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VA Benefits

Thursday, December 3, 2015

Important Things You Need to Know About Medicare Part D

 

This year, a relative of mine had two issues that affected her prescription plan.  First, she was diagnosed with an illness and prescribed new drugs.  Second, she forgot to pay her Medicare Part D premiums and lost her prescription coverage.  How do you choose a Medicare Part D plan?  How do changes in medication affect the Part D insurance plan a participant might choose?  

Medicare Part D is the health insurance that covers prescription medication for outpatient drugs.  Part D is a fairly recent addition to the Medicare Alphabet, having been added in 2006.  This plan seems incredibly confusing, and it can require some research to determine the best plan for each individual.

Medicare Part D is a federally subsidized drug benefit.  The participants will pay a monthly premium to an insurance company that has contracted with the government.  In 2015, the average premium is around $33.15 per month.  After a participant has paid the deductible $320.00, the participant will pay 25% of the cost of the drugs until the total cost of the prescription drugs has reached $2960.  The federal government pays $2,220 of this amount and the participant will pay $760.  

But how to choose a Medicare Part D plan?  Medicare has a pretty powerful program online that can help you make the decision.  Go to www.medicare.gov/find-a-plan.  It will ask you to enter the zip code of the participant, and then will ask for all of the medications the participant is taking, the dosage of the medications, and the number of pills purchased each time.  It will also ask for the pharmacy where the participant usually purchases the drugs.  Once all of that information is entered into the find-a-plan site, the site will spit out a list of plans with comparative information including the cost of premiums, the annual drug deductible, the estimated annual drug costs, and the rating of the plan based on 3 out of 5 stars assigned by Medicare. Medicare sometimes assigns a 5-star rating for a Part D insurance plan that will be indicated by a yellow star with a 5 in the middle next to the Medicare Part D plan.   Once you have entered all of the information, you can compare the costs of the various plans.  Of course, the information is only valid if all of the drugs in the correct dosages are entered into the system.  Be sure to check to see whether the cost of the drugs will go up during the year.  Usually, the cost of the prescription drugs goes down once the deductible is met, and goes up again when the participant hits the donut hole at $2960.

The participant will have to go to a pharmacy in the plan’s network in order to get the lower price you expect to pay. 

Not everyone needs a Medicare Part D plan.  Some retirees may have coverage under their retirement plans, veterans who qualify for free or reduced price medications may not need the coverage. That is called “creditable coverage.”  If you do need it, though, and don’t sign up for it when eligible, you will be charged a penalty when you do finally sign up.  The penalty is at least 1% for every month you delay enrolling past the Initial Enrollment Period.

 

 

 

 


Thursday, July 23, 2015

Four Ways to Pay for Long-Term Care

Concerned about how your parents will pay for their long-term care?  Here are the four basic ways to pay for care.


Read more . . .


Thursday, July 16, 2015

The Zen of a Family Meeting: The Five Things You Must Cover When Planning for Your Aging Parents’ Care

 

 

July is Sandwich Generation Awareness Month.  The Sandwich Generation refers to those people, mostly in their mid-40’s to late 50’s, who are caring for aging parents as well as caring for young children or dependent young adult children.  If you are the meat or peanut butter in that sandwich, you might be looking for help from your siblings or other family members.  One of the best ways to plan the care for an aging or disabled family member is by holding a family meeting.  The meeting is designed to do many things:  get information from the aging or disabled person about their needs, figure out what kind of care is needed and brainstorm about ways to find that care, gauge the financial resources available for care, and assign duties to various family members so that one caregiver does not get burned out.

Who should attend the meeting?  I recommend that all of the parents and siblings attend a meeting, preferably where they can meet face to face to talk about the issues facing the aging parent now, and those issues that may come up in the future.  If grandchildren, aunts and uncles or friends will be responsible for some of the care, invite them along.    The parent or person with a disability should be in attendance so long as they are physically able to be there. 

It is usually best to hold the meeting in a neutral place, such as a meeting room in a hotel or community center.  I also recommend there be a fairly impartial facilitator to keep the meeting on track, if possible.  And, there should be plenty of snacks and drinks so people won’t want to leave before you’ve discussed all the important points.

With so many families spread out over the world, it can be difficult to get everyone together.  If the family has a regular family reunion, perhaps the reunion time can be extended to allow the family to get together for this meeting.  If there is no regularly scheduled reunion, you can use scheduling programs such as www.doodle.com to find out when the most attendees will be available. If some family members absolutely cannot meet in person, you can use tools such as Skype www.skype.com or Google Hangouts www.google.com/hangouts‎ to bring those other family members in by video.

Once you have set the time and place, have everyone agree to an agenda.  Appoint someone to come up with a proposed agenda in advance of the meeting, and then circulate that proposed agenda for comments, additions and changes.

Here are the five basic items that should be covered in the meeting:

 

  1. The Health and Safety of the aging parent or person with a disability

     

    How do they feel about their own healthcare and safety and what are they concerned about?

    Are there any disease or illness diagnoses?

    Are they paying attention to personal hygiene?

    Have there been any instances where the safety of the parent has been compromised, such as falling, leaving the stove on, wandering, etc.?

    Who are their physicians, dentists, therapists, professional and volunteer caregivers?

    What medications are they taking and are they remembering to take them regularly? 

     

    What health insurance do they have?  If they are on Medicare, is there supplemental insurance or prescription medication coverage?

    How are the premiums paid and is there someone who will be informed if the premiums are not paid?

     

    How are their finances? 

    What financial resources do they have? 

    What are their regular bills and how do those bills get paid?  How will you know if they forget to pay the bills?

     

  2. The current living and care arrangements, whether those arrangements are working, and a plan for future living arrangements

 

 If the parent’s condition is changing, what living and care arrangements will be necessary in the future?

How will you find appropriate housing and care?

 

  1. The legal documents do they have and the legal documents they need

     

    Who is their lawyer and when was the last time they saw a lawyer?  Where are the legal documents stored?

    Who is named as Agent, Personal Representative, etc. in those documents?

    Who are their beneficiaries on their IRA’s, 401(k)’s, life insurance policies and annuities?

     

  2. A plan to pay for long-term care

    Is there long-term insurance available?  If so, what are the terms?  Where is the policy and how are the premiums paid for? 

    If there is no long-term care insurance, can the parent or person with disability afford to pay for care by him or herself?  Are there any government programs, such as Veterans benefits or Medicaid, that can help pay for long-term care?

     

  3. The family caregivers – who will do what and when

Sometimes family members volunteer to perform the tasks for which they have talent.  The brother who is a nurse may be the natural fit for the person to oversee the parent’s healthcare and the sister who is the CPA will take over the finances.  What if it isn’t so clear or if no one wants to take on the tasks?  Can people be hired to perform some of the tasks such as paying the bills? 

Can the family agree that it may not be fair to one of the children to take on all of the responsibility for care?

If one family member is taking on the bulk of the care, can the others agree to take a turn to provide relief to the primary caregiver? 

 

The topics may vary from family to family, and for those families who may find it especially hard to discuss these items you might consider having a professional or a mediator to assist in these discussions.

 

 

 

 


Tuesday, July 1, 2014

VA Improved Pension and Medicaid

 

 

Joe, an 89-year-old veteran served in WWII.  He and his wife, Mary, have been living in an assisted living facility for three years and Joe has been receiving VA Pension with Special Monthly Pension for Aid and Attendance.  Joe recently fell, and his physician has decided Joe cannot return to the assisted living facility.  Joe is now in a Nursing Home and needs to apply for Medicaid to cover the cost of his care.   

 

VA Pension Benefits can be a lifesaver for veterans or their surviving spouses who need home care or assisted living facility care.  The added money the VA awards eligible veterans or their surviving spouses when added to social security income is often just enough to help a veteran or spouse afford to stay at home with companion care or be able to move to a good assisted living facility (ALF). 

 

When a veteran, his or her spouse or surviving spouse needs skilled nursing care in a skilled nursing facility or nursing home, though, the VA Pension is often not enough to cover the cost of that level of care.  The average cost of a semi-private room in a nursing home in Georgia is about $181.00/day or about $5430.00 for a 30-day month, according to the MetLife Survey of Long-Term Care Costs published in November of 2012.    For 2014, the maximum VA Pension award for a married couple is $2085.00. *(This maximum amount includes Basic Improved Pension plus Special Monthly Pension for Aid and Attendance).  Currently, the Social Security Administration estimates that the average Social Security benefit for an aged couple when both are receiving benefits is $2,111., while the average for a single aged widow or widower is $1243 per month.   Since the combined VA Pension and Social Security rarely exceed the $5000 monthly price tag for a nursing home stay, the veteran or spouse may need to qualify for Medicaid in order to afford to live in the nursing home. 

 

Medicaid is a federal/state program available to people with low assets and income who meet the physical requirements for admission to a nursing home.  Generally, that means that the person is deficient in some of the activities of daily living.  While circumstances vary, usually a Medicaid recipient pays his or her monthly income to the nursing home, and then Medicaid pays the difference up to the amount Medicaid has contractually agreed to pay the nursing home. 

 

A single veteran who qualifies for Medicaid will have his entire VA pension benefit reduced to $90.00.  If a veteran is married and qualifies for Medicaid, whether or not he can continue to receive Improved Pension will depend on whether his spouse’s income is sufficiently reduced by unreimbursed medical expenses to make them eligible for the Improved Pension award. 

 

A married veteran can still receive the VA pension benefit and the additional part considered to be aid and attendance, so long as he would be otherwise eligible for the benefit.  If the income of the couple is less than the pension amount, the award can be apportioned to the spouse who is not in the Nursing Home and receiving Medicaid.

 

If Joe goes into the Nursing Home and begins receiving Medicaid, his Pension with Aid & Attendance can be apportioned for Mary to spend on her Assisted Living Care. 

 

 

 

 


Monday, June 30, 2014

Adaptive Housing for Veterans with Disabilities

Steve, a veteran who receives service-connected compensation for ALS, amyotrophic lateral sclerosis, often known as Lou Gehrig’s disease, has trouble walking up the stairs and it is getting increasingly difficult for him to get in to the bathtub.  His wife, Jane, can no longer lift him into the tub.

Steve may be eligible for a grant from the VA to adapt his house to accommodate his disability.  The VA provides grants to Service members and Veterans who have total service-connected disabilities to help modify a home, purchase an already adapted home, build an adapted home on land already acquired, or pay down the unpaid principal on the mortgage of an adapted home the Service member or Veterans has already acquired. 

There are two types of grants, with unfortunately similar acronyms:  the Specially Adapted Housing (SAH) Grant, which provides up to $67,555 or the Special Housing Adaptation (SHA) Grant, which provides a maximum of $13,511 in 2014.

The SAH Grant is available to Service members and Veterans who have certain permanent and total service-connected disabilities, such as the loss of or loss of use of both legs.   The medical requirements for the SAH are presumed for those with ALS with a service-connected rating of 100%.  In addition to the medical requirements, the disability must require that the Veteran or Service member have the regular and constant use of a wheelchair, brace, crutches or canes as the regular mode of locomotion. 

 The SHA Grant is available to Veterans and Service members who have service-connected disabilities which include: blindness in both eyes with 5/200 visual acuity or less; the anatomical loss or loss of use of both hands; certain severe burn injuries; or certain severe respiratory injuries.

Steve will need to file an application on VA Form 26-4555, Veteran’s Application in Acquiring Specially Adapted Housing or Special Housing Adaptation Grant. Those Service members or Veterans whose disability is not one presumed to meet the medical requirements for the grants will need to make sure that the VA Loan Guaranty office at their Veterans Regional Office gets a report of examination or hospitalization and VA Form 10-4555b, Certificate of Medical Feasibility.

 

 

 

 

 


Friday, February 28, 2014

FIDUCIARY APPOINTMENTS BY THE VA

What is a Fiduciary and why does the VA want to appoint one for my dad?

George, a veteran of WWII who now lives in an assisted living facility, applied for Improved Pension with Aid & Attendance.  After a few months, the VA sent him a letter explaining that George had been awarded the Pension, but would not receive his retroactive check until the VA determined whether he was competent to handle his affairs and whether the VA should appoint a fiduciary to manage his checks. What is a Fiduciary and why does the VA want to appoint one for my dad?

George, a veteran of WWII who now lives in an assisted living facility, applied for Improved Pension with Aid & Attendance.  After a few months, the VA sent him a letter explaining that George had been awarded the Pension, but would not receive his retroactive check until the VA determined whether he was competent to handle his affairs and whether the VA should appoint a fiduciary to manage his checks. 

Often veterans or their surviving spouses applying for VA Pension or Compensation benefits have some mental disease or injury that affects their ability to manage their financial affairs.  Before the VA will issue payment, the VA wants to know that if the veteran or spouse cannot manage the money they receive from the VA, someone trustworthy will be able to manage their money for them. 

The VA may appoint an individual or a corporation to serve as a fiduciary, or may authorize someone who has been appointed by a court to serve as a fiduciary.  A fiduciary is a person or legal entity that has been appointed by the VA to receive VA funds on behalf of a beneficiary for the use and benefit of the beneficiary and his/her dependents.  See A Guide for VA Fiduciaries. A beneficiary is an individual entitled to receive VA benefits.    The definition of incompetent for VA purposes is a minor or an adult who is rated incompetent by the VA or is under a legal disability by reason of court action.

The VA first makes a determination based on the evidence submitted that the veteran or surviving spouse is not able to manage their money.   If the veteran or spouse wishes, they can tell the VA that they are incompetent and request someone they know and trust be appointed to serve as the fiduciary. 

Before the VA appoints the person, though, they will do what is called a “field examination” to check that the person is trustworthy.

A VA employee, called a Field Examiner, will interview the potential fiduciary to ask whether they are willing to serve, will check the person’s credit rating, do a criminal background check, and ask for personal references.  If the veteran or surviving spouse does not have anyone they trust, or if the VA finds that the person nominated by the veteran or surviving spouse is not trustworthy, the VA can appoint a corporate fiduciary.  In some cases, the VA appoints an employee of an institution, such as an assisted living or nursing home,  to serve as a fiduciary.

The fiduciary is responsible to oversee the veteran or spouse’s VA award, and is required to use the VA funds to pay the basic living expenses for the beneficiary and his or her dependents first, and to provide goods and services to improve the lifestyle of the beneficiary and dependents only once the basic needs are met.

George requested that the VA appoint his oldest son, John, as his fiduciary.  Once the VA investigated John, they made him the payee of George’s VA check.  John received George’s retroactive Pension payment, and now receives George’s monthly check.  John must keep the deposits separate from his own accounts and keep records of payments he makes for George from the VA funds. He also agreed to keep the VA informed of any changes in George’s residence or medical condition, and to file a Federal Fiduciary’s Account, VA Form 21P-4706b, every year.


Monday, February 17, 2014

Income for VA Purposes - IVAP

Unreimbursed Medical Expenses

The VA terminology is confusing, to say the least.  We’ve discussed what a Pension is, but you may be wondering how the VA figures out Income for VA Purposes, or IVAP. 

The definition of IVAP means all of the income received by the individual applying for the benefit, and all of the income of the spouse as well.  That income may include Social Security, Pension, mandatory IRA distributions, annuity payments, and interest income.  This list is not exhaustive, but basically any money that the veteran, spouse, or surviving spouse receive may be considered income.  However, for IVAP purposes, the term income actually means all the money received, minus unreimbursed medical expenses – or “UME’s” in VA-speak.  In other words, medical expenses that are not paid for by insurance, Medicare, long-term care insurance, or another program or party may be considered to be unreimbursed medical expenses.

So what kinds of expenses are unreimbursed medical expense?

The answer, like the answer to so many other legal questions is, that depends.

If the veteran, spouse, or surviving spouse is in a nursing home or an assisted living that provides custodial care and assistance with the activities of daily living, the room and board at the facility may be considered to be an unreimbursed medical expense. 

A recent “fast letter” issued by the VA outlines the circumstances under which the room and board may be deducted from income.  The letter, which is an explanation to those VA employees trying to determine which medical expenses qualify, states that

“The cost of room and board at a residential facility is a UME if the facility provides custodial care to the individual, or the individual’s physician states in writing that the claimant must reside in that facility to separately contract for custodial care with a third-party provider.

A facility provides custodial care if it assists the individual with two or more ADL’s.

If the facility does not provide the claimant custodial care, or the claimant’s physician does not prescribe care by a third-party provider in that facility, VA will not deduct the cost of any medical or nursing services obtained from a third-party provider.

So you can see that if a claimant is deficient in Activities of Daily Living (ADL’s), and the facility provides assistance with those ADL’s, the money paid for rent and food at the facility will be deducted from the income.  If, however, the claimant is at facility that is better characterized as an independent living facility, and the claimant is only there because they need assistance with meal preparation and transportation, the room and board will not be considered to be a medical expense and cannot be counted to offset income.

Can room and board ever be considered as a UME if the resident is in an Independent Living Facility?  If a physician prescribes third-party custodial care that can only be provided in the facility, the room and board can be used as a medical expense.  Most ILF’s contract with home-care companies to provide assistance with ADL’s to their residents.  The facilities themselves are not licensed to provide such care, so they make arrangements with other companies to send their employees in to provide the care.

So, in addition to room and board, what other medical expenses can be deducted?

For an initial application, the VA considers what they characterize as prospective, recurring expenses that are likely to continue for the twelve months following the initial application.  Home care provided by an in-home attendant may be deducted from income if the veteran or spouse has been rated as housebound or in need of Aid & Attendance.  In that case, the attendant need not be a licensed healthcare professional.  If the veteran or spouse has not been rated as housebound or in need of the Aid & Attendance of another person, the in-home attendant must be a licensed healthcare professional in order for the expenses to count as unreimbursed.

The VA considers health or hospitalization insurance premiums for both the veteran and the spouse to be unreimbursed medical expenses.  The monthly Medicare insurance premiums deducted from Social Security are considered unreimbursed medical expenses.

For the most part, the VA does not count payment for prescription medications as unreimbursed medical expenses on the initial application.  However, prescription expenses may be claimed as additional expenses after the first year.  


Thursday, February 13, 2014

UPDATE: Spouse for VA Purposes

Who is a spouse for VA benefit purposes?

The United States Code and the Code of Federal Regulations – the rulebook for the VA – state that a spouse is a person of the opposite sex, whose marriage meets the requirements of the state in which the parties resided at the time of the marriage.  [1]

The Supreme Court recently struck down a provision in the Defense of Marriage Act that stated that for federal purposes, a marriage between members of the same gender could not be valid.  Why did the Supreme Court strike this down?  Primarily because marriage has historically been a state law question.  In other words, each state has defined the rules for marriage as that state sees fit.  Recently, some states have changed their laws to allow two people of the same sex to marry.  Since some state laws conflicted with parts of the Defense of Marriage Act (DOMA), the Supreme Court ruled that that part of DOMA was unconstitutional and ordered the federal government to change its regulations to comply.

What does that mean for veterans who are in same sex marriages – or are thinking about marrying someone of the same sex- for purposes of qualifying for veteran’s benefits that are available to veterans with spouses?   The answer currently is that it seems to depend on which state the veteran is in when he or she applies for the benefits. The Obama administration decided to extend military spousal benefits to legally married same –sex couples.  However, since whether a same-sex marriage – or any marriage- is legal is left to the individual states, whether a couple is legally married for military and veterans benefits will depend on which state the parties are in when they apply for the benefits. [2]

For example, Georgia does not allow same sex marriages.  In fact, Georgia does not recognize same-sex marriages even if they were entered into in a state that does allow them.  If a veteran married legally in another state,  moves to Georgia with his or her spouse and then applies for benefits claiming a spouse as a dependent, the VA most likely will not award the benefits since the marriage is not valid in Georgia. 

Contrast this with the same veteran who applies for the same benefits in a state in which same-sex marriage is valid.  He or she will be eligible for the increase in benefits based on the spouse and will most likely be awarded the benefits.  If he or she then moves to Georgia with the spouse, he or she will continue to receive the increased award based on a spousal dependent.  The VA will not likely take the benefits away once awarded.

The VA is currently in the process of changing the language in its code sections, federal regulations, and manuals to comply with the decision in the Windsor case. 

Until the VA does re-write its manuals, and until the new marriage policies are known to all those at the VA, veterans and their spouses may face inconsistent decisions from the VA and my need to fight to obtain benefits to which they are entitled.

Recently, Attorney General Eric Holder announced that the Justice Department would no longer deny certain benefits to legally married same-sex spouses.  Specifically, Holder stated that spouses would not be compelled to testify against their spouse in court, that spouses can now visit their incarcerated spouse in a federal penitentiary, and that couples can now apply for federal benefits under programs such as the Sept. 11 victim’s fund.   Holder did not specifically mention any VA programs, however, the statements seem to be an indication that the government intends to end forms of discrimination against same-sex couples at least in the programs which are truly federal programs.



[1] 38 U.S.C. Section 101(31) and 38 C.F.R. Section 3.50(a) and Section 3.1(j)

[2] Currently 13 states and the District of Columbia have legal same-sex marriage.  The states allowing same-sex marriage:  California, Connecticut, Iowa, New Hampshire, Massachusetts, Delaware, Minnesota, Rhode Island, Vermont, Maine, Maryland, Washington, and Washington, D.C.


Thursday, February 13, 2014

Income for VA Purposes - IVAP

Unreimbursed Medical Expenses

The VA terminology is confusing, to say the least.  We’ve discussed what a Pension is, but you may be wondering how the VA figures out Income for VA Purposes, or IVAP. 

The definition of IVAP means all of the income received by the individual applying for the benefit, and all of the income of the spouse as well.  That income may include Social Security, Pension, mandatory IRA distributions, annuity payments, and interest income.  This list is not exhaustive, but basically any money that the veteran, spouse, or surviving spouse receive may be considered income.  However, for IVAP purposes, the term income actually means all the money received, minus unreimbursed medical expenses – or “UME’s” in VA-speak.  In other words, medical expenses that are not paid for by insurance, Medicare, long-term care insurance, or another program or party may be considered to be unreimbursed medical expenses.

So what kinds of expenses are unreimbursed medical expense?

The answer, like the answer to so many other legal questions is, that depends.

If the veteran, spouse, or surviving spouse is in a nursing home or an assisted living that provides custodial care and assistance with the activities of daily living, the room and board at the facility may be considered to be an unreimbursed medical expense. 

A recent “fast letter” issued by the VA outlines the circumstances under which the room and board may be deducted from income.  The letter, which is an explanation to those VA employees trying to determine which medical expenses qualify, states that

“The cost of room and board at a residential facility is a UME if the facility provides custodial care to the individual, or the individual’s physician states in writing that the claimant must reside in that facility to separately contract for custodial care with a third-party provider.

A facility provides custodial care if it assists the individual with two or more ADL’s.

If the facility does not provide the claimant custodial care, or the claimant’s physician does not prescribe care by a third-party provider in that facility, VA will not deduct the cost of any medical or nursing services obtained from a third-party provider.

So you can see that if a claimant is deficient in Activities of Daily Living (ADL’s), and the facility provides assistance with those ADL’s, the money paid for rent and food at the facility will be deducted from the income.  If, however, the claimant is at facility that is better characterized as an independent living facility, and the claimant is only there because they need assistance with meal preparation and transportation, the room and board will not be considered to be a medical expense and cannot be counted to offset income.

Can room and board ever be considered as a UME if the resident is in an Independent Living Facility?  If a physician prescribes third-party custodial care that can only be provided in the facility, the room and board can be used as a medical expense.  Most ILF’s contract with home-care companies to provide assistance with ADL’s to their residents.  The facilities themselves are not licensed to provide such care, so they make arrangements with other companies to send their employees in to provide the care.

So, in addition to room and board, what other medical expenses can be deducted?

For an initial application, the VA considers what they characterize as prospective, recurring expenses that are likely to continue for the twelve months following the initial application.  Home care provided by an in-home attendant may be deducted from income if the veteran or spouse has been rated as housebound or in need of Aid & Attendance.  In that case, the attendant need not be a licensed healthcare professional.  If the veteran or spouse has not been rated as housebound or in need of the Aid & Attendance of another person, the in-home attendant must be a licensed healthcare professional in order for the expenses to count as unreimbursed.

The VA considers health or hospitalization insurance premiums for both the veteran and the spouse to be unreimbursed medical expenses.  The monthly Medicare insurance premiums deducted from Social Security are considered unreimbursed medical expenses.

For the most part, the VA does not count payment for prescription medications as unreimbursed medical expenses on the initial application.  However, prescription expenses may be claimed as additional expenses after the first year.  


Friday, November 29, 2013

How to Talk to Your Parents, Friends, In-laws, etc. about VA Benefits

How to talk to your parents,

Siblings, Friends and Neighbors about Veterans Benefits

Most of us know someone who served in the military at some point in time.  We’ve seen pictures of them in uniform posted on their walls, or we’ve heard them talk about when they were in Korea, or Viet Nam, or Fort Benning. 

Today, there is a lot of anxiety about healthcare costs, education costs, and long-term care costs.  Have you ever asked someone who served in the military whether they are receiving any benefits or have thought about receiving benefits?  Often veterans or their families will say, “When my dad came back from the war, he never wanted to talk about the war and the VA just reminded him of a really bad time in his life. “  Or, my dad visited a VA hospital and it was too confusing and overwhelming for him.  He was told he didn’t qualify for anything because he had too much money, or didn’t serve at the right time or had never been injured in service, so he just gave up.

To be frank, the VA often does a really bad job of informing veterans about what benefits they might qualify for.  The VA is especially bad in giving advice over the telephone.  Of course, as most of us know, in any business the advice you get depends on who happens to answer the telephone when you call.  What I’ve learned as an attorney is that the caller has to be responsible for asking enough questions and asking them in as many different ways as possible to get to the right answer.  Step one is often to learn the language of the institution you are calling.  When you call your doctor’s office, you try to convey your symptoms in a way that will let the office know enough about your illness or injury to let you know whether you need to rush to the emergency room, or whether your symptoms are nothing to worry about.  You know the doctor will want to know whether you have a fever, whether you are bleeding, when was the onset of the fever.  In order to get the best advice, you are responsible for using language that the doctor’s office will understand.

In order to get the best advice possible from the VA, and in order to help your family and friends get the benefits they deserve, you can learn how to talk to them about VA benefits.

First, you can ask about their service.   When I was a kid, we had a green gas mask stored in our basement storage closet.  My dad would take it out occasionally – usually when entertaining the male teachers he supervised – and tell them the story of how he was part of a unit that used chemicals to experiment on monkeys.  My father was stationed at the Aberdeen Proving Grounds during the Korean War where they experimented with chemical weapons.  I know that my father was stationed there and that my sister was born while he was stationed there in 1953.  I also know that shortly after my sister was born, my dad must have been discharged since they moved back to South Dakota where my dad was a teacher for the next 40 years.

But, how can I prove that my dad was in the service?  First, I can ask him if he has his discharge paper.  The discharge paper is often referred to as the DD-214, for the Department of Defense form number that is used now for most discharges.  However, in WWII and the Korean War it may have been referred to as a separation paper, a Certificate of Discharge, an Enlisted Report and Record of Separation, or some similar title.

There is a lot of information on the discharge paper, and the veteran will need it or a copy to get benefits.  One question you can ask is whether the veteran has that paper or if he or she recorded the paper with the county in which he or she was living at some point after discharge.  If the veteran does not have that paper, he or she will need to get one.  You can help get the discharge paper, but you will need to know the following information:  Branch of Service, Dates of Service (approximate is okay, although the more accurate the information the better chance you’ll have of getting the document) and Social Security number.  You’ll need to know the veterans full name – make sure it is the name he or she used while in the service.  I’ve known veterans who never used the name on their birth certificate, but their military records are all under the name as on the birth certificate.  Be sure you know the spelling used on the birth certificate, too.

If you don’t have the paper, you can order it from the archives.  Here is the website:  www.archives.gov/veterans/.

There was a fire in the storage facility in St. Louis in the 1970’s where many military records were stored.  Thus, some records were destroyed.  Most can be reconstructed, but it may take a little longer to get the records if they were part of that group destroyed in the 1970’s.   You will need to have some patience.

If your parent is reluctant to find out what services are available through the VA or at the VA, ask what experiences they’ve had in the past – if any- and ask whether they would like to hear some of the benefits that are available.  If you know someone in a similar situation who is receiving benefits, you can discuss what benefits that person is receiving and maybe something about their experience with the VA.

I often talk to veterans who feel that the VA has been a lifesaver for them -especially for unemployed or self-employed veterans who may not have cheap affordable healthcare available to them in their area.   My friend swears by the care given to him at the VA.  He is a middle-aged, self-employed, Viet Nam Veteran, who needed care for a heart condition that he could not afford without health insurance.  He found that he was entitled to care at the VA, and since then he has been treated regularly at the VA.

Another client, a successful man in his 60’s, discovered that he had a form of cancer.  Since he was “in country” in Viet Nam, he is now receiving a service-connected disability payment for the cancer.  In addition, the VA is evaluating his claim for PTSD.

Many of my veteran clients now receive hearing aids and other help for hearing loss through the VA.  When they were young, they didn’t notice that their experience around noisy combat affected their hearing, but in older age, the hearing loss is apparent and the treatment for that hearing loss is their right.

I encourage my clients to enroll in the VA healthcare system by filing a form 10-10-EZ, Application for Health Benefits.  You can find that online at www.1010ez.med.va.gov/sec/fha/1010ez/.


Wednesday, November 27, 2013

Nursing Home Care for Veterans

Nursing Home Care for Veterans

The VA provides “Community Living Centers”, or what used to be called Nursing Homes.  These are operated by the VA, and are usually in a Veterans Administration Hospital.  These Community Living Centers (CLC’s) provide rehabilitation for veterans recovering from injury and illness in the short-term, but also provide long-term skilled nursing care for veterans who need care for long periods of time for a service-connected injury.

For veterans rated at 70% service-connected or higher, or for those who need nursing home care for their service-connected injuries, the VA pays for their nursing home placement as part of their package of healthcare benefits.

The CLC’s are available for non-service connected veterans who are enrolled in VHA healthcare, and need short term services such as rehabilitation, hospice, respite, and for those waiting for placement in the community.

VA provides care to veterans based on a priority system.  There are currently 8 categories of veterans based on service- connection and financial need.  For example, a veteran who is 50% service-connected or higher is in category 1.  A non-service connected veteran with significant assets and income is most likely going to be enrolled in category 8.

Veterans in category 1 will be eligible for placement in a CLC, and will not have a co-pay, but those in category 8 will be placed in a CLC only if there is availability and no one in a higher category needs the bed.  The veteran in category 8 will pay a daily co-pay for services in the CLC.

In Atlanta, the CLC is located in the VA hospital on Clairmont Road, and is almost always full to capacity with a waiting list.  For those veterans for whom nursing home care is not part of the package of medical benefits, they may be able to find placement in one of the two Georgia War Veterans Homes.

The two Georgia War Veterans Homes in Georgia are not run by the national VA, but are available to veterans.  The Georgia Department of Veterans Services and the Georgia Health Sciences University operate the Georgia War Veterans Nursing Home in Augusta.   The Georgia War Veterans Home in Milledgeville is operated by United Veteran Services of Georgia, Inc., which operates the home for the Georgia Department of Veterans Services. 

In order to be eligible for admission to a Georgia War Veterans Home, the person must be domiciled in Georgia, and must have resided in Georgia for the five years immediately preceding admission.  He or she must have been a “war veteran”, defined as any veteran who served on active duty in the Armed Forces of the U.S. during wartime or during the period between January 31, 1955 and May 7, 1975.  In addition, the U.S. Department of Veterans Affairs must approve them as “eligible for care and treatment”.  Veterans accepted into the Georgia War Veterans Homes will be required to pay some expenses such as Medicare or health-care insurance deductibles and co-pays.  The forms to apply for admission to the Georgia War Veterans Homes are found at veterans.georgia.gov/gwvh-forms.


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