs for home health care or for assisted living, you may report
these costs as well. You may not include expected future costs if they are not currently being
incurred.
Enter one provider per line. For example if you or your spouse incur co-pays from CVS every
month, enter a single line for the full yearly amount and enter “annual” in column C.
After you have reviewed the description of the benefits, determined that the benefit is
applicable and completed both forms, contact our office and we will assist you in completing
the rest of the application process.
Sincerely yours,
Timothy Niejadlik
Director and Agent
Member Towns
Ashfield
Bernardston
Buckland
Charlemont
Colrain
Conway
Deerfield
Erving
Gill
Greenfield
Hawley
Heath
Leverett
Leyden
Monroe
Montague
New Salem
Northfield
Plainfield
Rowe
Shelburne
Shutesbury
Sunderland
Warwick
Wendell
Whately
Member Towns
Ashfield
Bernardston
Buckland
Charlemont
Colrain
Conway
Deerfield
Erving
Gill
Greenfield
Hawley
Heath
Leverett
Leyden
Monroe
Montague
New Salem
Northfield
Plainfield
Rowe
Shelburne
Shutesbury
Sunderland
Warwick
Wendell
Whately
Department
of
Veteran
Services
294
Main
Street
Greenfield,
MA
01301
Phone
413-772-1571
Fax
413-772-1401
www.ureenfield-ma.gov
Timothy
Niejadlik,
Director
Laura
Thorne,
Assistant
Brian
Brooks,
1~SO
Christopher
Dernars,
VSO
UPPER
PIONEER
VALLEY
VETERANS’
SERVICES
DISTRICT
l4jtera,,
Resource
alit!
Referra!
center
!ocated
in
Green/kid,
sate/lire
locations
throughout
the
district
Pension
with
Aid
and
Attendance/Housebound
General
Description
of
the
Benefit
(Applies
to
either
Veteran
or
Widow)
Wartime
veterans
and
spouses/widows who
are
seriously
disabled
may
quali~’
for
Aid
and
Attendance
or
Housebound
benefits. This
benefit
may
also
be
applied
for
by
those
with
service-com~ected
compensation
provided
that
the
compensable
injury
is
causing
the
need
for
the
Aid
and
Attendance.
Widow’s
who
are
eligible
for
VA Widow’s
pension
may
also
file
for
Aid
and
Attendance
if
they
meet
the
criteria.
Initial Screening
Net
worth:
Gross
income plus
gross
assets
(excluding
primary
home)
may
not
exceed
$80,000.
If
slightly
higher,
the
VA
recommends
filing
and
allowing
them
to
decide
on
a
case-by-case
basis.
Countable Income:
Income
received
by
the
veteran
and
his
or
her
spouse,
from
most
sources.
Includes
earnings,
disability
and
retirement
payments, interest
and
dividends,
and
net
income
from farming
or
business.
VA
will
not
count
881
but
it
should
be
reported.
Assets:
Includes
bank
accounts,
stocks,
bonds,
mutual
ffinds
and
any
property
other
than
the
primary
veteran’s
residence.
Calculation
of
Benefit
The
VA
uses
a
benchmark
of
approximately
$11
76/month
(widow),
$1402
(spouse
of
living
vet),
$183
0/month
(single
veteran)
or
$2169/month (couple),
subtracts
all incomes
for
both
parties
and
pays
the
difference
as
a
benefit.
Medical
premiums
and
expenses
will
be
counted
by
the
VA
to
reduce
gross
incomes.
Medical
expenses
include
Medicare
B
for
both
parties,
supplemental
premiums,
all
co-pays,
dental
expenses,
Visiting
nurses
and
assisted
living
costs.
The
Ton’n
of
Greenfleld
is
an
Affirm
ati,’e
Action/Equal
Opportunity
Employer,
a
designated
Greet:
community
and
a
recipient
of
the
“Leading
by
Example”A
ward
Page 2
The
VA
will
total
all
countable income
and
subtract
allowed
medical
deductions.
The
remaining
countable
income
after
deductions
is
subtracted
from
the
appropriate
benchmark
limit.
The
resulting
benefit
is
paid
directly
to
the
veteran.
Supporting
Documentation
Physician’s
Report
Must
report
in
detail
exactly
what
services
must
be
performed
by
nursing
assistants
including
the
ability
to
dress
and
undress, to feed
oneself;
to
attend
to
sanitary
needs,
and
to keep
oneself
ordinarily
clean
and
presentable.
In
addition, it
is
necessary
to
determine
whether
the
claimant
is
confined
to
the
home
or
immediate
premises.
Whether
the
claim
is
for
Aid
and
Attendance or
Housebound,
the
report
should
indicate
how well
the
individual
gets
around,
where
the
individual
goes, and
what
he
or
she
is
able
to
do
during
a
typical
day.
If
in Nursing
home
-
statement
from
nursing
home
with
date
of
admission
and
status.
Considerations
A
veteran
or
widow
may
be
eligible for
A&A
when applicant:
Requires
aid
of
another
person
to
perform
personal
everyday
functions
(bathing,
feeding,
dressing,
wants
of
nature,
adjusting
prosthetic
devices,
or
protection
from
the
hazards
of
daily
environment,
-
or
Is
bedridden,
in
that
disabilities
require
remaining
in
bed
apart
from
any course
of
convalescence
or
treatment,
-or
Is
a
patient in
a
nursing
home
due to
mental
or physical
incapacity,
-or
Is
blind,
or
nearly
blind
(corrected
acuity
of
5/200
or
less,
in
both
eyes,
or visual
field
of
5
degrees
or
less.
A
veteran
or
widow
may
be
eligible
for
Housebound
benefits when
the veteran
has:
A
single
permanent
disability
evaluated
as
100-percent
disabling
and,
due
to
such
disability,
is
permanently
confined
to
immediate
premises,
-or
A single
permanent
disability
evaluated
as
100-percent
disabling
and,
another
disability
evaluated
as
60
percent
or more
disabling.
A
veteran/widow
camiot receive
both
Aid
and
Attendance
and
Housebound benefits
at
the
same
time.
The
Tonn
of
Green/kid
is
an
Affiiaiati,e
Action/Equal
Opportunity
Enipiover,
a
designated
Green
Coinmuii
tip
and
a
recipient
oldie
Leading
hi’
Exan~ple
‘‘A
ward
Page 3
Understanding
the
Veterans Pension
Benefit
and
the
Aid
and
Attendance
Allowance
Estimates
show
agoroximatelv
10
million
seniors
--
about
25%
of
all
geoole
over
65
--
could
cualify
for
Pension
or
Death
Pension by
meeting
the
tests
outlined
in
this
fact
sheet.
That’s
how
many
war
veterans
or
their
surviving
spouses or
their
living
spouses
there
are
in
this
country.
Unfortunately,
few
people know how
to
get this benefit
and
currently
only
about
543,000
individuals
are
actually
receiving
it.
This
represents
only
5.4%
of
those
who
could
be
eligible.
What
is
Pension
and
Aid
&
Attendance?
Disability
Pension
and
Death
PensiOn
are
disability
income
VA
programs
available
to
veterans
or
to
the
single
surviving
spouses
of
deceased
veterans.
The
veteran
had
to
have served
on
active
duty
at
least
90
days
with
one
of
those
days
during
a
period
of
war.
Service
in
combat
is
not required, only
that
the
veteran
was
in
the
service
during
wartime
and
was
discharged honorably.
Charts
showing
the
available
amount
of
income
and
the
dates
for wartime
service
are
included below.
There
is
a
sister
benefit
to
Pension
called
Compensation.
This
is
for
veterans who
are
disabled
because
of
injuries
or
illnesses
incurred
while
on
active
duty.
Compensation
is
generally
the
more
desirable
benefit
for
a
number
of
reasons
we
will not
go
into
here.
A
veteran
household
cannot
receive
Pension and
Compensation
at
the
same
time.
A
decision
must
be
made
as
to
which
benefit
is
better
and
the
veteran
must
choose
only
that
benefit.
Period
of
Beginning
and
Ending
Dates
War
World
War
December
7,
1941
through
December
31,
1946
11
Korean
June
27,
1950
through
January
31,
1955
Conflict
Vietnam
August
5,
1964
through
May
7,
1975;
for
veterans
who
served
“iii
country”
Era
before
August
5,
1964,
February
28,
1961
through
May
7,
1975
Gulf
War
August
2,
1990
through
a
date to
be
set
by
law
or
Presidential
Proclamation
The Special
Case
for
Long
Term
Care
Costs
A
special
provision
for
calculating
Pension
income,
allows
household
income
to
be
reduced
by
12
months
worth
of future,
recurring
medical expenses.
Normally, income
is
only
reduced by
medical expenses
incurred
in
the month
of
application.
These
allowable,
annualized medical expenses
are
such
things
as
insurance
premiums, the
Updated
12/29/17
Page 4
cost
of
home
care,
the
cost
of
paying
any person
to
provide
care,
the
cost
of
adult
day
care,
the
cost
of
assisted
hying
and
the
cost
of
a
nursing
home
facility.
In
most
cases,
these
expenses are
only
deductible if
there
is
a
rating.
This
special
provision
can
allow
veteran
households
earning
more
than
the
annual
MAPR
to
qualify
for
Pension.
As
an
example,
a
veteran
household
earning
$6,000
a
month
could
still
qualify
for
Pension
if
the
veteran
is
paying
$4,500
to
$6,000
a
month
for
nursing
home
costs.
The
applicant
must
submit
appropriate
evidence
for
a
rating
and
for
recurring
costs
in
order
to
qualify
for
this
special
provision.
VA
normally
does
not
tell
applicants
about this
special
treatment
of
medical expenses
or
how
to
qualify
for
it.
For
an
explanation
of
the
special
annualized
treatment
of
unreimbursed
long
term
care
costs and
insurance
premiums
please go
to
the
article
entitled
“Understanding
the
special
case
of
long
term
care medical
costs’.
Dealing
with
Assets
That
May
Disqualify
the
Applicant
There
is
also an
asset
test
to
qualify
for
Pension.
Any
asset
or
investment
that
could
be
easily
converted into
income
might
disqualify the
claimant.
An
asset
ceiling
of
$80,000
is
often
cited
in
the
media
as
being
the
test.
The $80,000
has
to
do
with
VA
internal filing
requirements
and
is
not
an
actual
test.
In
reality,
there
is
no
dollar
amount
for
the
test
and
any
level
of
assets
could
block
the
award.
The asset
test
ultimately
becomes
a
subjective
decision
made by
the
veterans
service
representative,
processing
the
application.
A
home,
used
as
a
residence,
vehicles
and
difficult-to-sell
property
are
generally
excluded
from
the
asset
test.
The
Rating
A
rating
for
‘aid
and
attendance”
or
“housebound’
allows
VA
to
pay
additional benefits
beyond
the regular
Pension
benefit
ceiling
in
order
to
help
cover
the additional
costs
associated
with
added
disabilities.
A
rating
for
these
allowances
is
determined
by
a
veteran
service
representative
who
has been
trained
to recognize
from
medical
reports
and
interviews
whether
the
veteran
or
his
surviving
spouse
needs
the
additional
care.
Determinations
of
a
need
for
aid
and
attendance
or
housebound
benefits may
be
based
on
medical
reports
and
findings
by
private
physicians
or
from
hospital
facilities.
Authorization
of
aid
and
attendance
benefits
without
a
rating
decision
is
automatic
if
evidence establishes
the
claimant
is
a
patient
in
a
nursing
home.
Aid
and
attendance
is
also
automatic
if
the
claimant
is
blind
or nearly
blind
or
having
severe
visual
problems.
According
to
38
CER
Part
Three,
the
following
criteria
are
used
to
determine
the
need
for
aid
and
attendance:
o
inability
of claimant to
dress
or undress
himself
(herself),
or
to
keep
himself
(herself)
ordinarily
clean
and
presentable;
frequent
need
of
adjustment
of
any
special
prosthetic
or
orthopedic
appliances
which
by
reason
of
the particular disability
cannot
be
done
without
aid
(this
will
not
Updated
12/29/17
Page 5
include
the
adjustment
of
appliances which
normal
persons
would
be
unable
to
adjust
without
aid,
such
as
supports,
belts,
lacing
at
the
back,
etc.);
inability
of
claimant
to
feed
himself (herself)
through
loss
of
coordination
of
upper
extremities
or
through extreme
weakness;
inability
to attend to
the
wants
of
nature;
or incapacity,
physical
or
mental,
which
requires
care
or
assistance
on
a
regular
basis
to
protect
the
claimant
from
hazards
or
dangers
incident
to
his
or
her
daily
environment.
Not
all
of
the
disabling
conditions
in
the list
above
are
required
to
exist
before
a
favorable rating
may
be
made.
The
personal
functions
which
the
veteran
is
unable
to
perform
are
considered
in
connection
with
his
or
her
condition
as
a
whole.
It
is
only
necessary
that
the evidence
establish
that
the
veteran
is
so
helpless
as
to
need
regular”
(scheduled
and
ongoing)
aid
and
attendance from
someone
else,
not
that
there
be
a
24-hour
need.
‘Bedridden”
is a
definition
that
allows
a
rating
for
aid
and
attendance
by
itself.
“Bedridden”
is a
condition
which
requires
that
the
claimant
remain
in
bed.
A
person
who
has
voluntarily
taken
to
bed
or
who
has
been
told
by
the
doctor
to
remain
in
bed
will
not
necessarily receive
the
favorable
rating
for
aid
and
attendance.
There
must
be
an
actual
need
for
personal
assistance
from
others.
Housebound
means
“permanently
housebound
by
reason
of
disability
or
disabilities.”
This
requirement
is
met
when
the
veteran or
his
or
her
widow
is
substantially
confined
to
his
or
her
dwelling
and
the
immediate
premises
or,
if
institutionalized,
to
the ward
or
clinical
area, and
it
is
reasonably
certain
that
the
disability
or
disabilities
and
resultant
confinement
will
continue
throughout
his
or
her
lifetime.
A
person
who
cannot
leave his
immediate
premises
unless
under
the
supervision
of
another
person
is
considered
housebound.
This
might
include
the
inability to
drive
because
of
the
disability.
A
housebound
rating
does
not
mean
a
person
needs
to
be
confined
to
a
personal
residence.
It
can
apply
to
any
place
where
the
person
is
living
whether
in
a
facility
or
in
the
home
of
someone
else.
In
order
to receive
one
of these
ratings
the
claimant must
schedule
an
exam
with
his
or
her
physician
and have
the
physician
complete
VA
Form
21-2680.
This
Examination
for
Housebound Status
or
Permanent
need
for
Regular
Aid
and
Attendance
is
then
included
with
the
initial
application.
We
also
provide
in
our
book
a
supplemental
form
entitled
“Form
12
--
Statement
of
Attending
Physician
(used
to determine
rating
for
AM
or
HB).’
This
document
is
similar to
a
form
used
internally
by
VA
to
obtain
information
from
veterans
medical
facilities
for
determining
a
rating.
It
is
in
a
format that
a
veterans
service
representative would
recognize.
Medical
evidence
for
a
rating
for
“aid
and
attendance”
or
“housebound”
for
living
arrangements other than
a
nursing
home should
be
submitted with
the
application
to
avoid
a
delay
in
the approval
process.
Waiting
for
the
regional office
to order
medical
Updated
12/29/17
Page 6
records
is
a
time-consuming
process,
main’y
because
doctors’
offices
dont
respond
quic[dy
to
these
kinds
of
requests.
Updated
12/29/17
Page 7
Using
Aid
&
Attendance
to
Pay
any Person
for
Home
Care
Most people
who
have
heard
about
Pension
know
that
it
will
cover
the
costs
of
assisted
living and,
in
some
cases,
cover
nursing home
costs
as
well.
But
the
majority
of
those
receiving
long
term
care
in
this country
are
in
their
homes. Estimates
are
that
approximately
700/c
to
80%
of
all
long
term
care
is
being
provided
in
the
home.
All
of
the information
available
about
Pension
overlooks
the
fact that
this beneflt
should
be
used
to
pay
for
home
care.
Maybe
if
more
people
knew
this
fact,
more
people
would
be
applying
for
the
benefit.
It
also
comes
as
a
surprise
to
most
people
that
VA
will
allow veterans’
households to
deduct the
annual cost
of
paying
any
person such
as
family
members, friends
or
hired
help
for
care
when calculating
the
Pension
benefit.
This annual
cost
is
then
used
to
calculate
the benefit
based
on
a
new
“countable income”
and
allows
families
earning
more
than
the
pension
benefit
to
receive
a
disability
income
from
VA.
This
extra
income
can
be
a
welcome
benefit
for
families
struggling
to
provide
eldercare
for
loved
ones
at
home. Under
the
right
circumstances,
this
annualized
medical
expense
for
the
cost
of family
members,
friends
or
any
other
person
providing
care,
could
create
an
additional
household income
of
up
to
$1,153
a
month
for
a
singe
surviving
spouse
of
a
veteran,
up
to
$1,794
a
month
for
a
single
veteran
or
up
to
$2,127
a
month
for
a
couple.
If
the
disabled care
recipient
has been
rated
“housebound”
or
in
need
of
“aid
and
attendance”
by
VA,
all
fees
paid
to
an
in-home
attendant
will
be
allowed
as
long
as
the
attendant
provides
some
medical
or
nursing
services
for
the
disabled person. The
attendant
does
not
have
to
be
a
licensed
health
professional.
Services
of
licensed
home
care
providers
can
be
deducted
without
any need
for
a
rating
but
the
pension
award
is
a
lesser
amount.
It
is
our
understanding
that
a
non-licensed
in-home
attendant
could
be
just
about
anyone
receiving
pay
for
providing
services. This
might
be
members
of
the
family,
friends,
or someone
hired
to
live
in
the
home.
Examples
of
medical
or
nursing
services
would
be
help
with activities
of
daily
living
such
as
dressing,
bathing,
toileting,
ambulating,
feeding, diapering
and
so
on.
Other
services
might
include
medication
reminders
or
supervision
necessary
to
provide
a
protective
environment for
the
care
recipient
--
in
the
case
of
dementia
or
Alzheimer’s.
All
reasonable
fees
paid
to
the
individual
for
personal
care
of
the
disabled
person
and
maintenance
of the
disabled
person’s
immediate
environment
may
be
allowed. This
includes
such
services
as
cooking
and
housecleaning.
It
is
not
necessary to
distinguish
between
“medical”
and
“nonmedical”
services. Services
which
are beyond
the
scope
of
personal
care
of
the
disabled
person
and
maintenance
of
the
disabled person’s
immediate
environment
may
not
be
allowed.
This
might
include
paying
the
bills,
providing
transportation for
other
family
members, cooking
and
cleaning
for
other
family
Updated
12/29/
17
Page 8
members,
providing
entertainment,
providing
transportation for
personal
needs
other
than
medical
and
so
on.
For
a
disabled
person
who
has
been
rated,
a
family
member
may
be
considered
an
in-
home
attendant,
but that family
member
has
to
be
paid
for
services
duly rendered.
There
is
potential
for
fraud
here
where
a
family
member
may
move
into
the
home
and
ostensibly
receive
payment
as
a
caregiver
but
not
actually
provide
the
level
of
care
paid
for.
Documentation
for
this
care
must
be
provided
to
VA,
and
it
is
reasonable
for
VA
to
question
whether
the
services being
purchased
from
a
family
member
living
in
the
household
are
legitimate.
Such
arrangements
should
be
extensively documented
and
completely
arms-length.
The
care
arrangements
and
payment
must
be
made
prior to
application
and
there
must
be
evidence
that
this
care
is
needed
on
an
ongoing
and
regular
basis.
We
recommend
a
formal
care
contract
and
weekly
invoice
billing
for
services.
Money
must
exchange
hands
and
there
must
be
evidence
of
this.
All
of
this
documentation
must
be
provided
as
proof
to
VA
when
making
application
for
the
pension
benefit.
Costs
for
these
services
must
be
unreimbursed;
meaning
these
costs
are
not
paid by
insurance,
by
contributions
from the family
or
from
other
sources.
Let’s
look
at
the following
example.
Michelle,
who
is a
divorced
mother
of
two
teenagers,
moves
in
with
her
mother.
Michelle’s
mother,
Carla, has
recently
had
a
stroke
and
needs
supervision
and
help.
In
order to
take
care
of
her
mother,
Michelle
cannot maintain full
employment
outside
of
the
home.
She
has
found
a
company
that
will
let her
work
at
home
on
her
computer but
it
is
not
full
time employment
and
it
does
not
pay
well.
Michelle
has
expenses
she
needs
to
cover
for
existing
debts and
to
support
her
two
teenage
children.
She
does
not
have
housing
costs
but
does
consume additional
food
and
utilities
resources due
to
her
presence
and
her
children
being
in
the
home.
She
also
incurs
transportation
costs
for
her
car,
running
errands,
shopping
for
the
household,
taking
Carla
to
doctor’s
appointments
and
transporting
her
children.
Carla’s
household income
is
$1,400
a
month
which consists
of
Social
Security
and
a
small
Pension.
She
has
about
$20,000
in
savings
in
the
bank.
She
owns
her
home
and
a
car.
Michelle’s and
Carla’s
combined
income
is
just
not
enough
to
make
ends
meet
for
both
families.
Carla
is
the
single
surviving
widow of
a
Korean
veteran.
Michelle
has
heard
of
a
veterans benefit consultant
who
helps
families
in
this predicament
obtain the
Pension
benefit.
Michelle
meets
with the consultant
and
he
suggests
that
Michelle
and
her
mother
establish
a
contract
for
care and
that
Carla
pay her
daughter
$1,300
a
month
to
provide
care.
He
then suggests
submitting
a
claim
for
a
Death
Pension
for
Carla.
The
consultant
makes sure
a
legitimate
arm’s-length
agreement
is
written
up
and
that
the
care
services
and
payments
to
Michelle are
accurately
documented.
In
order
for
these payments
to
Michelle
to count towards
a
Pension
award,
Carla
must
have
a
rating
from
the
VA
for
“aid
and
attendance”
or
“housebound.”
The
consultant
provides
forms
and
advice
to
guide
Michelle
and
her
mother through the
application
process.
He
makes
sure
that
all
of
the
required
documentation
is
in
place
before
the
Updated
12/29/
17
Page 9
application
is
submitted.
He
reviews
all
documentation
and
the
completed
form,
which
Michelle
and
her
mother
have
filled
out, before
final
submission.
For
information
on
ratings
please
go
to
the
article
entitled
“Who
is
eligible
for
the
aid
and
attendance
Pension
benefit?’
If
VA
allows
annualization
of
the
cost
of
the
care
contract
in
calculating
the
Pension
benefit,
Michelle’s
mother
should
receive
an
award.
In
calculating
Pension,
Michelle’s
$1,300
a
month
contract
payment
should
be
annualized
and
subtracted
from
her
annual
income.
An
additional
medical
deduction
is
included
for
Carla’s
$200
a
month payments
for
Medicare
Part
B,
Medicare Part
D
and
a
Medicare
supplement
policy.
This
additional
amount
should
be
annualized
and
also
subtracted
from
Carla’s
income.
Both
the
contract
payments
and
the
insurance premiums
are
adjusted
for
S%
of
MAPR
before
being
subtracted
from
Carla’s
income.
Her
new
“countable”
income
will
be
negative
and
subtracting
that
new
income
from
the
MAPR
will
allow
Carla
to
receive
the maximum
Pension
benefit
for
her
rating
category.
For
an
explanation
of
the
special
annualized
treatment
of
unreimbursed
long
term
care
costs and
insurance
premiums
please go
to
the
article
entitled
“Understanding
the
special
case
of
long
term
care medical
costs”.
After
five
months,
VA
awards
Carla
$1,153
a
month
in
additional
Pension
income.
Her
total
income
is
now
$2,333
a
month.
VA
also
awards
a
total
of
four
months
of
benefit,
payable
retroactively
to
the
first
day
of
the month
following
the
mqnth
in
which
the
application
was
received
in
the
regional
office.
Condusion
Depending
on
household
income
and
the
amount
of the
care
contract
and
the
amount
of
VA
Pension
income,
these types
of
care
arrangements
could
be
a
welcome
addition
for
families
struggling
to
provide
care
for their
loved
ones
at home.
Family
care
providers,
on
contract
with
their
loved
ones,
do
not
have
to
be
residing
in
the
home.
Caution should
be
exercised
that
these
are
indeed
legitimate
contracts
and
care
provider arrangements
and
there
are
no
behind-the-scenes
transfers
of
monies.
Updated
12/29/17
Page 10
Using
Aid
&
Attendance
for
Professional
Home
Care
Annualization
of
Home
Care Casts
Medical
expenses
for
home
care
aides
are
allowed
prospectively
for
annualization
if
those
expenses
are
reasonably
predictable.
The
evidence would
also
have
to
show
that
the
need
for
care
is
ongoing
and
regular.
Expenses
may
be
allowed
whether
the
care
recipient
has
a
rating
for
aid
and
attendance
or
housebound
or
is
not
rated. However,
deductible
payments
to
a
non-rated
beneficiary
are
more
restrictive.
Evidence
must
be
submitted
indicating
an
ongoing
need
for
the
care
and
the
level
of
care
in
order
for
the Veterans
Service
Representative
to
consider the
medical expense
as
recurring
and
eligible
to
be
annualized.
A
form
such
as
the
one
we
provide
in
our
block
entitled
‘Form
2
--
Care
Provider
Report (used
to
provide
evidence
of
recurring
medical
expenses)”
should
be
used
for
this
purpose.
Also
a
copy
of
a
contract
between
the provider
and
the
recipient,
covering
at
least
a
year,
and
outlining
the
provisions
and
the
cost
should
be
submitted
to
prove
the
intent
of
the
care
recipient
and
the
provider.
For
an
explanation
of
the
special
annualized
treatment
of
unreimbursed
long
term
care
costs
and
insurance
premiums
please go
to
the
article
entitled
“Understanding
the
special
case
of
long
term
care medical
costs”.
The
non-veteran
spouse
of
a
living
veteran
may
also
be
eligible
for
annualization
of
home
health
aide costs.
If
the
home
care
is
being
furnished
by
a
licensed
health
professional,
then
not
much
further
proof
is
necessary
other
than
the
documentation
proving the
care
is
being
provided.
If
the provider
is
not
licensed,
a
separate
letter
from
the doctor
must
be
produced
that
says
the
person
needing
care
must
be
in
a
“protected
environment.”
VA
will not
rate
a
non-veteran
spouse
of
a
living
veteran
for
“aid
and
attendance”
or
“housebound”
and
even
though
the
spouse’s
home
care
medical expenses
may
be
annualized
to
produce
a
benefit, the
Pension
award
will
be
much
smaller
without
the
allowance
for
a
rating.
Of
course,
a
death
claim
is
different
because
the
surviving
spouse
can
receive
a
rating
in
that
case.
For
information
on
ratings
please
go
to
the
article
entitled
“Who
is
eligible
for
the
aid
and
attendance
Pension
benefit?’
Home
Care
Recipient
Is
Not
Rated
Payments
for
care
at
home
for
a
recipient
who
is
not
rated
for
housebound, or
aid
and
attendance
are
only
allowed
for
annualization
if
made
to
a
licensed
health
professional.
The
term
“licensed health
professional”
refers
to
an
individual
licensed
to furnish
health
services
by
the
state
in
which the
services
are
provided.
The
term
includes
registered
nurses,
licensed
vocational
nurses
and
licensed
practical
nurses.
Some
states
also
license
non-medical
home
care
providers
to
provide
services
as
well.
Since
this
is
a
fairly
new practice, we
don’t
know
if
these
people
would
qualify
under
the definition
above
but
we suspect
they
will.
Updated
12/29/17
Page 11
All
reasonable
fees
paid
to
the
licensed
health professional
for
personal
care
of
the
disabled
person
and
maintenance
of
the
disabled
person’s
immediate
environment
may
be
allowed,
This
includes
such
services
as
cooking
for
the
disabled
person and
housecleaning
for
the
disabled person.
It
is
not
necessary
to
distinguish
between
“medical”
and
“nonmedical”
services.
However,
services
which
are beyond
the
scope
of
personal
care
of
the
disabled
person
and
maintenance
of
the
disabled
person’s
immediate
environment
may
not
be
allowed.
Services
beyond
the
scope
might
be
services
such
as
driving
the veteran’s
spouse
to
appointments,
paying
bills,
answering
the
phone,
providing
shopping
errands
for
the
household,
and
so
on.
If
an
hourly
rate
is
being
paid
to
the
home
care
provider,
a
portion of
this
rate
may
be
disallowed
for
services
beyond
the
scope
of
personal care.
Care
Recipient
Is
Rated
for
“Aid
and
Attendance”
or
“Housebound”
If
the
disabled
care
recipient
has been
rated
“housebound”
or
in
need
of
“aid
and
attendance”
by
VA,
all
fees
paid
to
an
in-home
attendant
will
be
allowed
as
long
as
the
attendant
provides
some
medical
or
nursing
services
for
the
disabled person. The
attendant
does
not
have
to
be
a
licensed
health
professional.
All
reasonable
fees
paid
to
the
individual
for
personal
care
of
the
disabled
person
and
maintenance
of
the
disabled
person’s
immediate
environment
may
be
allowed.
This
includes
such
services
as
cooking
for
the
disabled
person
and
housecleaning
for
the
disabled
person.
It
is
not
necessary
to distinguish
between
“medical”
and
“nonmedical”
services.
However,
as
with
an
unrated
beneficiary,
services
which
are
beyond
the
scope
of
personal
care
of
the
disabled
person
and
maintenance
of
the
disabled
person’s
immediate
environment
may
not
be
allowed.
For
a
disabled
person
who
has been
rated,
a
family
member
may
be
considered
an
in-
home
attendant,
but
that
family
member
has
to
be
paid
for
services
duly rendered.
There
is
potential
for
fraud
here
where
a
family
member may
move
into
the
home
and
ostensibly
receive
payment
as
a
caregiver
but
not
actually
provide
the
level
of
care
paid
for.
Documentation
for
this
care
must
be
provided
to
VA,
and
it
is
reasonable
for
VA
to
question
whether
the
services being
purchased
from
someone
living
in
the
household
are
legitimate.
Documentation
of
Home
Care
Expenses
If
the
fees
for
an
in-home
attendant
are
an
allowable
expense, receipts
or
other
documentation
of
this
expense
are
required. Documentation
includes
any
of
the
following:
1.
a
receipt
bill
2.
statement
on
the
provider’s
letterhead
3.
computer
summary
4.
ledger, orbank
statement.
The
evidence
submitted
must
include:
1.
the amount
paid
Updated
12/29/
17
Page 12
2.
the
date
payment
was
made
3.
the
purpose
of
the payment (the
nature
of
the
product
or
service
provided)
4.
the
name
of
the
person
to
or
for
whom
the
product
or
service
was
provided
5.
identification
of
the provider
to
whom
payment
was made.
Updated
12/29/
17
Page 13
Using
Aid
and
Attendance
to
Pay
for
a
Nursing
Home
The
Easiest and
Most
Difficult
Application
For
a
potential
beneficiary
in
a
nursing home,
the application
for
Pension
with
Aid
and
Attendance
is
very
straightforward.
For
Veterans
The
claimant
simply
has
to
file
VA
Form
21p-527ez
and
indicate
that
he
or
she
is
a
patient
in
a
nursing home
on
VA
Form
21-0779
(for
a
veteran
in
skilled
nursing)
or
VA
Form
21-2680
and
a
Care
Provider
Statement
(for
a
veteran
in
intermediate
care).
An
award, including
an
aid
and
attendance
allowance from
VA,
is
almost
always
forthcoming
without
any
additional requirements relating to
a
rating.
Nursing
home
costs
are
also
automatically
annualized.
The
veteran must
also
submit
service
records
and
meet
VA’s
income
and
asset
requirements.
For
Surviving
Spouses
The
claimant must
file
VA
Form
21p-534ez
and
indicate
that
he
or
she
is
a
patient
in
a
nursing
home
using
a
detailed
Care
Provider
Statement
and
certify
a
need
for
the
aid
and
attendance
of
another
person
via
VA
Form
21-2680.
The
surviving
spouse
must
also
submit
the
veterans
service records,
a
marriage
certificate,
a
death
certificate,
and
meet
VA’s
income
and
asset
requirements.
Pension
or
Medicaid
While
in
a
Nursing
Home
Unfortunately,
in
most
cases, Pension
does
not
work
well
for
paying
the
costs
of
a
nursing
home.
This
is
because
the
amount
of
Pension
income
is
rarely
enough
to
cover
the
difference
between
the
cost
of
the
nursing home
and
the
beneficiary’s income.
On
the
other
hand,
Medicaid
will cover
this
difference
in
cost
and
in
most
cases
Medicaid
is
a
better
alternative to
Pension.
Eligibility
for
Medicaid
causes
difficulty
for
those
beneficiaries
who
also
want
to
receive
Pension
income
in
a
nursing
home.
For
a
single person,
VA
refuses
to
pay
the
full
Pension
benefit
if
that
person
is
eligible
for
Medicaid
and
will
only
pay
$90
a
month
towards
nursing
home
costs.
For
a
beneficiary
with
a
spouse
at
home,
the
combination
of
Pension
and Medicaid
may
not work
due
to
Medicaid rules.
There
are,
however, circumstances where
Pension
fits
very
well
for
a
beneficiary
in
a
nursing
home.
One
case
would
be
where
the
nursing
home
patient
has
to go
through
a
spend
down
in
order
to
be
eligible
for
Medicaid.
Pension
would
also
be
beneficial
where
the
nursing
home
patient
is
strictly private-pay
or
is
private-pay
awaiting
an
available
Medicaid
bed.
And
in
some
cases,
Pension
and
Medicaid
together
might
be
a
better
alternative
where
there
is a
spouse
at
home. But
each
of
these
instances
is
specific
to
the
individual
circumstances.
Updated
12/29/
17
Page 14
As
easy
and
simple
as
the
Pension
application
for
a
nursing
home
patient
is,
claimants
should
always
seek
the
advice
of
a
consultant
who
understands
both
Medicaid
and
the
VA
benefit.
There
are
strategies
that
can
be
pursued
to
make
Pension
for
nursing
home
patients work
out
in
certain
cases.
But
most
people
can’t
solve
it
on
their
own
and
it
requires
an
expert to
make
the
combination
of
Medicaid and
Pension
successful.
Annualization
of
Nursing
Home
Costs
If
the
veteran
or
veteran’s
surviving
spouse
is
a
patient
in
a
nursing
home,
VA
should
automatically
allow
12
months
worth
of
nursing
home
costs
to
be
applied
as
medical
expenses. The
patient
will
also
automatically
receive
an
aid
and
attendance
allowance.
The expenses applied
are
out-of-pocket
costs
after
reimbursement.
For
an
explanation
of
the
special
annualized
treatment
of
unreimbursed
long
term
care
costs
and insurance
premiums
please
go
to
the
article
entitled
“Understanding
the
special
case
of
long
term
care medical
costs”.
An
annualized medical expense
deduction
can
be
allowed
for
unreimbursed
nursing
home fees
even
if
the
nursing home
is
not
be
licensed
by
the
state
to
provide
skilled
or
intermediate
level
care.
The
definition
of
a
“nursing
home”
for
purposes
of
the
medical
expense
deduction
is
not
the
same
as
the
definition
of
nursing
home
set
out
in
38
CER
3.1(z).
A
nursing
home
for
purposes
of
the
medical
expense
deduction
is
any
facility
which provides extended
term, inpatient
medical
care.
A
responsible
official
of
the
nursing
home
must
sign
a
statement
that
the
disabled
claimant
is
a
patient
(as
opposed
to
a
resident)
of the
nursing
home.
We
have
included
on
this
site
a
copy
of
a
VA
form
that
is
used
for
this
purpose.
It
is
called
“VA
Form
21-
0779
--
Request
for
Nursing Home
Information
in
Connection
with
Claim
for
Aid
and
Attendance.”
A
copy
of
the
contract
with the
facility
should
also
be
included when
submitting
this
form.
Statements
and
evidence
of
payment must
also
be
included.
Canceled
checks are
not
acceptable.
Veterans
in
State
Veterans
Homes
may
apply
their
out-of-pocket
costs
for
use
of
the
home
as
a
recurring
prospective,
medical expense
deduction.
Again,
a
statement
from
an
official
of
the
state
home
indicating
the veteran
is
a
patient,
not
a
resident, should
be
submitted.
In
the
case
of
a
non-veteran
spouse
in
a
nursing home,
where
the
veteran
is
still
alive,
the
VA
application 21-527ez
does
not
have
a
provision
for
disclosing the
spouse
receiving
nursing home
care.
The
spouse
nursing
home
cost
is,
however, eligible
for
annualization
of
medical
expenses. Separate evidence
must
be
provided.
A
veteran
in
a
nursing home will receive
a
rating
for
aid
and
attendance,
but
the
non
veteran
spouse
of
a
living
veteran
will not,
Of course,
a
death
claim
is
different
because
the
surviving
spouse
can
receive
a
rating
in
that
case.
If
VA
allows annualization
of
nursing
home
costs
for
a
non-veteran
spouse
of
a
living
veteran,
there
will
be rio
allowance
for
aid
and
attendance,
and
the
Pension
award
will
be
much
smaller.
Updated
12/29/
17
Page 15
Retaining
VA
Benefits
and
Imputed
Income
VA
wiN
not
pay
anything
more
than
$90
a
month
if
a
single veteran or single
surviving
spouse
is
eligible
for
Medicaid
covered
nursing
home
care.
State
veterans
homes
are
exempt
from
this
ruling.
The
most
VA
will
pay
to
offset
the
cost
of
a
nursing home
is
$2,127
a
month
for
a
couple,
$1,794
a
month
for
a
single
veteran
or
$1,153
a
month
for
the
single
surviving
spouse
of
a
veteran.
With
nursing
home
costs
ranging
from
$5,000-$7,000
a
month,
generally
the
VA
benefit
cannot
cover
the
difference
between
the
veteran
household
and
the
nursing
home
cost.
In
most
cases
there
is
a
deficit.
Medicaid
will
cover
the
actual
difference
between
the
Medicaid
beneficiary’s income
and
the
cost
of
the
nursing
home.
Medicaid
is
therefore
a
more
viable
benefit.
For
the
reasons
outlined
above,
many
practitioners
feel
that
trying
to
dovetail
Medicaid
with
VA
payments
is
not
a
useful exercise,
and
for
those
eligible
for
Medicaid,
applying
for
Pension
might
be
a
waste
of
time.
But
there
are
situations
where
Medicaid
may
be
available,
and
the
Pension
could
be
a
valuable
benefit
as
well.
We
offer
an
example
of
this
further
on
in
this
article
where
a
veteran,
going
through
spend
down
to qualify
for
Medicaid,
can
provide
more
income
that
might
be
used
for
the
spouse
at
home.
Or
Pension
income
can
be
used
to
lengthen
the
spend
down
process, and
if
the
veteran
dies
while
going
through
this
process,
valuable
assets have
been
retained.
Another
use
for
the
Pension
benefit
associated
with
nursing home
care
is
where the
single
veteran
or
surviving
spouse
might
be
eligible
for
Medicaid,
but there
is a
statewide
waiting
list
for
Medicaid
beds.
With
the
tightening
of
government
purse
strings,
this
situation
is
more likely
to
occur
in
the
future.
The
Pension
benefit
allows
the
veteran,
the
surviving
spouse
or
his
or
her
family
additional
money
to
cover
part
of
the
cost
of
private
pay
until
a
Medicaid
bed
becomes
available.
For
the beneficiary who
is
eligible
for
Medicaid
and
has
dependents at
home, sharing
the
Pension
with
Medicaid
may
be
more useful
than
allowing
Medicaid
to
pay
the
entire
bill. State Medicaid
programs
require
veterans to
apply
for
Pension
because
it
reduces
Medicaid’s
liability
for
the
cost.
Hypothetical
Case
Example (Veteran and
Spouse
--
Veteran
in
a
Nursing
Home)
Thi~
case
illustrates
the
maximum
benefit
available
to
a
sihgle
veteran
with
aid
and
attendance
allowance. Residency
in
a
nursing
home
automatically
includes
the
aid
and
attendance
allowance.
The case
was
spedfically
desiqned
to
illustrate
how
Medicaid
and
veterans
Pension
could
dovetail
in
pro
viding
more
ihcome. As
a
general
nile,
VA
Pension
does
not
work
well
with
Medicaid
unless
there
is
a
spend
down
as
fri
this
case
or
the
Updated
12/29/17
Page 16
nursing
home
has
no
Medkaid
beds.
If
Meth~aid
is available,
it
is
unlikely
that
VA
Pension
would
be needed.
*we
híghly
recommend
fri
cases
such
as
this
one
that
you
contact
a
consultant
who
is
proficient
hi
both
planning
for
VA
benefits and
hi
Medicaidp/ann/i
7g.
To
try
and
understand
what
the
best
solution
is
by
yourself
is
probably
not
possible
without
a
thorough
knowledge
of
both
Meckaid
and
Pens/of?.
John
is
84
years
old
and
is a
veteran
of
World
War
II.
He
did
not
serve
in
a
combat
zone. Mary,
his
wife,
is
79
years
old.
John
is
a
large
man
and
has
many
medical
problems.
He
takes
a
variety
of
expensive prescription
drugs
and
has
difficulty
attending
to
his
own
needs
without
help. Mary
is a
frail
woman
and has
difficulty
helping
him
get
out
of
bed, dress,
bathe
and
move
about.
John
also
suffers
from
mild
dementia
and
is
often
confused
and
Mary
is
concerned
about
leaving
him
alone.
It
is
difficult
for
John
to
leave
his
home
without
using
a
walker
and
an
aide
to
help
him.
John and
Mary
have
a
combined
income
of
$2,400
a
month
which
consists
of
Social
Security
for
both,
a
small
Pension
and
interest
income.
They
have
$66,000
in
retirement
savings
and
own
a
house
and
a
car.
They
also have
$120,000
available
to
them
as
a
reverse
mortgage
equity
line
of
credit
if
they
choose
to
exercise
this
option.
They
are
not required
to
pay
anything other
than
the
closing
costs
for
this
line
of
credit
as
long
as
one
or both
of
them
is
alive
and
living
in
the
home. In
other
words,
there
are
no
monthly
loan
payments. The
potential
line
of
credit
will grow
by
earning
6%
interest
as
well.
John
has
a
nasty fall
and
breaks
his
hip.
After
surgery,
a
hospital
stay
and
a
30
day
stay
in
a
nursing
home rehab
facility,
John’s
health
deteriorates
even
further.
Mary decides
she
cannot
care
for
him
at
home
and
after
being
told
by
several
assisted living
facilities
they
cannot
take
him,
she
finds
she
must
place
John
in
a
nursing
home.
Because
of
the
differential
in
cost
between
the
nursing home
and
their
income,
John
will
qualify
for
the improved
Pension
benefit with
an
aid
and
attendance
allowance
but
in
the
state
in
which
they
live,
he
will
also
qualify
for
Medicaid.
VA
will
not
pay
more
than
$2,127
a
month
in
Pension
that
could
be
applied
to
John’s
nursing
home
cost.
On
the
other
hand,
Medicaid
will
pay
the
much
higher
cost
between
the
nursing home
and
John’s income
in
lieu
of
the
VA
Pension
benefit.
Should Mary
worry
about
applying
for
the
Pension
benefit knowing
that
Medicaid
may
cover
the entire
cost
of
the
nursing
home
and
allow
a
guaranteed
spousal
income
as
well?
In
this
particular
example Mary
could come
away
with
more
money
for
her personal
needs
by
using
both
the
VA
benefit
and
Medicaid.
To
understand
why
the combination
of
the two
benefits
is
better
we
need
to
understand
how
Medicaid
works.
Suppose
John
and
Mary
do
not
have
the
VA
benefit.
Medicaid
will
not
start
paying
for
John’s
nursing
home
costs
until
he
has
spent
his
portion
of
the
family
assets
down
to
less
than
$2,000.
In
the
state
in
which
he
resides, John
is
responsible
for
spending
$33,000
of
their
$66,000
in
retirement
savings.
He
can
spend
this
on
anything
he
wants
Updated
12/29/
17
Page 17
but
in
this
case
the
money
needs
to
go
towards
the
nursing
home
or
he
wont
have
a
place
to
live.
John’s
income
is
$1,800
a
month
and
Mary’s
income
is
$600
a
month.
The cost
of
the
nursing home
is
$5,000
a
month.
John
must
pay
$3,200
a
month
out
of
his
$33,000
of
spend
down money
to
the
nursing home.
After
10
months
John
will
be
below $2,000
and Medicaid
will take
over
paying
the
$3,200
a
month.
Or Mary
could
take
whatever
income
she
needs,
perhaps
the
full
$2,400
a
month,
and
let
John
spend
the
$33,000
for
the
nursing
home
in
which
case
he
would
quality
for
Medicaid
in
about
6
months.
After
Medicaid
takes over,
John’s
income
must
go
towards
the
nursing
home.
In
addition
to
$600
a
month,
Mary
has
her
own
$33,000
and
she
also
has
access
to
$120,000
in
the
reverse
mortgage
which
if left
in
the
line
of
credit
will
not
count
against
John
quaflfying
for
Medicaid.
Medicaid
will
also
not
impoverish
Mary
completely
and
in
the
state
where
Mary
resides,
Medicaid
will
give her
back
$1,600
a
month
from
John’s
income
to bring her
income
to
$2,000
a
month.
This
is
called
the
“community
spouse
monthly
income
allowance”.
But
this
is
only available
after
John
has
spent
down
his
$33,000
and
qualifies
for
Medicaid.
Mary
has
to
live
on
something
else
in
the
meantime.
Now
let’s
suppose
that
Mary
helps
John
apply
for
the
VA
Pension
with
aid
and
attendance
and
Medicaid
at
the
same
time.
John
must
spend
his
share
of
the
assets
before
he
becomes
eligible
for
Medicaid.
As
John
goes
through
his
spend
down,
VA
will
also
provide
additional
money
for
this
period
of
time.
The
benefit
estimate
is
in
the
table
below.
Estimating
the
Pension
Benefit
with
Aid
and
Attendance
Allowance
.
Calculate
Pension
Total Family
Income Calculate
Countable
Income
~
Benefit
family
income
$2,400
family
income:$2,400
allowable
benefit;$2,127
plus
pension,
less
unreimburset
less
countable
benefit$2,127
medical$3,310
income~ $0
total
income
$4
419
countable
income
-$910
pension
benefit
$2
127
Please
note
that
VA
calculates
benefits
and
costs
on
an
annual
basis and
divides
by
12
John
and
Mary
have
an
additional
$2,127
a
month
to
use
for
income or
to
apply
to
the
nursing home
while
John
is
going
through
his
spend
down. Over
the
period
of
months
where
John
is
applying
his
spend down money,
this
is
an
additional
$10,800
to
$18,000
Updated
12/29fi7
Page 18
(depending
on
the
spend
down period)
that
they
have
that
wouldn’t
be
there
without
the
VA
benefit.
After
John becomes
eligible
for
Medicaid,
things
get
complicated.
Medicaid does
not
count
as
income
for
VA
purposes
but
VA
Pension
does
count
as
income
for
Medicaid
purposes.
Whether
the
combination
of
the
two
benefits
or
Medicaid
alone
is
better
must
be
considered case-by-case.
Such
things
to
consider
are
the
spousal
minimum
income
allowance
from
Medicaid
or
whether
Medicaid’s
payments
on
behalf
of
John
will
become
part
of
a
recovery
effort
by
the
state.
If
John
were
single,
the solution would
be
simple.
VA
quits
paying
all
of
its
benefits
except
for
$90
a
month
when
John
becomes
eligible
for
Medicaid.
When
John
dies,
Mary’s
lower
income
may
qualify
her
for
a
death
benefit
Pension
from
the
VA.
Updated
12/29/17
Page 19
Submitting
a
Claim
for
the
Veterans
Aid
and
Attendance
Pension
Benefit
Two
Types
of
Pension
Claims
As
mentioned
in
a
previous
article
on
this
site,
there
are
two
types
of
Pension
applications. The
first
of
these
are
applications
for
veteran
households
with
low
income
and
few
assets.
For
living
veterans
under
the
age
of
65,
medical evidence
must
also
be
submitted
for
proof
of
total
disability.
For
living
veterans,
age
65
and
older,
there
is
no
requirement
to
be
disabled.
Single
surviving
spouses
of veterans
also
have
no
requirement for
disability. These low
income
applications
may or
may
not
have
a
need
for
an
additional
rating
to
receive
an aid
and
attendance
or
housebound allowance.
The
second
type
of
application
is
one
where the
household
may
have
higher
income
and
assets
but
one
or
more
members
of
the
household
are
incurring the
high
costs
of
long
term
care.
These
costs
may
be
for
the
following
types
of
services:
hey/no
~nen~~’en~
of
the
~a/7?H~V
10
oyo’iOh
cate
at
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These
types
of
claims
require
medical
evidence
in
order
to
receive
a
rating
for
aid
and
attendance
or
housebound
allowances.
These
ratings
must
be
received
or certain
medical expenses associated
with
long
term
care
are
not
deductible from
income.
These
claims
also
warrant
special
treatment for
deducting
the
annual cost
of
care
from
household income.
This
requires
special
documentation
and
evidence.
Claims
for
this
second
type
of
application
are
the
subject
of
this website
and
this article.
Here
are
the
forms typically
associated
with
these
types
of
claims.
VBA
Form
21P-527ez
--
Veteran’s Application
for
Pension
(for
a
living
veteran)
VBA
Form
alp_53Lj
Application
for
Dependency
and
Indemnity
Compensation,
Death
Pension
and
Accrued
Benefits
by
a
Surviving
Spouse
or
Child
SF
180
--
Request Pertaining
to Military
Records
(Used
to
obtain
discharge
record)
VBA
Form
21-0779
--
Request
for
Nursing
Home
Information
in
Connection
with
Claim
for
Aid
and
Attendance
VBA
Form
21-2680--
Examination
for
Housebound Status
or
Permanent
need
for
Regular
Aid
and
Attendance
(Completed
by
Claimant’s
Physician)
Care
Provider
Certification
of
Services
--
Care
Provider Report (Completed
by
Claimant’s
Care
Provider
&
used
to
provide
evidence
of
recurring
medical expenses)
Updated
12/29/17
Page 20
Questions and
Answers
about
Pension
Claims
Who
can
submit
a
claim?
A
claim
is
submitted
by
the
veteran or
by
the
veteran’s
single surviving
spouse
in
the
case
of
a
death
claim.
A
duly
appointed
service
organization,
an
employee
of
the
local
regional
VA
office,
or
a
VA
approved
agent
may
file
a
claim
on
behalf
of
the
veteran
or
the
spouse.
A
claim
cannot
be
filed
with
a
general
or
durable
power
of
attorney.
The
application
will
be
sent
back
requesting proper
documentation
for
a
VA
power
of
attorney.
The
veteran must
sign
a
document
specifically
authorizing
a
power
of attorney
for
someone
to
submit
an
initial
claim
for
him.
Many
chagrined
children
with
a
state
authorized
durable power
of
attorney
have
submitted
claims
on
behalf
of
a
parent
only
to
have
the
claim
rejected
by
VA.
What
happens
if
the
veteran
is
incompetent?
If
the
veteran cannot
submit
the
original
application
or
sign
a
power
of
attorney
for
a
surrogate to
file
an
application,
then
a
duly
appointed guardian
can
complete the
application.
VA
also
allows
the
spouse,
a
parent
or
next
of
kin,
or
a
friend to
complete
and
submit
an
application
on
behalf
of
an
incompetent
veteran
if
that
person
submits
the
proper
power
of
attorney
request
and
indicates
the applicant
could
be
considered
incompetent
for
financial affairs.
Even
though
the
veteran
or
surviving
spouse
may
be
considered
incompetent
for
financial affairs,
he
or
she
must
always
sign
the
power
of
attorney
request if
he
or
she
is
can
physically
do
so. VA
may
appoint
a
fiduciary
to
take
over
the
the
financial
management
of
pension
funds
for
the
claimant
if
VA
determines
he
or
she
is
incompetent.
What
is
an
“aid
and
attendance”
or
“housebound”
rating?
A
“rating’
is
granted
by
a
veteran
service
representative where
a
condition
exists
that
requires
more
caregiver
support
for
the
disability.
Medical
evidence
is
required
unless
someone
is
a
patient
in
a
nursing
home,
and
then
the
requirement
is
waived.
The
rating
allows
VA
to
pay
an
additional
monthly
amount
of
Pension
or
Compensation
to
a
veteran
or
a
surviving
spouse
for
additional
costs
associated
with
this disability.
How
does
one
qualify
for
aid
and
attendance
or
housebound
rating?
The
application
form
has
a
block
allowing
for
a
request
for
either
rating.
Submitting
medical
evidence
in
advance
instead
of
waiting
for
a
request
from
VA
can
help
expedite
the
process
of
getting
this
rating.
Can
the
non-veteran
spouse
of
a
living
veteran
receive
a
rating
for
aid
and
attendance
or
housebound?
If
the
veteran
is
receiving
Compensation
and
is
at
least
30%
or
more
service
connected
disabled
there
is
an
allowance
available
if
the
spouse needs
aid
and
attendanceor
is
housebound.
An aid
and
attendance
or
housebound allowance
is
also
available
to
a
surviving
spouse receiving
DIC.
According
to
VA,
a
rating
is
not
available
to
the
non
veteran
spouse
of
a
living
veteran
for
Pension.
A
rating
is
available
to
the
single
surviving
spouse
for
death
Pension.
Updated
12/29/17
Page 21
What
documentation
is
required?
The
veteran
must
provide
an
original
copy
of
discharge
from
service,
typically
a
DD
214
or
a
WD.
A
photocopy
is
allowed
if
it
is
certified
by
a
government
agency
recognized
to
do
this.
This could
be
the
local
courthouse.
For
a
death
benefit,
a
death
certificate
must
be
furnished
as
well.
VA
may
request
copies
of
other
documents,
but,
generally,
providing
sufficient information
on
the
claim
form
will satisfy
the
need
for
other
documentation.
If
an
applicant
for
Pension
is
younger
than
65,
medical evidence
of
total
disability
must
also
be
submitted.
Total
disability
for
65
and
older
is
not
a
requirement
for
death
Pension.
What
is
the
effective
date?
The
effective
date
is
generally
the
day
VA
receives
an
original application.
If
it
takes
three
months
for
the
process
of
approval
or
six
months,
it
doesnt
matter.
The
effective
date still
reverts
to
receipt
of
the original application.
When
does
payment
begin?
Generally,
payments
start
on
the
first
day
of
the
month
following
the month
of
the
effective
date.
This
means
that
if
it
took
six
months
to get
approval,
at least
five
months
of
benefit
will
be
paid
retroactively.
VA
requires
automatic
deposit
of
awards
in
a
checking
or
savings
account.
What
happens
if
the
veteran
dies
during
the
period
of
application?
If
the veteran
dies
during
the
period
of
application
and
the
application
was
not
approved prior
to
the
death,
there
may
be
accrued
benefits.
If
the
regional
office
had
all
of
the
information
in
its
possession
that
would
have
led
to
an
approval,
then
there
is
an
accrued
benefit
payable.
Otherwise there
is
none.
The
full
benefit
is
available
up
to
the
month
of
death
of
the veteran
and
to
a
surviving
spouse
through
an
application
on VA
Form
21-0847
(REQUEST
FOR
SUBSTITUTION
OF
CLAIMANT
UPON
DEATH
OF
CLAIMANT).
If
a
claimant
dies
while
a
claim
or
appeal
for
any
benefit
under
a
law
administered
by
the
Secretary
is
pending,
a
living
person
who
would
be
eligible
to
receive
accrued
benefits
due
to
the
claimant
under
section
5121(a)
of
this
title
may,
not
later
than
one
year
after
the
date
of
the
death
of
the
claimant,
request
to
be
substituted
as
the
claimant
for
the
purposes
of
processing
the
claim
to
completion.
A
new
claim
for
death
pension
can
abs
be
started
using
VA
Form
21-534ez.
What
is
a
veteran’s federal
fiduciary,
and does
that
affect
the
application?
For
a
veteran
who
is
considered
incompetent
to
handle
his
own
financial
affairs,
VA
will
appoint
a
fiduciary
to
receive
the
money
and pay
the
bills.
A
federal
fiduciary
is
an
individual
appointed
for
this
purpose,
usually
a
spouse
or
a
family
member.
In
most
cases
--
except
for
the
spouse living
with
the
veteran
--
there
is
an
interview
required
and
paperwork.
This
process
can
take
a
long
time,
and
it
is
to
the
advantage
of
the
person
filing
an
original
claim to
request the
appointment
of
himself
or
herself
as
a
fiduciary
or
for
some
other appropriate
person
or organization
to
act
as
a
fiduciary
in
order
to
help
expedite
the
process.
VA
always
makes
the
final
decision
on
whom
it
appoints
as
a
fiduciary.
In
fact, the
agency
might
well
ignore
court
appointed fiduciaries.
In
general,
the
decision
favors
declaring
the
veteran
competent
and
avoiding
a
fiduciary
where at
all
possible.
Updated
12/29/17
Page 22
What
is
the difference between
Compensation
and
Pension?
Compensation
is
paid
for
service-connected
disabiNties;
whereas,
Pension
is
paid
to
veterans
who
are
disabled because
of
non-service-connected
causes.
Compensation
is
meant to
compensate
a
veteran
for
loss
of
income due to
the
disability.
Pension
is
meant to
provide
more
income
to
low
income, disabled,
active
duty
veterans who
served
during
a
period
of
war.
Which
benefit
is
better?
The
veteran
can
choose
the
larger
of
either
benefit
but
cannot
have
both.
If
the
veteran
is
receiving
military
retirement
or
has
received
other
reimbursement
related
to
military
service, those
monies
will
be
reduced
by
the amount
of
Compensation. There
are
special
rules
for
reducing
this
offset
for
veterans
who
are
500/c
or
more disabled.
Pension does
not
reduce
military
retirement.
For
veteran
families with
expensive home
care
services,
assisted
living, or
nursing home
costs,
Pension
is
could
be
the
larger
benefit.
Can
a
veteran apply
for
Compensation
years
after
leaving
the
military?
A
recent
survey
by
VA
found
that
a
large
percentage
of
older veterans
had
never
applied
for
Compensation
but
could
be
eligible
based
on
injuries
or illnesses
incurred
while
they
were
in
the service.
A
veteran
can
apply
for
these
benefits
at
any
time.
Agent
Orange
claims
and
PTSD
claims
are
in
this category.
Can
a
veteran receiving
Compensation
reapply
for
additional
income?
Many
veterans
are
receiving Compensation,
but
their
disability
related to service
may
have
become
worse.
They
can
apply
for
a
higher
disability
rating
and
thus
more
money
at
any
time.
There
are
also
additional
benefits
for
veterans
who
may
have lost
limbs,
eyesight,
hearing,
or
the
use
of
other
parts
of
their
body.
Can
a
veteran
receiving
military
retirement
pay
also
receive
Compensation?
A
veteran cannot
receive
Compensation
and
military
retirement
at
the
same
time.
Generally,
the
veteran
will
waive
a
portion
of
military
retirement that
equals
Compensation
because
retirement
is
taxable
and
Compensation
is
not.
Since
2004
military
retirees
with
a
VA
rated
disability
of
50%
or
more
are no
longer
being
required
to
waive
military
retirement
pay
to
receive
VA
disability
Compensation. This
new
law
is
being phased
in
over
a
9-year
period. However
military
retirees
with
a
VA
rated
disability
of
4O%
or
less
are
still
required
to
waive
a
portion
of
their
military
retirement
pay
to
receive
Compensation.
What
is
the
income
test
for
Pension?
If
the
household
income
adjusted
for
medical expenses
is
greater
than
the
maximum
allowable
Pension
rate
--
MAPR
-~
there
is
no
benefit.
In December
2013
-
December
2014,
the
maximum
allowable rate
for
a
couple
with
aid
and
attendance
allowance
is
$25,022
a
year.
For
a
single
veteran it
is
$21,107
a
year.
Without
aid
and
attendance
or
housebound
allowance
the
maximum
couple’s rate
is
$16,569
a
year
and
for
a
single
it
is
$12,652
a
year.
Death
Pension
rates
are
lower.
People
seeking
a
benefit with
adjusted
incomes
greater than
these
levels
will
be
denied.
Updated
12/29/17
Page 23
Can
a
household
with
income
above
the
maximum
limit
qualify?
A
special
provision
in
the
way benefits
are
calculated
can
allow
individuals
and
couples
earning
between
$24,000
to
$60,000
a
year
to
still
qualify
for
a
benefit.
It
has
to
do
with the
treatment
by
VA
of
the very
large
recurring
medical
costs
associated
with
home
care,
assisted
living,
or nursing
home
care.
What
is
the
Pension
household asset
test,
and
what
can
be
done
if
the
asset
test
is
not
met?
As
a
general
rule
assets
cannot
exceed
$80,000.
But
there
is
no
specific
test
in
the
regulations.
Veterans
service
representatives
are
requiredto
file
paperwork
justifying
their
decision
if
they
allow
assets
greater than
$80,000. Thus
this amount
has
become
a
traditional
ceiling.
The service
representative
is
encouraged
to analyze
the veteran’s
household
needs
for
maintenance
and
weigh
those
needs
against
assets
that
can
be
readily
converted
to
cash.
In
the
end,
the
decision
as
to
allowable
assets
is
a
subjective
decision
made by
a
service
representative. In
certain
cases
a
benefit
award could
be
denied
unless
assets
are
below $20,000 or
$10,000
or
even
zero
dollars.
What
proofs
and
documents
are
required
with
the
Pension
claim?
We have
already
discussed
the
requirements for
power
of
attorney
and
fiduciary
if
they
apply.
In
addition,
an
original
copy
of
the
discharge
from
service
--
typically
DD
214
or
form
WD
--
is
required
and
the
discharge
must
have
been
other
than
dishonorable.
If
there
is
a
question
about
the
marriage
relationship,
a
marriage certificate
or
other proof
may
be
necessary.
Birth
certificates
of
dependent
children
are
usually
not required
but
may
be
necessary
under
certain
conditions.
A
dependent
child
is
a
minor,
a
dependent
student
under
age
23,
or
a
totally
dependent adult
child.
There
are
certain
documents
that
need
to
be
submitted to
prove
future
recurring
medical
expenses
and
to
prove
need
for
aid
and
attendance
or
housebound allowances.
VA
does
not
furnish
these
documents
nor
provide
any
information
that
they
are
required.
Can
someone
charge
to
help
fill
out
the
form?
Federal
code
and
VA
regulations
prohibit
an
agent
or
attorney
from
charging
a
fee
to
fill
out
an
application prior
to
denial
of
an
appeal.
Some
practitioners or
providers
help
their
clients
for
free, sometimes
in
the
context
of
solving
other
retirement
issues
or
providing
long
term
care
services.
Some
practitioners
offer
advice
for
a
fee
but
will
send
their
clients
to
a
veterans’
service
organization
to complete
the
application.
Charging
a
fee
for
advice
not
related
to
assistance
with
a
claim
for
benefits
appears to
be an
acceptable
practice allowed
by
VA.
How
are
assets,
income
and
unreimbursed
medical
expenses
determined?
The
applicant
must
submit
details
on
the
application
of
all
income
and
all
assets
including
retirement
savings
accounts
such
as
IRAs.
Almost
any
type
of
money
received
or
anything
received
that
can
be
converted
into money
is
income.
The
only
exclusions
for
assets are
a
personal
residence
and
a
reasonable
amount
of
land
it
sits
on
as
well
as
vehicles
and
other
personal
possessions.
Personal
possessions
used
as
an
investment
such
as
a
coin
collection
are
counted
as
assets.
Unreimbursed
medical expenses
can
be
almost
any
expense
related
to
medical
needs.
Updated
12/29/17
Page 24
Are
there
any
other
reporting
requirements?
VA
requires
that
any
change
in
income
or assets
be
reported immediately,
The
award
is
calculated
for
12
months
in
advance,
but
at
the beginning
of
each
calendar
year,
a
formal
report
called
an
EVR
(eligibility
verification
report)
must
be
filed
detailing
all
income,
assets
and
unreimbursed
medical expenses
for
the
coming
calendar
year.
For
example
if
the
award
is
granted
in
April
for
12
months
in
advance,
an
EVR
must
be
submitted
in
January
of
the
next
year
that
could
affect
the
award
amount
for
the
remaining
four
months.
The
EVR
will
be
used
for
determining
benefits
for
the
calendar
year
on
which
it
is
based
and
possibly
adjusting benefits
already
received
or
even
demanding
repayment
for
overpayment
of
benefits.
Will
the
Pension
benefit
pay
a
non~llcensed
homecare
provider?
VA
does
not
pay
providers
directly but
provides extra
income
to
make
up
for
the
cost
of
medical
care
providers.
Medical
conditions
or
injuries
or
diseases
that
require
a
need
for
ongoing
homecare
will
allow
the applicant
to
reduce
household
income
by
the
cost
of
homecare making
it
possible
to
receive
the
additional
income
from
a
Pension
award.
If
the
beneficiary
has
an aid
and
attendance
or
housebound
allowance,
VA
will
pay
nonlicensed
providers.
Will
the
Pension
benefit
pay
a
member
of
the
family
to
provide
care
at
home?
As
explained
above,
VA
will not
pay
providers
directly but
only
indirectly
through
extra
income.
If
the beneficiary
receiving
care
in
the
home
has
received
a
rating
for
aid
and
attendance
or housebound,
VA
will
allow
expenses
paid
to
a
family
member
for
care
to
be
counted
as
unreimbursed
medical expenses
to
qualify
for
the benefit.
Does
the
Pension
benefit
pay
the
costs
of
a
nursing
home?
The
application
form
has
provision
for
indicating residency
in
a
nursing home
and
whether
or
not
the applicant
is
eligible
for
Medicaid.
VA
will
automatically
apply the
monthly
cost
of
the
nursing home
in
determining
the
Pension
benefit.
If
the
applicant
is
single
with
no
dependent
children
at home
and
is
eligible
for
Medicaid,
VA
is
required
to
stop
any
payment
of
benefits
and
only
provide
the
veteran
with
$90
a
month.
Does
the
Pension
benefit
pay
the
costs
of
assisted
living?
As
explained
above,
VA
will
not
pay
providers
directly but
only
indirectly
through
extra
income.
If
the beneficiary
receiving
care
in
assisted living
has
received
a
rating
for
aid
and
attendance
or
housebound,
VA
will
allow
expenses
paid
to
assisted
living
for
aid
and
attendance
or
housebound
including
room
and
board
to
be
counted
as
unreimbursed
medical
expenses.
The cost
of
assisted
living
being
used
as
a
retirement
residence
is
not considered
a
medical expense.
What
are
the
requirements
to
receive
a
Death
Pension
benefit?
The
applicant
must
be
a
surviving
spouse
or
a
dependent
child
of
an
eligible veteran.
VA
form
21-534ez
is
used
to
apply
for
death
Pension,
death
Compensation,
accrued
benefits,
or
dependency
and
indemnity
Compensation
(DIC).
The
surviving
spouse
must
be
single.
A
surviving
spouse
of
any
age
is
eligible
as
long
as
the
deceased
veteran
served
at
least
90
days
during
a
period
of
war. They
had
to
be
married
at
least
a
year
prior to
death or
have
a
child
as
a
result
of
the marriage.
There
is
no
requirement
for
Updated
12/29/17
Page 25
total disability
for
the
surviving
spouse nor
for
the
deceased
veteran
to
have
been
totally
disabled
or
older
than
age
65.
How
does
one
prove
that
unreimbursed
medical expenses
will
recur every
month?
VA
has
specific
rules
for
proving
future
recurring
medical expenses.
Information
in
our
book
outlines the
type
of
paperwork
that
must
be
submitted
for
each
type
of
long
term
care
service.
Neither
the
claims
form
nor
information
from the
regional
office
provides
any
guidance
on
the
rules
for
proving
future
recurring
medical expenses
for
home
care
or
assisted
living.
One
simply
has
to
know
how to
do
it.
What
if
the
veteran
or
spouse
is
currently
receiving
Medicaid?
Our
interpretation
of
the
rules
leads
us
to
believe
that
VA
will
not
consider
Medicaid
payments
as
income. However,
Medicaid
will
consider
the non-allowance
portion
of
the
Pension
to
be
income. This
could
affect
Medicaid
eligibility
in
income
test
states.
There
is
evidence
that
some
income
test
states
count
the
entire
Pension
benefit
including
the
allowance
as
income.
According
to
federal
Medicaid
rules
this
should
not
happen.
What
happens
when
the
veteran
or
spouse
wants
to
receive
Pension
&
Medicaid
together?
Federal law
requires
that
a
single veteran
receiving
Medicaid
with
no
spouse
or
dependent
children
can
receive
no
more
than
$90
a
month from
VA.
Veterans
in
state
veterans
homes are
exempt from this
requirement.
The
veteran
with
a
spouse
can
receive
the
benefit to
help
defray the
costs
of
a
nursing home.
As
a
general
rule,
the
Pension
benefit
would probably
not work
if
Medicaid
were
paying
the
bill.
But
the
benefit
does
work
well
for
non-Medicaid nursing
home
beds and
while the
recipient
is
going
through
the
Medicaid
spend
down.
We
highly
recommend
you
use
an aid
and
attendance
benefits
consultant
when
trying
to
make
Pension
and
Medicaid
dovetail
without
getting
into
trouble
with
Medicaid rules.
Medicaid
with
the
Aid
&
Attendance Benefit
Why
Aid
and
Attendance
Pension
Leads
to
Planning
for
Medicaid
If
the
person
receiving pension
is
also
receiving
home
care,
adult
day
care,
assisted
living
care
or
nursing
home
care
there
is
a
high
likelihood
that
Medicaid
may
become
part
of
the
planning
strategy
for
receiving
care.
The
application
for
aid
and
attendance
becomes
a
great
opportunity
to
examine
the
consequences
of
Medicaid
on
income
and
assets
prior to
the
need
for
applying
for
Medicaid.
Most
people
only
deal
with
Medicaid
when
they
reach
debt
crisis
moment
or
assets
or
income
or
insufficient
to
pay
for
existing
care.
Doing
some
planning
in
advance
may
allow
individuals
or households
to
save
some
assets
or
to
provide
more income
for
a
healthy
spouse.
This
planning may
also
allow
the
opportunity
to
preserve
the
home
from
Medicaid
recovery.
A
Brief
Description
of
Medicaid
Medicaid was
established
as
Title
IX
of
the
1965
Amendment
to
the
Social
Security
Act
while
Medicare
was
established
at
the
same
time
as
Title
VIII
of
the
Act.
Medicaid
is
a
health
insurance
program
for
certain low-income
people.
These
include: certain
low-
Updated
12/29/
17
Page 26
income
families with
chfldren;
aged,
(65
and
older)
blind,
or
disabled people
on
Supplemental
Security
Income;
certain
low-income pregnant
women
and
children;
and
people
who
have
very
high
medical
bills.
Medicaid
is
funded
and
administered
through
a
state-federal
partnership.
Although
there
are broad
federal
requirements
for
Medicaid,
states
have
a
wide degree
of
flexibility
to
design
their
programs.
States
have
authority
to
establish
eligibility
standards,
determine
what
benefits
and
services
to
cover,
and
set
payment
rates.
All
states,
however,
must
cover
these
basic
services:
inpatient
and
outpatient
hospital
services,
laboratory
and
X
ray
services,
skilled nursing
and
home health
services,
doctor’s
services,
family
planning,
and
periodic health
checkups,
diagnosis
and
treatment
for
children.
Funds
for
Medicaid
are
provided
jointly
by
the federal
government
and
the
states.
On
average,
the
federal
government
provides
about
57%
of
Medicaid
funds
and
the
states
provide
the
other
43%.
The
amount
of
shared
funding
varies
from
state
to state
depending
on
the
per
capita
income
in
each
state.
States
with
low
per
capita
income
such
as
Mississippi
receive
up
to 83%
of
their
Medicaid
funding
from the federal
government
and
the
state
provides
the
other
17%.
On
the
other
hand, states
with
high
per capita
income
such
as
Connecticut
share
Medicaid
funding
with
the
federal
government
on
a
SO%
to 50%
basis.
Long-term
care
recipients
of
Medicaid
come
almost
exclusively
from
the
aged,
blind
and
disabled
group
of
eligible
beneficiaries
but very
few
of
those
are
actually
receiving
SSI
(Supplemental
Security
Income).
SSI
is
a
welfare payment
for
certain
disabled
or
handicapped
individuals
who
are unable
to
work,
have
no
assets and
have
no
extended
family
financial
support.
Certain
provisions
of
the
enabling
Act,
as
well
as
congressional
amendments
since
1965
have
allowed
the
aged,
blind
and
disabled
who
dont
qualify
for
SSI
to
receive
Medicaid
under
an
alternate
set
of
eligibility
rules.
Currently
there
are
about
60
million
people
or
20%
of
the
US
population
receiving
Medicaid
support.
Most
of
these
people
are
receiving
various forms
of
health
care
services
and
are
younger
than
age
65.
Our
interest
lies
with
those
Medicaid
beneficiaries
who
need
long
term
care and
can
receive
help
from
Medicaid
to
pay
those
costs.
In
addition,
we
focus
aln9ost
exclusively
on
aged
long
term
care
beneficiaries
--
those
over
the
age
of
65.
Aged
long
term
care
Medicaid
beneficiaries
represent
about
7%
of
the entire
Medicaid
population
or
about
4
million
beneficiaries.
Out
of
these
long
term
care Medicaid
beneficiaries,
approximately
1
million
are
receiving
various
levels
of
Medicaid
funding
support
in
nursing
homes
and
approximately
3
million
are
receiving
some
form
of
home-
based
or
community-based
Medicaid long
term
care
support.
Even
though
elderly
long
term
care
beneficiaries
only
represent about
7%
of
the
Medicaid
population
they
account
for
about
19%
of
all
Medicaid
spending.
This
is
because
long
term
care
services
are
very
expensive,
particularly
those funds
used
for
nursing home
care.
Medical
Eligibility
for
Long
Term
Care
An
individual
must
go
through
an
evaluation
with
a
state
Medicaid
assessment
specialist
in
order
to
determine
a
need
for
care.
If
the
individual
fails
to
meet the
minimum
level
Updated
12/29/17
Page 27
of
care
needed
to qualify
for that
State’s
Medicaid
coverage, then
no
Medicaid
help
is
forthcoming.
A
need
for
skilled
nursing
care will
automatically qualify
a
person
in
any
state.
It’s
also
likely
that
a
candidate
already
in
a
nursing
home
but
not
needing
skilled
care
will still
qualify.
Skilled
care
must
be
needed
on
a
frequent
basis.
Examples
of
skilled
care
might
include
the
need
for:
frequent
monitoring
of vital
signs,
wound
dressing
changes,
maintenance
of
mechanical
ventilation
equipment,
maintenance
of
a
catheter,
help
with
elimination
problems,
maintenance of
IV
administrations,
careful
monitoring
of
medication
usage,
managing
colostomy
problems,
careful
supervision
of
severe
diabetes,
frequent
injections, maintaining
a
feeding
tube
and
many
more
problems
requiring
the
skill
of
a
nurse
or
doctor.
Medical
eligibility
for
home
and
community-based
services
could
be based on
different
criteria
from
those
for
nursing
homes;
but
in
some
states,
a
person
must qualify
for
Medicaid
based
on
the
nursing
home
eligibility
standards
in
order
to
receive
Medicaid
services
at
home
or
in
assisted
living.
Income
and
Asset Tests
There
is
both
an
income
and
an
asset
test
to
qualify
for
Medicaid long
term
care
services.
In
general,
these
tests
are
applied
for
nursing home
services
but
these
same
tests
may
also
be
used
to
qualify
individuals
for
home
or
community-based
Medicaid
services
as
well.
In
other
states
the
financial
requirements
for
community-based
services may
be
more
stringent
than
those
for
nursing
homes
or
they
may
be
less
stringent.
For
the elderly
and
people
with
disabilities
with long-term
care needs,
income
qualifying
levels
are
often tied
to
the
Supplemental
Security
Income
(551)
program—$674
per
month
in
2010
—but
income
limits
can
be
higher
in
states
that
have
more liberal
rules.
Most
states allow
the
“medically
needy”—those
with
large
medical
or
long-term
care
bills
--
to
deduct
these
costs
from
their
gross
income
to
reach
the
required
income
level
and
participate
in
Medicaid.
These
criteria
are
usually
quite
stringent
as
most
states set
their
medically
needy
income
level
at
or below
551
levels.
This deduction
from
income
can
happen
in
a
direct
manner
or
it
can
happen
indirectly
by
potential
beneficiaries
paying
in
a
so-called
‘co-pay’
for
their
share
of
the
services. This
co-pay represents
the
amount
of
income above
the
state
income
qualification
level.
This
medically
needy
program
is
optional
for
states, however,
and
15
states
(plus
the
District
of
Columbia)
do
not
have
medically needy
programs.
In
some
states
that
do
not
have
medically
needy
programs,
individuals
needing
nursing
home
care
can be
covered
under
the “300
percent
rule”.
Under
this option, individuals
with
income
up
to
300°k
of
SSI
($2,094
per
month
in
2012),
can
qualify
for
institutional
care.
Other
states
may have
more
stringent
income
rules
for
Medicaid
qualification.
In
states
that
apply
a
strict
income
rule,
individuals
having more
than
the
state income
limit
cannot
receive Medicaid
assistance regardless
of
their
expenses.
These
states
are
called
“income
cap
states.”
There
are
currently
22
income
cap
States.
Updated
12/29/17
Page 28
Under
the
Medicare
Catastrophic
Coverage Act,
income
cap
states
must
allow
those
individuals
with
incomes
above
the
cap
to
qualify
for
Medicaid
if
they
put
their
excess
income
in
a
trust
known
as
a
“Qualifying
Income
Trust.”
States are
allowed
to
recover
funds
in
the
trust
after
the
person’s
death.
Nursing home
residents
who qualify
as
medically
needy
or
through
the
300
percent
rule
must
apply
the
majority
of
their monthly
income
toward
the
cost
of
care,
thereby
reducing
the amount
that the
Medicaid
program
must
pay. Medicaid
nursing home
residents may
keep
only
a
small
personal
needs
allowance (between
$30-$90
per
month)
to
pay
for
items
that
are
not
covered
by
Medicaid,
such
as
clothing,
books,
toiletries, or
telephone
service.
Medicaid
beneficiaries
receiving
home
and
community
based
services are
also
required
to
apply
a
portion
of
their
income
to
the
cost
of
care,
although
states
may
allow
them to
retain
more
of
their
income
to
maintain themselves
at
home
than
if
they
were
in
an
institution,
where
Medicaid
covers room
and
board.
States
are
required
to
allow
nursing
home
residents
with
spouses
living
in
the
community
to
retain
a
certain
amount
of
income
for
the
support
of
the
community-
residing
spouse.
This
set-aside
for
the
healthy
spouse
at
home
avoids
impoverishing
that
spouse instead
of
using
all
of the
household
income
for
nursing
home
costs.
States
may
set
their
own
income
limits
for
this
spousal
allowance
but
must
allow
a
community
spouse
to
keep
between
$1,838.75
and
$2,841
per
month
in
2012.
The
community
spouse
is
also
required
to
receive
additional
income
allowances
above
the minimum
rate
and
not
to
exceed
the maximum rate
for
excessive
utility
costs
or
excessive
costs
expended
to
maintain shelter.
In
most
states,
an
individual
needing
Medicaid
nursing
home
care
must
have assets
less
than
$2,000.
A
couple needing
Medicaid
nursing care
must
have assets
less
than
$3,000
in
most
states.
When one
member
of
a
couple
needing
care
in
a
nursing home
becomes
a
resident,
Medicaid
will
take
a
snapshot
of
the
coupleTs
combined
resources
at
that
point.
Resources
are
anything
that
can
be
converted
to
cash
to
pay
for
nursing home
care.
The
healthy
spouse
is
allowed
to
keep
up
to
half
of
these
resources
not
to
exceed
$113,640
(for
the
year 2012).
The
balance
of
the
resources
belong
to
the
nursing
home
spouse
and
must
be
spent
down
to
below
$2,000 before
Medicaid
will
start contributing
its
share
of
the
cost. There
is
no
requirement
that
the
nursing
home
Medicaid
recipient
must
spend
his
or
her share
of
the
resource
assets
on
the
nursing home.
The
money
can
be
spent
on
anything.
If
the
combined
resources are
less
than
$22,728
(for
the
year
2012)
the
healthy
spouse
keeps
it
all.
If
assets
are
between
$22,728
and
$222,280,
some
states
will
allow
the
community
spouse
to
keep
everything
up
to
$113,640.
These states
are called
lOO%
states.
Other
states,
called
50%
states,
are
less
generous
and
only
allow
the
community
spouse
to
keep
50°k
of
the
assets
up
to
$113,640.
Many
states
have
more
lenient
rules
pertaining to
the
amount
of
resources
that
can
be
retained
by
the
so-called
community
spouse
and
in
addition,
some
states exclude certain
types
of
community
spouse assets
as
counting towards
the
resource
test.
Updated
12/29/17
Page 29
Certain
assets
are
not
counted towards the
less
than
$2,000
asset
limit.
These
assets
are
exempt.
o
Personal
possessions,
such
as
clothing,
furniture,
and
jewelry
o
One
motor
vehicle
is
excluded,
regardless
of
value,
as
long
as
it
is
used
for
transportation
of
the
applicant
or
a
household
member. The
value
of
an
additional
automobile
may
be
excluded
if
needed
for
health
or
self-support
reasons.
(Check
your
state’s
rules.)
o
The
applicant’s principal
residence, provided
it
is
in
the
same
state
in
which
the
individual
is
applying
for
coverage
o
Prepaid
funeral
plans
and
a
small
amount
of
life
insurance
o
Assets
that
are
considered “inaccessible”
for
one
reason
or
another
In
some states
if
a
single
Medicaid
beneficiary
is
not
residing
in
the
personal residence
and
there
is
no
anticipation
that
person
can
return
to
his
or
her home,
the
State
may
require
that
the
home
be
sold
to
pay
for
Medicaid costs.
In
other
states,
the
home
can
be
left
vacant
in
anticipation
of
the
beneficiary
returning
whether
the
beneficiary
is
medically
capable
or
not.
In
some
states,
the
beneficiary
must
sign
an
intent
to
return
home
document
to
keep
the
home
from
being
sold
or
counting
as
an
asset
for
the
asset
test.
For
those states
that
have
adopted
the Deficit
Reduction
Act
of
2005,
a
home
worth
more
than
$525,000 ($786,000
in
some
states)
is
not
exempt
and
must
be
counted
as
an
asset
to
qualify
under
the
asset
test.
These
equity
limits
increase
in
response
to
inflation.
The
house
may
be
kept
with
no
equity
limit
if
the
Medicaid
applicant’s
spouse
or
another
dependent
relative
lives
there.
Although
mandatory
for
nursing
home residents,
states
are
not
required
to
offer
the
spousal
impoverishment
protections
discussed
above
to
home
and
community-based
service
waiver
program
participants.
Consequently,
a
substantial number
of
states
(19)
fail
to
offer the
spouses
of
waiver
participants the
full
level
of
income
and/or
asset
protection
afforded
the
spouses
of
nursing
home
residents.
Thirteen
states
protect
neither
the
income nor
assets
of
spouses
of
waiver participants,
and
an
additional
6
states
protect
the
assets
but not the
incomes
of
the community
spouses
of
waiver
participants
The
discussion
below
is
based
on
new rules
for
Medicaid
eligibility
that
were established
by
the
Deficit
Reduction
Act
of
2005.
This
act
was
incumbent
upon
all
states
to
adopt
the
new
rules.
Many
states
have
already
changed
legislation
and
regulations
to
incorporate the
new
rules
under
the
DRA,
but
a
number
of
states
have
not fully
implemented
these
rules
--
notably
California
and
Florida.
In
general,
in
those
states
that
have
not
adopted the
new
rules,
restrictions under
the
act
discussed
below
are
more liberal
towards transferring
assets
and
income
to
qualify
for
Medicaid.
Transferring
Cash
Assets
A
number
of
people
who
eventually
need
Medicaid
assistance
have
gifted
cash
or
cash
equivalent
assets
to
their
children
or
other
members
of
the
family either inadvertently
or
deliberately prior
to
applying
for
Medicaid,
Any
transfer
for
less
than
value,
whether
it
is
a
gift
or
at
a
reduced
purchase
price,
is
subject to
a
penalty
from
Medicaid
at
any
time
during
60
months
from the
date
of
the
gift.
The
penalty
is
calculated
by
dividing
the
Updated
12/29/17
Page 30
less-than-value
amount
of
the
transfer
by
the
average
monthly
Medicaid
nursing
home
cost
in
the
state.
Each
state
calculates
its
monthly
average
Medicaid
cost
at
least
yearly.
As
an
example,
suppose
John
transferred
s500,000 in
an
irrevocable
trust
to
his
children
4
years
ago.
He
received
nothing
in
return.
Now
John
needs
long
term
care
in
a
nursing home
and
applies
for
Medicaid.
Because
he
is
applying
for
Medicaid inside
of
the
60
month
look back
period
for
assessing
a
penalty,
he
will
not
qualify
for
Medicaid
assistance
until
the
penalty
has
been
satisfied.
John
has
two
options.
He
can
have
his
children reinstate the $500,000
back
into
his
name
and
do
away
with
the penalty
or
he
can
accept
the
penalty
and
have
the
children
pay
it
out of
the
trust.
The
penalty
is
calculated
by
dividing
the
$500,000
by
the
state
Medicaid
rate
which
is
55,000
a
month.
The
result
is
a
period
of
100
months or
approximately
8.3
years
where
John
must
pay
for
his
nursing
home cost
out
of
his
own
pocket
before
Medicaid
will
start
helping
him
cover
the
cost.
When
John
transferred the
assets
he
started
the
clock
ticking
on
what
is
called
the
look
back.’
This
is
a
period
of
60
months
or five
years
in
which
Medicaid
can
assess
the
penalty
if
a
transfer for
less
than
value
has
occurred.
After
the
look
back
has
been
met,
Medicaid
cannot
assess
a
penalty.
It
is
interesting to
note
in
this
example
that
had
John
waited
one
more
year,
he
would
not
have
incurred
a
penalty
of
8.3
years
from
Medicaid.
It
is
also
interesting to
note
that
the
penalty
is
longer
than
the
look
back.
If
John
were
anticipating
Medicaid
within
five
years,
he
would
simply
not
apply
for
Medicaid
until
he
had
met
5
years.
By
applying
for
Medicaid
before
this
time,
John
will
trigger
an
8.3-year
penalty.
John
simply
has
to
have
his
children
pay
the
remainder
of
the
5
years
out-of-pocket
and
then
apply
for
Medicaid.
This
is
a
much
cheaper
option.
Transferring
a
Personal
Residence
There
are
numerous
planning
strategies
to
transfer
a
personal residence
in
order to
avoid
a
transfer
for
less
than
value
or
to
avoid
Medicaid
recovery against
the
home.
Medicaid
planning
specialists
understand
the
rules
in
their
particular
states
for
doing
this.
Transfers of
the
home
may
also
be
made
under
the
following
conditions
without
Medicaid
penalty.
Here
are
those
exceptions.
transfer
to
the
applicants
spouse
o
transfer
to
a
child
who
is
under
age
21
or
who
is
blind
or
disabled
o
transfer
into
a
trust
for
the
sole
benefit
of
a
disabled
individual under
age
65
(even
if
the
trust
is
for
the
benefit
of
the
Medicaid
applicant, under
certain
circumstances)
o
transfer
to
a
sibling
who
has
lived
in
the
home
during
the
year
preceding
the
applicant’s
institutionalization
and
who
already
holds
an
equity
interest
in
the
home
°
transferred
to
a
“caretaker
child,’
who
is
defined
as
a
child
of
the
applicant
who
lived
in
the
house
for at
least
two
years
prior to
the
applicant’s
institutionalization
and
who
during
that
period
provided
care
that
allowed
the
applicant
to
avoid
a
nursing home
stay.
Medicaid Recovery
Federal Medicaid rules
require
states
to
attempt
to
recover
all
or
part
of
that
state’s
Medicaid costs
for
a
beneficiary
from the
beneficiary’s
estate.
Recovery
applies
to
Updated
12/29/17
Page 31
beneficiaries
age
55
and
older.
As
a
general
rule,
the
only
remaining
assets
would
be
the
principal residence
as
generally
all
other
assets
had
to
be
spent down.
But
certain
business
interests,
assets used
by
the
family
to
create
an
income
and
other
inaccessible
assets
could
also
be
excluded.
Even
though
many states
have
the
enabling
laws
to
recover
assets
held
in
any
arrangement
such
as
trusts,
assets
in
joint
tenancy
or
life
estates,
many
states
only
attempt
recovery
under
probate.
In many states,
the recovery program
is
underfunded
and
inefficient.
We
have
observed
that
many states
are
very
lax
in
their
ability to
recover
funds.
The
principal
means
of
recovery
is
putting
a
lien
against
the
home.
If
a
surviving
spouse
or
a
dependent
child
is
living
in
the
home,
recovery
will
not
take
place
until
the
house
is
sold
or
death occurs.
In
many
states,
no
lien
is
applied
if
the
surviving
spouse
is
living
in
the
home.
In
other
words,
the debt
under
recovery
is
forgiven.
Updated
12/29/17
Page 32
Important Information
and
Warnings
Regarding
Effective
Dates
and
“Intents
to
File”
(formerly
known
as
an
~Informal
Claim”)
This
article
was
written
to
help
senior
veterans
and
their
surviving
spouses
applying
for
VA
Pension
or
Death
Pension
understand
the
process
of
establishing
an
Effective
Date
with
the
Department
of
Veterans
Affairs
(VA).
This
article
also
explains
how
an
“Intent
to
File”
(formerly
know
as
an
Informal
Claim)
works
and
how
VA
may
grant
retroactive payment
if
certain criteria
are
met.
Furthermore,
this article
highlights
serious
issues
involving
the
filing
of
an”Intent
to
File’
before
a
claimant
(applying
for
pension
or
death pension)
has
met the
medical,
asset,
and
income
standards
set
by
VA.
EFFECTIVE
DATE
An
Effective
Date
is
typically
the
date
an
application
(or
original claim)
for
VA
Pension
or
Death
Pension
was
received
by
the Department
of
Veterans Affairs
(VA).
In
some
cases
(which
may
be
beneficial
to
the
claimant) there
are
exceptions
to
this
rule
which
can
allow
for
an
earlier
date.
(see 38
U.S.C.S.
§5110
and
38
C.F.R.
§3.400).
Generally, payments
for
a
VA
Claim
are
effective
from the
first
of
the
month
following
the
month
in
of
the
Effective
Date
(so long
as
an
award
is
given).
For
instance,
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off
sTh
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epaw’e71
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ma
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In
the
situation
above,
notice
that
the
lump
sum
retroactive
payment
did
not
include
the
month
of
March
when
the
veteran
made
application.
Although
the
effective
date
was
established
in
March,
the
VA
will
not
make
any
kind
of
payment
in
the
month
in
which
the
original
claim
was
received.
“INTENT
TO
FILE”
A
CLAIM
Before
applying
for
benefits
a
veteran
or
the
surviving
spouse
of
a
veteran
(in
either
case,
the
claimant)
may
wish
to
establish
an
Effective
Date
by
using
an
“Intent
to
File”
form
(VBA Form
21-0966).
“Intent
to
File,”
formerly
known
as
an
Informal
Claim,
can
be
sent
to
VA
even
though
a
claimant
is
not
yet
prepared
to
apply.
This
is
done to ‘lock-in
a
date’
while
the
claimant
is
gathering
supporting
evidence
to
include
in
their
application.
Supporting
evidence
can
take time
to gather
and
may
include
any
of
the
following:
o
Military
Records
Doctor’s
Examinations
and
other
Medical
Evidence
o
Marriage
and
Death
Certificates
Banks
Statements
Statements
from
Care
Providers
updated
12/29/17
Page 33
Using
an
“Intent
to
File”
to
establish
an
Effective
Date
before
the
claimant
has
sufficiently
prepared
his
or
her
application will
allow
the
claimant
to
receive
a
larger
lump
sum
retroactive payment
than
he
or
she
otherwise
would
have.
For
instance:
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In
the
situation
above,
had
the surviving
spouse
not
submitted
VBA
Form
21-0966,
her
Effective
Date
would
have
been
April
rather
than February
(she
would
have
missed
the
retroactive
payments
for
the
months
of
March
and
April).
Remember,
VA
will not
make
any
kind
of
payment
in
the
month
in
which
the
claim,
or
in
this
case
the
“Intent
to
File’,
was
received.
SPECIFICS
OF
AN
“INTENT
TO
FILE”
An
“Intent
to
File”
is
a
specific
declaration
of
intent
to
apply
for
benefits
from
the
VA.
An
“Intent
to
File”
can
be
submitted
in
one
of
the
following
three
ways
(38
CER
3.155):
ii)
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[‘A
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claimant?
intent
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file
a
cialn~
~n
toe
cia~rnai7ts
recoros,
The
“Intent
to
File”
is
most
easily
accomplished
by
completing
VBA
Form
21-0966.
The
“Intent
to
File”
must:
ident/r3’
the
general
benefit
(Inc,,
compensation,
pensiOn),
but
need
not
identify
the
poecific
benefit
da~med
or
any medical
conthtlon(1)
on
170/foil
the
claim
it
based
The
Informal
Claim
must
also
list:
Updated
12/29/
17
Page 34
The
claimant’s
name
(if
other
than
the
Veteran)
2.
The
Veteran’s
name
3.
The
Veteran’s
social
security
#
4.
The
Veteran’s
birth date
Once
VA
receives
the
“intent
to
File”
(we
recommend
by
fax
AND
mail),
they
might
respond
to
the
claimant
by
sending
a
formal
application
(VBA
Form
21-527EZ
or
VBA
Form
21-534E7).
This
form
must
be
completed
within
one
year
from
the
date when
the
“Intent
to
File”
was
submitted.
If
the
claimant
does
not
submit
the
“Intent
to
File”
by
the
one-year
deadline,
the effective
date
established
by
the
“Intent
to
File”
will
no
longer
be
valid.
REMEMBER:
Always
keep
of
copy
of
anything
you send
to
VA
and
all
proof
of
any
transmition
or
mailing
(e.g.
fax
report
or
certified
mail).
SERIOUS
ITEMS
TO
BE
AWARE
OF
If
the
applicant
meets
the
medical
requirement
for
a
rating,
is
receiving
aid
and
attendance
services
and
can
demonstrate
having
paid
at
least one
month’s
worth
of
those
services
and
in
addition
meets
the
war
service
test,
and
meets
the
asset
test
and
the
income
test,
you
should
file
an
“Intent
to
File”
as
soon
as
possible.
This
will
establish
an
effective
date
with
VA.
If
you
do
not
meet
all
of
this,
ABSOLUTELY
DO
NOT
FILE
an
“Intent
to
File.”
Occasionally
(much
to
the
chagrin
of
the
claimant)
expectations regarding
an
Effective
Date are dashed
due
to
misinformation
or
a
lack
of understanding.
Below
are
a
few
examples
of
instances
where
a
claimant
was
expecting
retroactive
pay back
but
did
not
receive
what
was
expected.
EXAMPLE
1
(No Ongoing
unreimbursed
medical
expenses
(UMEs)
present
at
the time
the
“Intent
to
File”
was
submitted):
An
53
i/B3i
Q/Q•
5//?
/
VEieIei7
S
/7(7755
/770/
717?!
1!
~ncoine
is
cC
000.
He
lives
at
i~an~e
af
clue
to
his
poor
./7aalth
ne
real
ures
he/c?
v’/th
bath/np.
L7i?055/flQ.
wa/~c~na
arOtfl7C
/7/5
home,
and
chad/nc
/7//nse/.f
He
scrbim’ts
V&4
Form
21
-0966
to
VA
Ia
January
then
appere~
for
Feresisn
is
sipi/t
A
.isw
aere•~s
b.erZins
he
con?plecad
/u~
appficatiorr
,he
/7/nod
S
i7onle
care
camper/vIa
cr/cS
and
feed
i/Ho
healthy
meis/
heip
hIm
Dali/c.
chess.
and
move
a~vuryd
lyle
haccce,
Ft/i
I/IS
service
he
nays
c/i,
403004070/7th.
He
ihciudes
this
cost
an
his
app//cat/cu.
In
240/
[‘A
ai;
t•~ams
him
the
bench
t
but
dares
nat
grant
a
re/Inactive
nayment
far
me
n7c’nths
of
February
and
Mamrh
bacause,
durIng
tnat
0177/f.
the
veteran
b
incmynle
exceeded
the
income
i/nuts
(I
a
he
did
not
have
any
an
onoa~nc
care
cc5~,.
to
reducn
/7/5
inca/ne
51
/15
7flP17
f/v
EXAMPLE
2:
(Bad
/
Incomplete
Information):
An B5
year
old
si/ale
veteran
is
manna
i/to
an
assisted
I/n/p
fac/l’ty
and
learns
that
he
is
e14jTh/e
fcc
Si,
79r7’/nont/i
thivuph
[/4
Pension
with
Aid
and Atiandanca
His
saw//s
have venished
and
h/s
income
m•v/ll
not
adequabafy
cover the
care
casal
t//?fertlinate40
Updated
12/29/17
Page 35
c~
~
~7C~
~
CI[ftF~t.
75
flu/C
tw
tik•:.~
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Ll.5/V~
arC
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rfll
/3/It/V
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/fl9/5
3/.(t
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F.fl71
/7/5
3/IS/C
fl3r~
fl75~
rfl,~/7flhc
/7~t
1fl1;~L/1/)
/7?3/r/~
A/i
with
in
le
53/73
:‘77~7i2//
/~:)‘CV0~~n
/770/IS
nV//I
the
/hlflht/z,
fl/S//Is
4):;
/72/F/i
thuds
en
Cc/cot
to
F//c
em/i
.sar~os
:Vi~1/
c/a/ni
to
the
L7i~
753//n /770/7375
F:~~
el/a:
/3/
27
to
,
3
C C
,ch
CV~
/7/I3
/7C
070,7th
/1/77757
5/10?
,211V/77e/7//
15
/707
/537/3:
~/7Q~gfl
70
oecy
the
~‘l~/l
/7770/
/70V./..
7//Lie
r,
~/5
~Th
t733/S
13
2,
23’
~‘
75
Cu
~
c
/777/77
Iii
IT
thc:
:?/7.i.F7/.::
ore
7770/7th //7
Fi/h./dl
tile
c/1i~tri
~75r
‘Jhteilt
to
5th
/17
rece/Iec/
/7/3’
00/ltd
/F’eI47P
77303
3
tIe/ten
0/70/ce
~eqc/70hx~i
7/71’
/03.17,
On
rare occasions,
establishing
an
Effective
Date
can
be
detrimental
to
the
success
of
the
application.
Below
is
an
example
where
a
claimant
filed
an
“Intent
to
File
and
was
disqualified
because
of
it.
EXAMPLE
3
(Too
Many
Assets):
A/i
84
~air
old
sun..
~17~717(7
s~2n’n/se
ci
a
veteian
lh’es