We are getting conflicting information on
1) maximum allowable assets
2) what are the problems the VA MUST have to get accepted
in our case my 84 year old father (the Vet) has far less problems then my mother
3) is it worth paying an attorney so stuff doesnt just get thrown back at us
Please help
1. It is helpful to look at the income side of the equation first. There is no stipulated income level to qualify as there is with Medicaid. To be eligible for an award the veteran or surviving spouse’s Income for VA Purposes (IVAP) must be under the pension rate being sought.
To determine IVAP start with the veteran or surviving spouse’s gross household income (don’t forget to add back deductions that may be taken for insurances or taxes). From gross income the claimant is permitted to deduct Unreimbursed Medical Expenses (UME). UME may include medically related insurance premiums such as Medicare Part B premiums, Medicare Part D premiums, Medicare supplement premiums and long-term care insurance premiums.
Also permitted as deductions are physician and Rx co-pays or deductibles, medically related transportation expenses, durable medical equipment supplies, and ongoing over the counter remedies and supplies. Most importantly, the cost of home health care, provided by an agency, private provider, or even a family member, may be deductible as are the costs of care in an assisted living facility.
When discussing the application of a couple it is important to recognize that the claim is based on the need of the veteran, NOT the spouse. If the veteran does not need “…ongoing, regular, daily assistance to protect him/her from the hazards of his/her daily environment” (the overarching medical requirement) then the maximum award available will be that of the Basic pension NOT the improved Aid and Attendance pension. The expenses incurred as a result of the spouse’s need will be deductible from gross household income in determining IVAP, but the award itself is always based on the veteran’s need.
In 2013 this means that if the veteran does not meet medical criteria, and eligible expenses are not attributable to him/her, the maximum pension award for the couple will be $1,359 as opposed to the Improved Aid and Attendance pension of $2,053.
Once IVAP is determined, 5% of the applicable maximum pension award is deducted from IVAP to determine the net amount of UME that may be deducted from gross income.
Once the deductible is applied the result is compared to the dollar amount of the pension being sought. There will then be one of three results: No award, a partial award, or a full award.
Examples (expressed in months for convenience):
Couple (based on veteran receiving care)
Gross household income: $2,200
Unreimbursed Medical Expenses: $1,600
Maximum Aid and Attendance pension: $2,053
5% of Aid and Attendance max pension: $103
Deductible Unreimbursed Medical Expense: $1,497
Aid and Attendance Award: $2,053 - $1,497 = $703 (partial award)
Couple (based on veteran receiving care)
Gross household income: $2,200
Unreimbursed Medical Expenses: $2,500
Maximum Aid and Attendance pension = $2,053
5% of Aid and Attendance max pension: $103
Deductible Unreimbursed Medical Expense: $2,397
Aid and Attendance Award: $2,053 - $2,397 = under $0 = $2,053 (max. award)
2. With respect to the asset side of the equation there is, again, no stipulated asset level and a formulaic approach is used in determining eligibility. The VA considers a claimants “estate” everything owned except for the primary residence, automobile, and personal belongings. There are no “non-countable” assets are there are in the Medicaid rules (e.g., stipulations for IRA’s or income producing property) and the assets of both husband and wife are fully countable.
The calculation for an acceptable level of assets takes into account the dollar amount of the estate, the life expectancy of the veteran, and the unreimbursed medical expenses being claimed. The question is simply this:
If the estate is distributed over the lifetime of the veteran, will the estate be enough to satisfy the unreimbursed medical expenses being claimed? If the answer is yes, no award. If the answer is no, then an award may be granted.
There is no $50,000 asset limit for singles or $80,000 limit for couples. These numbers represent the asset level that beyond which if reflected on an application will cause the application to automatically be reviewed by a manager.
It is rare to see an application approved with such high asset level levels unless the claimant is relatively young or expenses are extraordinarily high.
If asset shifting in contemplation of applying for VA pension is being consider please keep in mind that VA pension and Medicaid are two separate and distinct programs with separate and distinct eligibility and qualification criteria. Planning for one set of benefits may disqualify an applicant for another set. When seeking advice be certain the advisor is familiar with how both programs operate.
i called them and they were very helpful