Elder Law Attorney Certified by the National Elder Law Foundation 1200 Converse Street, Longmeadow, Massahcusetts 01106

The harsh rules governing Medicaid eligibility make Veterans Aid and Attendance benefits an essential resource for many veterans and spouses. If the veteran has served ninety consecutive days active duty, with at least one day during war time, honorably discharged, there is eligibility for this important benefit. Aid and Attendance benefits can be combined with Social Security and pension income, to make long term care planning work for veterans and their spouses.

To qualify a veteran or his spouse for the Aid and Attendance pension, the VA regulations look at whether some or all of the claimant’s estate should be consumed for the claimant’s maintenance. The VA considers:

• whether the property can be readily converted into cash at no substantial sacrifice;
• life expectancy;
• number of dependents who meet the definition of “member of the family”
• potential rate of depletion, including unusual medical expenses under the principles outlined in 38 CFR §3.272(g) for claimant and dependents

To decide whether to award Aid & Attendance, the VA looks at the value of "liquid assets":
cash, stocks, IRA, 401k, other tax-deferred income, bonds, mutual funds, art, coins, stamps, and collectibles.

In addition to assets, the VA looks at monthly income. If unreimbursed medical expenses are equal to your household income, you are entitled to the maximum Aid & Attendance benefit amount listed in the drop down box on the right side of this page. Here is a simplified way to understand how the Aid and Attendance benefit amount would be determined in your case. If you are a married veteran who needs Aid and Attendance, the drop down box on the right side of this page lists a maximum monthly benefit of $1,949. Here are three examples of married veterans who have unremibursed medical expenses:

	Example 1	Example 2	Example 3
Income	$3,000	$3,000	$3,000
Unreimbursed Medical Expenses	-1,400	-3,000	-6,000
Amount left over that can be used for the couple's living expenses	1,600	0.00	0.00
Monthly Amount of Aid & Attendance Benefit paid by VA	$349	$1,949	$1,949

Examples 2 and 3 get the full amount because their unreimbursed medical expenses exceed their monthly income. Here is the same demonstration applied to the case of a surviving spouse of a veteran:

	Example 1	Example 2	Example 3
Income	$3,000	$3,000	$3,000
Unreimbursed Medical Expenses	-2,000	-3,000	-6,000
Amount left over that can be used for widow's living expenses	1,000	0.00	0.00
Monthly Amount of Aid & Attendance Benefit paid by VA	$56	$1,056	$1,056

The surviving spouse of the veteran gets the maximum monthly benefit amount of $1,056, as long as her unreimbursed medical expenses exceed her monthly income. Aid and Attendance benefits can be used for care at home and for assisted living if medically necessary.

Community Health Benefits for at home care are also available from the VA, if the veteran is enrolled in the VA, and has a primary care physician in the VA. The primary care physician puts in a referral, and the VA then purchases services from a local Visiting Nurse Association or other contractors:

• Skilled Services: Nursing OT, PT, Speech therapy
• Home Health Aides: assist with ADLs, showers – Number of hours depends on the situation. No more than 21 hours per week.
• Respite
• Home hospice
• Adult Day Healthcare - VA purchases services through local agencies. Van or busses transport.

There is no co pay if the need for care is 70% service connected. Service connected percentage can be assigned at any time. The most the veteran would be charged is $15/ visit. Co-pay depends on income.

Adult Day Healthcare is provided by the VA through local agencies. Van or busses provide transportation. Thayer Care in Hadley, Mercy Adult Day Healthcare in Westfield and Holyoke Geriatric Authority.

Prescription Benefits: The VA provides prescription medications at low copayment costs to veterans and spouses if the prescription is prescribed by a VA physician. Click here for links and more information on: Prescription benefits for veterans.

VA Nursing Home Care at Leeds, Massachusetts: The enrollment staff and social workers conduct a one on one review of each case. The official VA benefits brochure explains: “While some veterans qualify for indefinite nursing home care services, other veterans may qualify for short-term services.

Among those who automatically qualify for indefinite nursing home care are veterans whose service-connected condition is clinically determined to require nursing home care and veterans with a service connected rating of 70% or more.
Other veterans – with priority given to those with service connected conditions – may be provided short term nursing home care if space and resources are available.” Waiting lists and income and asset assessments are part of the process.

The Department of Veterans Affairs has published rules at 38 CFR 17.111 on VA co payments and how much money a spouse can keep, if the veteran is receiving long term nursing home care from the VA. A spouse can keep a primary residence, and some other assets. These rules are similar to the rules for MassHealth and Medicaid. The availability of care can prove more options to married couples who need care now, or may need care in the future.

Massachusetts Benefits for Needy Veterans under Chapter 115:
Financial and medical assistance for indigent veterans and their dependents is available through veterans agents in your city or town. Qualifying veterans and their family members receive necessary financial assistance for food, shelter, clothing, housing supplies, and medical care.

Since the state veterans benefits under Chapter 115 are based upon need, the applicant is required to execute an agreement to reimburse the city or town that pays the benefits. The agreement to reimburse is very broad and states that if the veteran receives a payment from another source covering the same time period, the veteran will report it to the veterans' service officer and repay the city or town for benefits received. The veteran is also required to apply for any sources of federal assistance for which he or she may be eligible.

If the veteran is disabled and receiving SSI, that would reduce the amount of his or her Chapter 115 payments. If the veteran receives SSI retroactively, he or she would be expected to reimburse the city or town for any retroactive benefits covering the same period during which he or she received Chapter 115, or risk being placed in Refund Status. Refund Status cuts off future Chapter 115 benefits until repayment is made. Rather than recoup overpayments through a partial offset, the Chapter 115 payments are usually resumed only after recoupment or if the veteran successfully appeals the denial.

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