Many veterans and their families assume that the Department of Veterans’ Affairs (the VA) will pay for the veteran’s long-term care needs, but this often will not be the case.
The VA is divided into three separate organizations:
- The Veterans’ Health Administration
- The Veterans’ Benefits Administration
- The National Cemetery Administration
Veterans Health Administration
The Veterans Health Administration (VHA) provides health care services to eligible veterans. The VHA also offers limited custodial care services in certain instances. Due to insufficient funding, the VA prioritizes available services to veterans based on the extent of their service-related injuries.
Here’s a summary of the priority groups:
- Priority Group 1: Veterans with service-connected disabilities rated 50% or more disabling, or veterans that the VA determines are unemployable due to service-connected conditions.
- Priority Group 2: Veterans with service-connected disabilities with a 30% or 40% disability rating.
- Priority Group 3: Veterans with service-connected disabilities with a 10% or 20% disability rating, veterans who are former POWs, veterans awarded the Purple Heart, veterans that were discharged for a disability that began in the line of duty, veterans who are disabled due to VA treatment or participation in a VA vocational rehabilitation program.
- Priority Group 4: Veterans receiving aid and attendance or housebound benefits (pension) from the VA, veterans that the VA has determined are catastrophically disabled.
- Priority Group 5: Veterans receiving VA pension benefits, veterans eligible for Medicaid programs, veterans with income and assets below the VA Means Test limits.
- Priority Group 6: Veterans with 0% service-connected conditions, but receiving VA compensation, veterans seeking care for disorders relating to Ionizing Radiation and Project 112/SHAD, veterans seeking care for Agent Orange exposure in Vietnam, veterans seeking care for Gulf War Illness or for conditions relating to exposure to environmental contaminants during Persian Gulf service.
- Priority Group 7: Veterans who agree to pay a copay with income and/or net worth above the VA Income Threshold and income below the Geographic Means Test Thresshold. Within this group there are 4 sub-priority groups.
- Priority Group 8: Veterans who agree to pay a copay with income and/or net worth above the VA Means Test Threshold and the Geographic Means Test Threshold. Within this group, there are 4 sub-priority groups.
Home and Community-Based Services (HCBS)
Veterans that enroll in the VA health care system are eligible for limited Home and Community-Based Services (HCBS) which may include hospice, adult day care, home health aides, homemaker services, and home-based primary care for those with a chronic disabling disease. A copayment may be applicable.
VHA Nursing Home Services
The Veterans’ Health Administration (VHA) provides nursing home services through three programs:
- Nursing homes owned and operated by the VA that typically admit those with a 70% service-connected disability, those who require care due to a service-connected disability, or those requiring short-term rehabilitative care. These homes may require a copayment.
- State veterans’ homes are a joint venture between the VA and states. The VA provides funds to help build the homes and pays for a portion of the cost of veterans who are eligible. The states typically set the eligibility criteria for admission. Usually, about one-third of the cost is paid by the veteran.
- The VA contract nursing home program is for veterans needing long-term care who may not be eligible for placement in a VA or state veterans home or if there is no VA or state nursing home available. These homes usually require a copayment.
VA & Long-Term Care
In 2003, the U.S. Government Accountability Office issued a report, “VA Long-Term Care: Service Gaps and Facility Restrictions Limit Veterans’ Access to Non-Institutional Care.” The report found that:
- Out of 139 VA facilities, 126 offered limited or no long-term care services and what was offered was based on available funding
- The GAO estimated that the VA paid for services for only 34,000 of the 235,000 veterans who needed care.
Ultimately, for most veterans, it will be prudent to develop your own long-term care plan because for most veterans, the VA likely will not cover long-term care.
Our office does assist wartime veterans with qualifying for and applying for the VA Aid and Attendance program which provides a monthly stipend (pension) to help offset some out-of-pocket medical expenses such as long-term care. However, the benefit amounts are capped and generally only cover a small portion of the long-term care costs.
We Can Help You Develop a Long-Term Care Plan
Having assisted many Wake County clients with long-term care planning, our team at Carolina Family Estate Planning understands that developing a long-term care plan is about not just protecting your own independence and dignity, but also protecting those you love from the physical, emotional, and financial toll that caring for a loved one can take.
We’ve helped many clients take an interdisciplinary approach to their long-term care planning by exploring both legal and financial options. Usually, a well-rounded long-term care plan will involve a combination of legal, health care, and financial tools to meet your goals and maximize your protection. To get started, register an upcoming seminar to learn more or call our office at 919-443-3035.