VA BENEFITS AND BASIC ELIGIBILITY
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1 VA BENEFITS AND BASIC ELIGIBILITY EDWIN W. JOHNSON, CW3, US ARMY RETIRED MINORITY VETERANS PROGRAM COORDINATOR, ORLANDO VAMC IBRAHIM RASADO, MSG, US ARMY RETIRED ENROLLMENT SPECIALIST, ORLANDO VAMC
2 OUR TIME TO SERVE To care for him who shall have borne the battle and for his widow and his orphan President Lincoln
3 Minority Veterans Program Coordinators (MVPC s, Who and where are we?) Interdepartmental program (App. 300 coordinators collaterally assigned within VHA, VBA and NCA) Principal advisor to the facility Director Support and initiate activities that educate and sensitize internal staff to the unique needs of minority veterans Target and participate in outreach activities, educational and informational forums utilizing community networks Assist the CMV in disseminating information
4 Center for Minority Veterans WHO WE SERVE Specifically, these veterans include the following minority groups: Pacific Islander Asian American African American Hispanic/Latino Native American including American Indian, Alaska Native, Native Hawaiian
5 Goal and Commitment The primary goal of outreach initiatives is to increase local awareness of minority veterans issues Develop strategies for increasing participation of minority veterans into VA healthcare
6 BASIC ELIGIBILITY Discharged from active military service other than dishonorable. Served a minimum of 24 months if you entered after 9/7/1980 (enlisted) or after 10/16/1981 (officer). If a National Guardsman or Reservist, you were called to active duty (Presidential order) and served the entire period (not just for training purposes). Begin 1/16/2003, meet income tests.
7 Documentation VA will verify the veteran s eligibility by electronic method. VA will assist veteran in obtaining necessary documents if unable to verify. Acceptable documents: DD-214 Ceritifcate of Discharge
8 Veteran s Health Administration Financial Assessment
9 What Is A Means Test? (Financial Assessment) Mechanism for identifying a veteran s ability to defray VA medical care costs. Assessment of the veteran s previous calendar year gross household income (less VA allowable deductible expenses) and assets. (VA 1010EZR)
10 Financial Assessment Population Excludes: Compensable SC NSC pensioners POWs C&P exams Allied Beneficiaries Retired/discharge for disability Purple Heart recipients
11 Financial Assessment Population Who is required to complete a Means Test? Includes: NSC without special eligibility Non-compensable 0% SC
12 PRINCIPLES Valid for 365 days. Required on the veteran s first visit and renewal needed the first visit following expiration of the Financial Assessment. May be accomplished before the anniversary date if completed in a new calendar year.
13 What Does the Financial Assessment Determination Mean to the Veteran? Copay Exempt - eligible for cost-free VA health care and/or medications. Copay Required - Veteran has agreed to pay the VA deductibles for visits and/or medications Responsible for full copay for inpatient care and per diem for NSC conditions. GMT Copay Required Veteran has agreed to pay the VA deductibles (visits and medications). 20% of inpatient copay.
14 PRIORITY GROUPS CRITERIA 1. Service Connection: 0%-100% 2. Income: $12,256 -$30, Special Categories: Purple Heart, POW, Environmental, VA Pensions, OEF-OIF, Catastrophically Dissabled
15 No co-payments for Visits Priority Groups: 1. Rated 50% or higher. 2. Rated 30%-40%. 3. Rated 10%-20%, POW, Purple Heart. 4. Aid and Attendance, Catastrophically Disabled. 5. VA Pension, NSC below threshold. 6. Environmental WWII, Korea, Vietnam, Gulf War, OIF-OEF Veterans.
16 Co-payments for Visits Priority Groups: 7. Above threshold, below Geographical Means Test. (Must agree to pay) 8. Above threshold. (Cannot be enrolled) More information in Pamphlets
17 2011 INCOME THRESHOLDS (for Year 2012 Co-pays) For 2012 Co-pays, the Priority 7 thresholds are: Veterans with no dependents: $30,460 Veterans with 1 dependent: $36,554 Veterans with 2 dependents: $38,647 Income and Assets net worth $80,000 If your net income minus medical (5%), educational, and funeral expenses is greater than the amounts listed above and your income and assets total are less than $80,000, you must agree to pay a copayment for your medical care. *Thresholds are subject to change annually.*
18 MEDICAL SERVICES Once Eligibility is established, the following medical services are available: Preventive services, including immunizations, screening tests, health education and training classes. Primary Health Care, including Diagnosis and Treatment. Surgery, including outpatient surgery.
19 MEDICAL SERVICES CONT. Mental Health and substance abuse treatment; Domiciliary. Home Health Care. Care Coordination Home Telehealth (CCHT). Respite, hospice care and palliative care. Urgent and limited emergency care services in VA facilities. Medications (as long as they have been prescribed by a provider employed by or under contract with the VA).
20 OTHER MEDICAL SERVICES Audio and Eye Exams: Open to all. Hearing Aides and Eyeglasses: Limited eligibility: Priority 1-4 or Service connected for hearing/vision. Nursing Home resident of the VA. Glasses broken or lost while under VA Care. Based on medical determination by Primary Care Provider
21 LIMITED MEDICAL SERVICES CONT Dental Limited Eligibility: You must be Service Connected for a dental condition Or 100% Service Connected for any medical condition Or former POW
22 LIMITED MEDICAL SERVICES CONT Dental Limited Eligibility Cont: Or Veterans who were not provided treatment within 90 days before separation and request care within 180 days from separation Or have a Service Connected condition that requires medication with dental side effects (determined by the VA dental professionals) Or Medical necessity
23 BENEFITS FOR OEF/OIF VETERANS Seamless Transition Case Management: Case managers at each campus will assist with questions, concerns and navigating the VA system.
24 Mental Health Services Depression Anxiety PTSD Grief/loss Substance abuse Adjustment to illness Interpersonal/life stress
25 PATIENT EDUCATION CLASSES Diabetes care High blood pressure care Healthy Heart class Lung disease class Stop Smoking class Healthy eating and exercise classes Aural Rehabilitation Class
26 VA Services are a Benefit IT IS NOT HEALTH INSURANCE YOU ARE COVERED FOR LIFE MEETS REQUIREMENT OF LAW TO HAVE HEALTH INSURANCE
27 Millennium (MILL) Bill Emergent Care 38 USC 1725 VA can authorize payment if veteran is: Financially Liable Enrolled and receiving care (24 Months) VA last resort payer Veteran has no other coverage VA facilities were not available Life threatening emergency No preference over VA facility Payment up to medical stabilization of veteran
28 VETERANS ID CARD (VIC) All Veterans need to get a new card. The Social Security Number and date of birth are no longer shown on the card. Your VIC can be presented at any VA across the nation. With your card, other VA facilities will have easier (but not instant) access to receive information regarding your eligibility status.
29 HOMELESS VETERANS PROGRAM Provides comprehensive medical, psychological and rehabilitation treatment for eligible veterans. VA domiciliaries Community based Stand Downs
30 MyHealtheVet New Patient Orientation Created: January 2010 John Royall
31 CHAMPVA CHAMPVA is available to beneficiaries of all 100% service connected veterans. Provides medical care in civilian settings and in some cases at VA hospitals. The Orlando VA Medical Center is not enrolling CHAMPVA patients at this time.
32 VHA HEALTHCARE OVERVIEW ORLANDO VA MEDICAL CENTER
33 New Orlando VA Medical Center Groundbreaking was in October, 2008 Expected opening is Summer of 2013 State of the art Medical Center 134 bed hospital, 120 bed Community Living Center, 60 bed Domiciliary, and a large Ambulatory Care Facility
34 AND FINALLY
35 QUESTIONS?
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You can see the specialist you choose without permission from this plan.
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