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Aid in Attendance For Veterans

Aid in Attendance Is Available For Wartime Veterans and Their Surviving Spouses

There is a little known and underutilized veterans benefit for wartime veterans and their surviving spouses, 65 years and older.  It is a tax-free benefit called Aid and Attendance,  provided by the Department of Veteran Affairs.
The Benefit  provides financial aid to help offset the cost of long-term care for those who need assistance of another person  in at least two of the daily activities of living such as eating, bathing, dressing and undressing, transferring and the needs of nature with the daily activities of living such as bathing, dressing, eating, toileting, and transferring.
The benefit is paid directly to the recipient.  It can be used for in-home care, board and care, assisted living communities, and private-pay nursing homes. All of the information available about  Aid in Attendance, overlooks the fact that this benefit  can  be used to pay for home care. Maybe if more veterans  knew this, more would apply.
How much money is available?
income of up to $1,149 a month for a singe surviving spouse of a veteran, up to $1,788 a month for a single veteran or up to $2,120 a month for a couple.
Who is Eligible?
A 65 year old 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.  Disability is required if younger than 65. An applicant must have on average less than $80,000 in assets, EXCLUDING their home and vehicles.
The veteran household cannot have income -- adjusted for unreimbursed 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 unreimbursed medical expenses. The Pension income is calculated, based on 12 months of future household income, but paid monthly.
How is the award calculated?
The monthly award is based on VA totaling 12 months of estimated future income and subtracting from that 12 months of estimated future, recurring and predictable medical expenses. Allowable medical expenses are reduced by a deductible to produce an adjusted medical expense which in turn is subtracted from the estimated 12 months of future income.

The new income derived from subtracting adjusted medical expenses from income is called "countable" income or IVAP (Income for Veterans Affairs Purposes). This countable income is then subtracted from the Maximum Allowable Pension Rate -- MAPR -- and that result is divided by 12 to determine the monthly income Pension award. This award is paid in addition to the family income that already exists.
Example:

Who can be paid for caring for the veteran or spouse?
Any person  other than the spouse, including a member of the family, friends, or someone hired to live in the home or visit on a regular basis.  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.  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.

 

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When the Family Can Submit a Claim without Help
A claim for a low income veteran with  few assets and no ongoing, long term care costs can usually be attempted by the veteran household or a member of the family perhaps with a little help.   If a member of the family or a trusted friend wants to submit a claim on behalf of a veteran, there must be a proper VA power of attorney.
Gather Necessary Documents
You will need the following documents in order to apply.  Prepare these before making your filing.

Discharge/Separation Papers (DD-214). If you need to request military records, you can either fill out Standard Form 180 or, you can visit the National Archives website for further instructions on how to request military records.
Copy of Marriage Certificate and all marital information.
Copy of the Death Certificate (surviving spouses only).
Copy of current Social Security Award Letter (the letter that Social Security sends at the beginning of the year stating what your monthly amount will be for the following year).
Net Worth information, including bank accounts, CDs, Trusts, Stocks, Bonds, Annuities, etc.
Proof of all income from pensions, retirement, interest income from investments, annuities, etc.
If you are a court-appointed guardian of the veteran or surviving spouse, a certified copy of the court order of the appointment is required.
Proof of insurance premiums, medications, medical bills or any other medical expenses that are not reimbursed by insurance, Medicare, or Medicaid.
Physician statement that includes current diagnosis, medical status, prognosis, name and address, ability to care for self, ability to travel unattended, etc. If you are a veteran in a nursing home, or a family member of a veteran in a nursing home, you can use this form as a certification of that status: Nursing Home Status Statement.
Banking information for Direct Deposit of A&A monthly payments (include a voided check).
Employment history (does not apply if you are over 65).
List of all doctors and hospitals visited in the last year. For a list of possible medical expenses, click here. For a medical expense report (VA Form 21P-8416), click here.

Complete the VA form for filing
For a veteran PDF download here:  http://www.vba.va.gov/pubs/forms/VBA-21-527ez-ARE.pdf
For Spouses here: www.vba.va.gov/pubs/forms/VBA-21-534EZ-ARE.pdf
Application hints:
The care arrangements and payment must be made prior to application.  You will need to provide evidence that the care is needed on an ongoing  basis.  A care contract and weekly invoice billing for services, even if a family member.  Some payment must be made to validate the contract.  This documentation will need to be provided as proof to VA when making application. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources.
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 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 5% 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 $1,149 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 month in which the application was received in the regional office.

Mail the application
Keep a complete copy of everything
Send Certified Mail “Return Receipt”
AL, AR, IL, IN, KY, LA, MI, MO, MS, OH, TN, WI
Department of Veterans Affairs
Claims Intake Center
Attention: Milwaukee Pension Center
PO Box 5192
Janesville, WI 53547-5192
AK, AZ, CA, CO, HI, IA, ID, KS, MN, MT, ND, NE, NM, NV, OK, OR, SD, TX, UT, WA, WY
Department of Veterans Affairs
Claims Intake Center
Attention: St. Paul Pension Center
PO Box 5365
Janesville, WI 53547-5365
CT, DC, DE, FL, GA, MA, MD, ME, NC, NH, NJ, NY, PA, PR, RI, SC, VA, VT, WV
Department of Veterans Affairs
Claims Intake Center
Attention: Philadelphia Pension Center
PO Box 5206
Janesville, WI 53547-5206

What to Expect after Filing for Aid & Attendance

It is hard to speculate on what you will experience while filing for the Aid & Attendance Pension. Each case is unique and carries its own set of challenges.​ It will also depend on which processing center will be handling the claim. For unknown reasons, some centers do a more efficient job than others. How complete the application package is will also impact the process.

One thing you can expect is that it will take between 8-10 months on average​ for your application to be processed and to receive a determination letter. Due to the current backlog of claims to be processed this timeframe can be much longer.

Many families can't afford to pay for care while waiting for the pension to be approved and funds to be released, which places an additional burden. Some Assisted Living Facilities will work with you if they know the resident qualifies for A&A. Fortunately, all benefits are retro-dated back to the original filing date.

If you or your loved one is age 90 or older, you should request the application process be expedited. The VA's own law states that applications for benefits for a veteran/widow age 90 or older are to be given priority. It is advised that you include a cover letter with the application noting this request.

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