The Importance of a Using a Knowledgeable
Consultant
Getting
the aid and attendance benefit is a slow process even for
those applicants who know what they are doing. On the other
hand, for those who blindly submit a claim without the proper
support documents, it can take 8 to 12 months for a decision
from VA. A poorly documented claim may also result in a
denial.
A knowledgeable
consultant can shorten the award decision to possibly
3 to 4 months. In addition, a consultant will make sure
that all deductible expenses are applied in order to maximize
the award. Finally, and most importantly, the consultant
will provide guidance to prevent denial of the claim.
Understanding
VA Pension and VA Pension with Aid and Attendance
Aid
and attendance is a commonly used term for a little-known
veterans’ disability income. The official title of
this benefit is Pension. The reason for using aid
and attendance to refer to Pension is that
many veterans or their single surviving spouses can become
eligible if they have a regular need for the aid and attendance
of a caregiver or if they are housebound. Evidence of this
need for care must be certified by VA as a rating.
With a rating, certain veterans or their surviving spouses
can now qualify for Pension. Pension is also available to
low income veteran households without a rating, but it is
a lesser dollar amount.
Pension
is an Underused Benefit
There
are different income categories for Pension, but the highest
could pay as much as $1,800 a month in disability income
to a qualifying veteran household. A study commissioned
by VA in 2001 estimated, over the next 14 years, only about
30% of eligible veterans would apply for Pension. The conclusion
was most veterans simply don't know about it. In fact, according
to the National Care Planning Council, about a third of
all seniors in this country, over the age of 65, could become
eligible for Pension under the right circumstances. That's
how many elderly war veterans or their surviving spouses
there are. The VA does not do a good job of educating eligible
veterans about how to obtain this benefit.
Eligibility
Rules for Pension
To receive
Pension, a veteran must have served on active duty, at least
90 days, during a period of war. There must be an honorable
discharge. Single surviving spouses of such veterans are
also eligible. If younger than 65, the veteran must be totally
disabled. If age 65 and older, there is no requirement for
disability. There is no disability requirement for a single
surviving spouse.
The
veteran household cannot have income -- adjusted for medical
expenses -- exceeding the Maximum Allowable Pension Rate--
MAPR -- for that veteran’s pension income category.
If the adjusted income exceeds MAPR, there is no benefit.
If adjusted income is less than the MAPR, the veteran receives
a Pension income that is equal to the difference between
MAPR and the household income adjusted for medical expenses.
The pension income is calculated, based on 12 months of
future household income, but paid monthly.
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 cost of home care, the cost of paying adult
children to provide care, the cost of adult day care, the
cost of assisted living 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.
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. VA will allow
assets to be transferred or converted to income in order
to meet the asset test. There is no look back penalty for
transferring assets as there is with Medicaid. There are
specific rules governing transfers of assets and what constitutes
income from assets and it must be done correctly.
A
Qualified Consultant Can Provide the Necessary Advice for
a Successful Award
Most
VA employees understand the Pension claims process regarding
low income or disqualifying assets, but they generally do
not understand the special-case application process required
for aid and attendance and long term care costs. Evidence
exists that VA employees who deal with the public, may even
be turning away long term care applicants, telling them
their income is too high. Of course, this is not true.
The
application form provides no information on the existence
of this special treatment for annualized medical expenses.
If the initial application, involving annualized costs,
is not done correctly, delays in record gathering could
force the award decision to take up to a year or the eventual
award could be substantially reduced or even denied. The
applicant must wait another full year to reapply or go through
a time-consuming appeals process to correct any unfavorable
decisions.
The
secret for receiving a successful award for aid and attendance
or housebound ratings is not in filling out the form but
in knowing what documents and evidence must be submitted
with the application. Knowing the secrets for a successful
award -- with the special case of long term care recipients
-- is 95% of the battle. Filling out and filing a claim
is a formality.
A
knowledgeable consultant can provide information to shorten
VA’s decision window of 6 to 12 months to possibly
3 or 4 months. The consultant also understands how
to maximize the benefit or avoid a denial. The consultant
can also provide guidance for meeting the asset test. Finally,
the consultant can provide the actual strategies for transferring
assets and he or she can arrange for trusts or income conversions
to allow for the best possible transfer of assets to beneficiaries
thus avoiding taxes, family disputes and Medicaid penalties.
Need
a VA Benefits consultant?
Please
call (914)948-1350 for recommendations and referrals.
This
article was provided by the National Elder Care Planning
Council as part of the "Elder Care Planning" series.
